WHY SHOULD YOU WORK TO AVOID BACK SURGERY / BACK INJURY?
"Back injuries are the most prevalent occupational injury in the United States. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. Conclusion. Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables."
- THE U.S. "AGENCY ON HEALTH CARE POLICY AND RESEARCH STUDY": In the biggest study of its kind (1994), our own government concluded that in most cases of acute low back pain, spinal manipulation should be used prior to spinal surgery, and that CORTICOSTEROIDS (injected or oral), ANTIDEPRESSANTS, and OTHER DRUGS are not helpful or recommended for people with acute low back pain.
- CANADA'S "MANGA REPORT": This study (1993) was Canada's version of the previous study. The Canucks realized they were spending way too much money on low back surgeries. The Magna Report concluded things like, medical doctors frequently did not know how to effectively deal with the causes of low back pain, chiropractors were well-trained to handle acute low back pain via spinal manipulation and other things, spinal manipulation is more effective than drugs and surgery for low back pain, spinal manipulation was extremely safe when preformed by chiropractors and less safe when performed by non-chiros, chiropractic care returned injured workers to work far faster than medical care, chiropractic care was far more effective than medical care, and on top of that, patient satisfaction ratings with chiropractic were higher than any other healthcare group.
- THE NEW ZEALAND COMMISSION REPORT: Clear back in 1979, New Zealand issued it's nearly-400 pages long report on chiropractic called, Chiropractic in New Zealand. Some of the things that emerged from this paper (a paper that underwent extensive governmental hearings) were that chiropractors carry out spinal diagnosis on a "sophisticated and refined level", chiropractors were the only practitioners with the proper training to do what they do, medical doctors and therapists should be barred from taking weekend classes and then offering spinal manipulation in their clinics, chiropractic care is not only effective but cost-effective for helping people with back pain, neck pain, and headaches (migraines included).
- THE SWEDEN REPORT: This study was done in the late 1980's, just after Sweden recognized chiropractic as a profession. Together with the governments of Denmark, Finland and Norway, Sweden established a chiropractic college at Denmark's University of Odense. The study said that the chiropractic training was, "equivalent to Swedish medical training" and that efforts should be made for the medical community and chiropractic community to work together.
As everyone from governmental groups (Obama Care) to private insurances are looking for ways to curb runaway costs of back injuries, chiropractic has shown repeatedly what its proponents have known for generations. Chiropractic not only works, it can be delivered with far less cost and far more safety than standard medical care. Listen to what Dr, Keith Overland, the president of the American Chiropractic Association recently said concerning this study. "Caring for patients with conservative treatments first, before moving on to less conservative options or unnecessary drugs and surgery, is a sensible and cost-effective strategy." How could you possibly argue with him? It is nice to see some common sense brought to the table regarding this issue. Time will tell how much it changes things.
Spinal structures including bones, nerves, muscles, tendons, ligaments, and blood vessels, are packed in very close to one another. Because surgery in the spine is itself physically stressful, it can weaken and destabilize the area even further. As a result of surgery, structures that have not been removed can become damaged or mechanically stressed, frequently becoming a new source of pain and degeneration.
Surgery will always result in some amount of scar tissue build up (HERE). If the scar tissue itself forms near any nerves, it becomes still another source of pressure and pain. This does not even take into account that scar tissue has the potential to be 1,000 times more pain sensitive than normal tissue! Since disc surgery takes place near inflamed and irritated nerves, there is a great possibility that the nerves will be damaged further during the procedure. If this happens, there will be even more pain, numbness, tingling, weakness, stiffness, and other problems ---- even beyond what you are already dealing with now.
Low back surgery also requires the use of anesthesia which can result in other medical risks including death.
One of the huge problems facing patients today is infection. Due to ANTIBIOTIC OVERUSE, deadly superbugs roam the hallways and operating rooms of America's hospitals. My brother (an MD) thought he was going to have to have a Lumbar Fusion Surgery a few years ago. He and his wife (also an MD) were genuinely freaked out at the prospect of having hardware inserted in his spine. When questioned about the reason for this, their answer was infection.
Spinal surgeries also require long recovery periods ----- time away from work, which most patients cannot afford. Recovery time can be anywhere from 6 weeks for a laminectomy to over a year for Spinal Fusion.
Even if the surgery is successful in and of itself, and even if no procedure-related problems actually occur; there is a high probability that within 2 to 5 years, another surgery will be needed to fix the levels above and below the targeted levels of the first surgery (a fact that any doctor will verify). Once you go down this road of surgery, you will increase the chance that you will need further surgeries in the future. And if you have studied this issue out and realize the odds are not great for your first spinal surgery to work well, go online and look at the odds of doing well with a second or third spinal surgery. They're literally in the toilet!
Need a way around this? I have just the post for you (HERE).
UNNECESSARY SPINAL SURGERY
A PROSPECTIVE 1-YEAR STUDY OF ONE SURGEON'S EXPERIENCE
- Background: There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.
- Methods: During a one-year period [November 2009-October 2010], the senior author, a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations. A patient was assigned to the "unnecessary surgery" group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans].
- Results: Of the 274 consults, 45 patients were told they needed surgery by outside surgeons, although their neurological and radiographic findings were not abnormal. An additional 2 patients were told they needed lumbar operations, when in fact the findings indicated a cervical operation was necessary. These 47 patients included 21 [23.1%] of 91 patients with cervical complaints, and 26 [14.2%] of 183 patients with lumbar complaints. The 21 planned cervical operations included 1-4 level anterior diskectomy/fusion [18 patients], laminectomies/fusions [2 patients], and a posterior cervical diskectomy [1 patient]. The 26 planned lumbar operations involved single/multilevel posterior lumbar interbody fusions: 1-level [13 patients], 2-levels [7 patients], 3-levels [3 patients], 4-levels [2 patients], and 5-levels [1 patient]. In 29 patients there were one or more overlapping comorbidities.
- Conclusions: During a one-year period, 47 [17.2%] of 274 spinal consultations seen by a single neurosurgeon were scheduled for "unnecessary surgery".
SOME COMMENTS BY READERS:
I have been practicing spinal surgery in Japan since 1980..... Through the communication with friends practicing neurosurgery in the US and with information from journals and meetings, I have noticed many different points in the rate and method of spinal surgery in the US and the other countries including Japan. As pointed out by the author, "unnecessary" spinal surgery was 17.2% in spinal consultation for the second opinion and overlapping comorbidities are as many as 29 out of 47 (62%). Significant increase of the rate of spinal surgery is attributed mainly to the development of diagnostic tools and operative techniques and implants in addition to increasing aged population in most countries [ (HERE & HERE) ]. However, the situation in the US seems to be a little bit different because of unusually high rate of spinal surgery. I am afraid that "unnecessary" spinal surgery and also "oversurgery" may be related to the money-oriented society which will subsequently jack up the medical costs and increase the rate of malpractice insurance. -Dr. Hiroshi Nakagawa. Professor Emeritus Aichi Medical University. Nagoya, Japan
Experienced and respected spinal surgeons regularly debate in conference forums how to manage specific cases. Disagreement on what to do, when to do it, and how to do it occurs more frequently than consensus. These debates highlight the deficiencies in our knowledge and understanding of degenerative, inflammatory, and mechanical spinal pathology. It is not surprising that the author came to a different conclusion in almost a fifth of the cases and it could be that a portion of these patients really could be managed with or without surgery. However, that cannot be true for all. The real message here is that there are surgeons recommending procedures without identifying the causative factor. Most of these procedures involved fusion which is more aggressive both biologically and economically as compared to nonoperative management or simple decompressions. Fusion was recommended for all of the lumbar procedures and half of these procedures were multilevel. The evidence supporting multilevel lumbar fusion for axial pain is very weak and even if the authors missed some cases of facet arthropathy this entity does not require a multilevel fusion. -Dr. Vincent C. Traynelis, Rush University Medical Center, Chicago, IL
This series includes psychiatric patients, cases without radiological precision and a predominance of "fusions" justified essentially on the notion of "instability" whose criteria are not established. The results of this kind of surgical procedure are poor with a significant morbidity leading to a therapeutic and financial higher bid. This article challenges: either the surgeons are inefficient or they are driven by commercialism. The first assumption seems unlikely considering that their technicality has been validated by various examinations and competitions. The second assumption can be retained. The US spent approximately $2.2 trillion on health care in 2007. Health care costs doubled from 1996 to 2006. The incidence of spinal fusion procedures increased from 60,973 cases in 1993 to 350,754 cases in 2007. -Gilbert Dechambenoit . Health Economist, Boulogne, France
Unnecessary --- A strong 'statement' - particularly if coming from one professional criticizing another. Although, I fundamentally agree with the principles addressed by the author, I question the validity of the methodology employed to justify such. Let's face it, we (Neurosurgeons) collectively do far too much spine surgery. The most challenging aspect of the 'unnecessary spine surgery discussion', however, is the clarification of the definition of 'unnecessary'. Unfortunately, what is 'unnecessary' to some, may be 'necessary' to others. -Dr. Edward Benzel. Chairman, Department of Neurosurgery, Cleveland Clinic
This paper is interesting in that virtually every neurosurgeon has had similar experiences to a greater or lesser degree. There are three reasons for unnecessary spinal fusions: greed, ignorance and stupidity. To illustrate this are situations that I have come across in my 46 years in practice. The big problem is greed. I hate to say it but most neurosurgeons want to do spine surgery because, at this time, it is lucrative. What is the solution - and there will be one. Either we solve the problem or the government will. I suggest that every hospital doing spine fusions establish a review committee to which the chart on every patient to be scheduled for fusion is reviewed to be sure that appropriate criteria are met. I suspect that this will reduce spine fusions by 20% or more. If we continue to ignore the problem then the government will step in, in a global fashion, by severely cutting the reimbursement for spinal fusion to the point that it will not pay to do that operation. Or worse, we will all be employees of the hospital or government. -Dr. Harold D. Portnoy. Director, The Hydrocephalus Clinic, St. Joseph Mercy, Pontiac, MI
If you are looking to break free from the chains of chronic pain and chronic illness, be sure to take a look at this extremely cool post (HERE). You're absolutely correct; it might not provide you a solution. But it might. At least take a look.
MONEY AND SPINAL SURGERY
WHAT HAPPENED TO CARING FOR THE GERIATRIC PATIENT?
The truth is, when it comes to back surgeries, even a significant number of doctors and surgeons admit that there is a serious lack of evidence-based support for more complicated and risky spinal fusion surgeries that are commonly done for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform these low back fusions.
SPINAL STENOSIS (the typically age-related narrowing of the spinal canal --- usually due to to enlarging of bone or ligaments) is the most frequent cause for spinal surgery in the elderly. Although there was a slight overall decrease in spinal surgeries between 2002 and 2007, there was also an utterly shocking 1,500% increase in spinal fusions. Could this massive increase in a dangerous and typically-ineffective spinal surgery be just about the money? Many doctors believe it is. The Journal of the American Medical Association concluded.....
It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications… financial incentives to hospitals and surgeons for more complex procedures may play a role…”
There is a significant difference in average hospital costs for simple decompression spinal surgery versus complex surgical fusion. The cost of the less invasive surgery is $23,724 compared to an average of $80,888 for a spinal fusion. Despite the much higher cost, there is no scientific evidence of superior outcomes. And while there are significant risks associated with the cheaper surgery, there are much greater risks of adverse events associated with the spinal fusion. So why perform these surgeries? Can anyone say "MONEY"? The surgeon is typically reimbursed $600 to $800 for the less invasive back surgeries and approximately ten times more ($6,000 to $8,000) for the complex fusions. In an accompanying JAMA editorial written by Dr. Carragee of Stanford University School of Medicine, the following comment was made.
In 2007, the final year of data reported in the study, Consumer Reports [the magazine] rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke..... The findings from the study should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.
Thanks Dr. C. But why don't we just call a spade a spade and admit to the general population (in plain English) that it is becoming increasingly difficult to trust anyone in the medical field? There is just too much money as stake (HERE)! Just take a look at my posts on EVIDENCE-BASED MEDICINE.
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A similar study was done earlier this year, looking into ways of improving the outcome of back surgery. Dr Allison McGregor, professor of musculoskeletal biodynamics (biomechanics), and her team of researchers at Imperial College London, looked at over 300 patients over a six year period, hoping to answer the question, "Can post-operative exercise and rehabilitation help people to recover from back surgery? Or is up-to-date information and advice just as good?" Sounds like a ridiculous question does it not? Everyone knows how great rehab is.
Their conclusions? Neither approach (post-operative exercise and rehab or "advice") makes any difference on the outcome of spinal surgery in terms of functional disability. In other words, spinal surgery is such a crap shoot; you have just as good of chance of doing well (or poorly) if you simply shank the rehab protocol and decide to watch a movie, read a pamphlet, or listen to a tape recording instead! If you are looking to help your back problem, why not read my post, CURE YOUR OWN BACK PAIN!
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
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