Infusions Instead of Back Surgery by Steven Baak, MD

My neighbor was walking slowly to his mailbox. 

I walked over and asked, “What happened to you?”

“I’m going in for back surgery on Wednesday. I waited six months to get this scheduled with the best surgeon in the Midwest,” he said. 

“What surgery are you getting?” I asked him.

“Oh, well, it’s super complicated, my MRIs are a mess, the surgeon is going to cut me from my neck to my tailbone and fuse my entire spine together,” he replied.

“Wow, that sounds terrible.”

“Well, I must do it. The doc said there is a 50/50 chance that I won’t walk again,” he said regretfully. “I’m going to have to move into a rehab hospital for 3 months after the surgery, and I have no choice.”

I looked at him and said, “Did the surgeon comment on your rash? Your psoriasis rash?”

My neighbor looked puzzled. “Well, no he did not.”

“Ever think your back pain could be psoriatic arthritis? Why don’t you come to my office Monday and let’s try some medicine?” I offered.

“No, no, I can’t do that. If I cancel this surgery, I won’t be able to get it for another six months.” He was adamant. 

“I insist. Come to my office, we will get you started on medicine and see if you get better.”

The neighbor came to my office and started on a biologic. That was 19 years ago. 

Since then, I have taken him on and off different biologics and he continues to do well with in-office infusions and clearly, he has avoided a disastrous surgery.  He is now 78 years old and still working in his car body repair shop.

In the world of Rheumatology, we have a broad spectrum of patient diagnoses and experiences. One of the least beneficial diagnoses is fibromyalgia, which frequently results in stopping the follow ups and referring the patient back to the Primary Care Provider (PCP). 

Over time, almost any diagnosis can and does evolve, and treatment becomes clearer. When we identify cases that suggest treatment for seronegative Rheumatoid Arthritis (RA), Psoriatic Arthritis (PSA) or Ankylosing Spondylitis (AS), careful evaluation of response to treatment becomes key. Many patients get the best results with in-office based care where questions and problems can be addressed at each treatment visit. 


Infusions can be life-saving and life-changing for so many patients who think that they are out of options. It is important to explore the option, discuss treatment, and create a plan to adhere to treatment. To learn more about getting your first infusion or what to expect, visit the Infusion 101 module.

And it is important to note that for many patients with AS and PSA, a justified expectation assists patients to avoid surgeries. It is important to emphasize that back surgery is not helpful and extensive work on medicine therapy is the best approach. As the infusion medicine treats the symptoms, back surgeries are routinely prevented.


Steven Baak, MD is the Medical Director of The Arthritis Center in Bridgeton, Missouri. He has been practicing Rheumatology since 1994. Have a comment or question for Dr. Baak? Leave it down below! 

  1. Helen 3 years ago

    Great info. I have heard of so many patients being bounced around for surgeries that have very disappointing results. Trying a medicine makes sense.

  2. Helen 3 years ago

    Great info. I have heard of so many patients being bounced around for surgeries that have very disappointing results. Trying a medicine makes sense.

  3. Keith 3 years ago

    Great insight and how fortunate for that patient and the many patients you currently treat.

  4. Ashley 3 years ago

    Dr. Baak, this article brought great insight into the benefits of biologics as well as the over diagnosis of fibromyalgia.

  5. Robert 3 years ago

    Dr Baak, this article highlights some very important and beneficial information. Individual should always exhaust alternative medical treatments before undergoing and risking serious surgery.

  6. Jeff 3 years ago

    Thank you for sharing this story, I remember you also sharing it with me a few months ago when I was describing my Mom’s many spine surgeries over the years and the complications that have ensued. I hope this serves as a cautionary tale for patients to explore 2nd and 3rd opinions prior to back/spine surgery.

  7. anonymous 3 years ago

    Thank goodness healthcare has come so far. 19 years ago the word of one doctor was gospel. Now patients are encouraged to seek second opinions, assigned or have a healthcare advocate, and access to reliable medical information is fairly easy to obtain. That pt was lucky he decided to take Dr. Baak up on his invitation to “come see him”.

  8. Mike R 3 years ago

    Dr. Baak is a remarkable physician and healer

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