2024 NICA Annual Conference

June 21 - 22


Las Vegas, NV.

Disease Management During COVID-19: From IBS Patient and Advocate, Andrew Donovan
May 8, 2020
BCBST: A Case Study for Trends in the Commercial Insurance Landscape
June 10, 2020

Infusions Instead of Back Surgery

June 2, 2020

Chronic Illness, Disease Management, Infusion Patients, Patients

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! 

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