Lower Back Surgery
Maybe Not Such A Good Thing

You are thinking about having lower back surgery or your physician has recommended it. Not sure what to do? Maybe you should think long and hard about undergoing the knife.

Consider these findings regarding lower back surgery from a medical review in a March 2009 article in Journal of the American Board of Family Medicine:

  • “4 randomized trials indicate that its benefit is more limited when treating degenerative discs with back pain alone (no sciatica).”
  • “Higher spine surgery rates are sometimes associated with worse outcomes.”
  •  “Multiple randomized trials suggest that adding surgical implants to bone grafting slightly improves rates of solid bone fusion but may not improve pain or function. Implants increase the risk of nerve injury, blood loss, overall complications, operative time, and repeat surgery.“
  • “Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. “

*Deyo, RA; Mirza, SK; Turner, JA; Martin, BI (2009). "Overtreating Chronic Back Pain: Time to Back Off?". Journal of the American Board of Family Medicine : JABFM

"Surgery Often Fails"

According to the Mayo Clinic ("Back Surgery: When Is It a Good Idea?" Mayo Clinic, July 7, 2011.), "back surgery is needed in only a small percentage of cases. Most back problems can be taken care of with nonsurgical treatments,..."

Lower back pain is very common as is lower back surgery for its treatment. However, the Mayo Clinic also states the following: "back pain is extremely common ... surgery often fails to relieve it."

In my 33 yrs. Of practicing chiropractic I have treated patients:

  1. That had surgery prior to seeing me.
  2. That had surgery despite my efforts.
  3. Was recommended surgery but opted to see me instead.

In all of these cases there were but an extremely few that actually needed surgery.

There were patients that I did refer to surgery that I did not treat at all or maybe treated them for a brief trial period. When I was confident that they were not going to respond to my care I readily referred them for surgical consideration.

To be honest and to their credit, some surgeons after my referral were hesitant to operate and did in fact not perform surgery. They monitored these patients while they either received conservative medical care or no care. Albeit, these were extremely rare occurrences but none the less they did occur.

I have also witnessed doctors performing surgery when it was contraindicated due to age.

In one particular case a physician performed a “new” surgical procedure on an elderly woman. I had warned this woman's daughter about the grave risk and felt that her symptom (pain) was not severe enough to justify this operation. I told the daughter that I felt this patient would not survive the procedure.

Sadly, she passed away due to complications within a few days of the “successful” surgery.

Surgery - Too Soon and Too Often

It used to be that the criteria for surgery was:

  • Severe, unrelenting pain lasting more than 6 months.
  • No clinical results only after trying all conservative treatment options (sadly this rarely included chiropractic care).
  • Neurological compromise such as paralysis, muscle atrophy, loss of reflexes or cauda equina,

Now surgery is recommended early in onset and often. One reason is due to the glut of orthopedic and neurological surgeons. It's what they do and how they make their living so it will be easy for them to recommend it when it really isn't needed.

To be fair, I have also witnessed some of my chiropractic colleagues failing to refer a patient for surgery when it was indicated or even referring for a surgical opinion.

Yes, it is probably for the same reason. Treating lower back pain patients is a lucrative business and the more they can see and treat and the longer they can retain these patients the more income the healthcare provider can generate.

These doctors, both medical and chiropractic, are the exception. Most are honest and caring individuals that only want the best for their patients.

It is because we healthcare professionals want what's best for them that we often are blinded due to our prejudices and fail to see that we can not, despite truly wanting to, help every patient that seeks our services.

What to Do?

The information to take away from here is:

  1. Most lower back pain patients do not need surgery.
  2. Utilize every conservative treatment option available before you consider surgery.
  3. Just because one chiropractor failed to achieve results doesn't mean another chiropractor's technique or care will also.
  4. Do your part. Become an active partner in your treatment. Lose wight if needed, quit smoking, walk daily, assume good posture, balance your body with heel lifts, orthotics if indicated, eliminate any and all trigger points, and ensure adequate nutrition and hydration.
  5. You may want to talk to your doctor and discuss considering surgery only if the pain is excruciating for several months and/or there exists neurological signs and symptoms. Pain is really not a good reason for surgery.
  6. Regardless, whether surgery is indicated or not, you will probably suffer with chronic pain to some degree and disability following surgery.

Guard your health...  It is a precious thing.

Never subject yourself to unecessay surgical procedures. Don't be fooled into believing that your pain and dysfunction will miraculously disappear after lower back surgery ...it never does. You will always be left with some degree of pain, dysfunction and disability following all lower back surgery.

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