Read about the risks of spine surgery because your doctor might not tell you

Neck and Back surgery

Spine surgery – Laminectomy, discectomy, spinal decompression, spinal fusion, spinal stenosis surgery, herniated disc surgery 

The position of this website is not to be against back surgery.  In fact, the Dr. Lumbago website hopes that all visitors who actually need spinal surgery have their operation and that the results are uneventful and outstanding.  However, I do take an extremely cautious and skeptical view about a lot of back surgeries that are done, simply because of the poor response rate that is achieved for most spine surgery.

From my perspective the problem arises when a patient who is in considerable pain goes to a spine surgeon and has unreasonable expectations about the outcome of a proposed laminectomy, spinal fusion or spinal decompression.   The patient is certainly hoping for prompt and effective relief of his back pain or neck pain symptoms; it appears that the surgeon does not do a good job to dissuade these patients from an overly optimistic and unrealistic expectation about back surgery.  It has been my experience that many spinal surgeons do a disappointing service to their patients by not fully explaining how the results of back surgery are often disappointing.

Another aspect of this ongoing problem of poor outcomes for spine surgery is that the average person with back pain or related symptoms does not do a good job of trying conservative measures before to undergoing a neck or lumbar operation.  It is because the patient has an idea that the surgery will easily, quickly and definitely solve all back problems he or she has, that makes the patient is so willing to jump on the operating table.  Because a spine operation is seen as a sure fix for his problems, the patient does not try very long or very hard to use conservative measures.

In my 42 years of active practice I have many times had a patient stop conservative treatment after two or three office calls to schedule an appointment with an orthopedic surgeon for a fast back operation, even when improvement was being made  within this short period of time.  Many times I learned later that the patient felt the progress – which they admitted to feeling – “was not fast enough.”  In my small town there were a few of these orthopedists who were only too eager to give the patient what they came in and asked for, even though the patient was improving under a short trial of conservative care.

Overstating the problem about back surgery? 

The website of the famed Mayo Clinic declares, “Back pain is extremely common, and surgery often fails to relieve it. Find out why your back hurts and whether surgery might help.”

They take a clear position that back surgery is needed in only a small percentage of cases presenting with back pain, leg pain and related symptoms that are common with a spinal problem.   And they further state that most common back problems that routinely end up in the operating room could have been taken care of with a round of nonsurgical treatments:  ice, heat, rest, massage, manipulation, OTC or prescription medication or physical therapy.  Mayo clinic admits neck and back surgery does not offer true relief and correction for every type of problem that cause spinal symptoms.

A review of records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database was made for those individuals with a diagnosis of disc degeneration, disc herniation or radiculopathy (nerve root pressure) and resultant pain, numbness, tingling and/or weakness of the limbs.  About half of these individuals had surgery to fuse two or more vertebrae as their spinal treatment.  The other half for one reason or another, although they had same of similar diagnoses and symptoms, and were identified as potential surgical candidates did not have surgery.  Two years later, 26 percent of those who had surgery returned to work, compared to 67 percent of patients who were able to work but did not have surgery.  While individuals in both groups used pain medication, especially narcotics, the group that had surgery had a 41 percent higher use of painkillers than the non-operated group.

Further, to show that the high rate of spine surgeries are either not helping or actually making back problem worse, within the practice of medicine there is a standard medical diagnosis that might surprise the average patient.  This diagnosis exists and is used only because there is a need for it because it expresses a common health problem:  “Failed back surgery syndrome.”   Think of it!  The problem is so common that a term had to be created for it.

A definition of a failed back syndrome is commonly agreed to be a chronic pain patient who has had one or more surgical procedure to the spine.  In these cases it is common for a particular doctor/patient relationship to exist prior to surgery hat seem to favor the development of a failed back surgery syndrome:

  1. A patient who makes greater and greater demands on the surgeon for symptomatic pain relief.  This is most effective when the surgeon feel a strong responsibility to do something to help the patient even when surgery might not be clearly indicated or have be risky.
  2. A domineering and aggressive patient who expresses anger and suggests to the surgeon that a lawsuit might be pressed if more effective treatment is not done soon.
  3. Escalation of narcotic pain medication use with deterioration of the doctor/patient relationship, as the patient take on personality changes of drug addiction.
  4. After failing to get relief or improvement from conservative treatments, the surgeon feels obligate to attempt one or more surgeries even though they are likely to fail as well.
  5. The patient who has been kept off work for a long period of time because of reported pain complaints and actively projects being a candidate for a work disability ruling against ever  returning to work.
  6. The patient whose financial incentives to remain symptomatic and disabled outweigh any  incentive to improve and recover.

Mayo Clinic concludes their discussion about the problem of neck and back surgeries that do not help the patient but make their problem worse by commenting, “Consider all options.  Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Spine surgeons hold differing opinions about when to operate, what type of surgery to perform, and whether — for some spine conditions — surgery is warranted at all.”

Several insurance research studies reveal a patient is more likely to have back surgery if he or she lives in one city, or one part of the country, than another.  This should make any patient wonder how an operation can be so much a preference or opinion of a group of doctors in one geographical location, rather than based on what is good for the patient and what is really necessary for recovery from a back problem.  The rate of U.S spinal surgeries has skyrocketed since the early 1990s, and has long been much higher than anywhere else in the world – even though the results are often disappointing.

According to ongoing studies conducted by the American Consumers Union group in the area of spinal surgery, a disturbing 27 percent of patients report that they had not been informed about any risk of spinal surgery (nerve injury, bleeding, increased pain as a direct result of surgery, loss of or reduced sensation, or infection) by their surgeon prior to the operation.   Without this information the patient is not able to make an informed choice and is more easily manipulated by a doctor who is in a position of authority over someone who is not only desperate but also in considerable pain.   The only defense for patients is to ask meaningful questions or have a family member or friend accompany on the office visit to assure that all questions are both asked and answered.  If a doctor will not answer a question or provides evasive answers, go elsewhere.

Acupuncture can be an excellent alternative to spinal surgery 

Before considering spinal surgery it is always a good idea to seek out acupuncture treatment from an expert acupuncturist who can provide treatment with acupuncture or acupressure to the area of complaint.  Many cases that have been headed for surgery have been avoided because of what acupuncture can do to permanently reduce back pain and neck pain and related musculoskeletal symptoms.

When to have spine surgery

It is my opinion that the time to have surgery is when:

  1. A patient has a progressive neurological loss of function or sudden onset of bowel or bladder incontinence.
  2. Two or more spinal specialists who are not associated with each other in any way recommend the need for the same type and location of surgery; preferably they are from a different geographical area so that their opinions are as unbiased and patient-focused as possible.
  3. There is a known and clearly identified problem with the patient’s anatomy that needs to be corrected or eliminated in order to reduce or eliminate pain or other symptoms.  Seldom is there a reason to consider exploratory surgery to “look” for a cause of pain.
  4. There is a recent history of failure for a wide and diverse range of several forms of conservative treatment, after at least three months of constant and aggressive use.

There is no magic bullet for the treatment of spinal pain, least of all neck and lower back pain.  Most individuals recover completely by doing simple, inexpensive and logical things:  avoid postures and activities that cause pain and other symptoms; rest; use ice/heat early; gently stretch the primary area of complaint.  With a less than great surgical response rate for most kinds of spinal surgery – and the real risk of greater injury as a result of inappropriate or poor surgery than from the initial complaint – it is advised to exhaust many – not just briefly “try” one or two – conservative treatment measures.   There is no such thing as a second surgery that can undo a first surgery, so be extremely cautious with the first spine surgery.