Will Surgery fix it?

Will Surgery fix it?

I love how life is a great ‘leveler’ of human emotions.

Some authors say that for every moment of pain we experience in life, we will experience an equal pleasurable event. For every moment of arrogance we succumb to, we will attract an equally humbling life experience etc. etc.

According to people who have spent considerable hours studying universal laws – the universe always works in balance. And yes the whole concept is fairly broad but believe me when we develop a keen eye we can certainly see these laws in motion – everyday, moment to moment.

I was contemplating this the other day whilst lunching with some friends and through the course of the conversation four people discussed how they had had severe back pain, and subsequently all had then seen chiropractors. Each of them had had their over health picture changed dramatically for the positive. These people were chatting about how they had been previously booked for surgery then for varied reasons they had decided to get a second opinion from a chiropractor and now they were, as they reported, “delighted” with the outcomes.

While pleased that my fellow colleagues had been of assistance, I tried to explain that it wasn’t chiropractic nor their chiropractor who had “fixed” the problem. Chiropractors do not fix anything. Instead by removing nerve interference via chiropractic adjustments, the body is able to re-calibrate and heal itself, expressing its true capacity for health and vitality. For the body, having nerve interference is a bit like driving a car with the hand brake on, our master control system is unable to co-ordinate itself effectively.

Only some individuals in this group seemed interested in this concept, so I decided to change the topic of conversation to “congratulating them” (something they were all interested in) for being so proactive about their health. Investing the time, energy and finances to “own and resolve” their problem rather than simply taking a medication to relieve the pain or choosing to hand their problem onto a surgeon. All the while hoping that someone or something will fix the problem for them.

Back to those universal laws.

I was then chatting to a young man the next day who had hurt his back some months previously and he reported he had been too nervous to see a chiropractor, in fact he had been advised not to. I sensed his awkardness with my inquiry about his evidently acute back (as he knew I was a chiropractor) and decided that I should simply actively listen his predicament rather than offer any advice at this point. I asked him what types of care he had to date (none), what medication he was on (lots of anti-inflammatories) and what research he had done on the success rate of his pending surgery (he’d asked a few mates who had had back surgery and half at best, were happy enough with the results). While I nodded supportively, listening intently, he shook his head in disbelief saying that, “He had had to literally plead to his specialist to have surgery, what an outrage!”

Then his final comment left me speechless.

In his complete exasperation he said, “Jen do you know what?, I am at the point where I feel like going for an extremely long run on Sunday and then doing 1000 sit ups so that when my doctor examines my back on Monday it is so bad that they have to book me for surgery right away and just fix the damn thing!”

Hmmmmmm ….well that’s one way to tackle back pain.

Obviously this young man was extremely frustrated with his situation and I understand how debiiltating pain can be. Sometimes however hunting for the short term fix may not offer us a long-term benefit, in fact sometimes short term fixes create further anguish and disappointment.

While popular, research now shows that in fact some forms of surgery for back pain do not have long-term therapeutic gain. With health care budgets reaching critical levels, there has been considerable review on which therapies or care provide the most reliable patient outcomes. There have been some startling results emerge and where possible orthopedic surgeons are being urged to refer patients for other nonsurgical cost-effective therapies.

Let’s look at some this research

According to a paper written in the International Orthopaedics (SICOT, 2008) low back pain is a common symptom affecting 70–85% of the population at some stage in their life. When it persists for longer than three months, it is classified as chronic.

Chronic low back pain is prevalent in 23% of the population and is the most common cause of activity limitation in people younger than 45 years of age. In addition to the physical symptoms endured by these patients, chronic low back pain poses a major economic problem due to their frequent use of health services and absence from work.

The paper continues with “the lack of consensus on whether surgical or non- surgical treatment should be offered to patients has prompted several randomised controlled trials (RCTs). In order to investigate the effectiveness of fusion as a treatment for chronic low back pain, we carried out a systematic review of the literature and a meta-analysis of RCTs and compared our findings to those of non-surgical intervention.”

Concluding statements from this review state that the improvement from surgical fusion was not statistically significant and surgeons should recommend spinal fusion cautiously to patients with chronic low back pain. (ORIGINAL PAPER Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials T. Ibrahim & I. M. Tleyjeh & O. Gabbar . International Orthopaedics (SICOT) (2008) 32:107–113 DOI 10.1007/s00264-006-0269-6 )

While a paper titled Back Surgery — Who Needs It? Focus on Research (Richard A. Deyo, M.D., M.P.H. New Engl J Med 356;22 www.nejm.org may 31, 2007) states that: Even among patients with persistent sciatica, recovery was likely whether or not surgery was performed. Studies involving repeated imaging show that most herniated disks shrink over time. But surgery accelerates the pace of recovery, and for some patients, faster recovery may be worth the risks. After a year, recovery was about the same with surgery as with nonsurgical care.

Another review states that “There is little evidence to support spinal fusion in association with diskectomy for patients with herniated disks and radiculopathy.” This trial compared spinal fusion with a more standardized rehabilitation approach for patients with diskogenic pain focusing on returning patients to their normal activities, reducing their anxiety about back pain, and promoting exercise. Conclusive statements include “surgery offered no advantage in pain relief or functional improvement.” (Spinal-Fusion Surgery — The Case for Restraint Richard A. Deyo, M.D., M.P.H., Alf Nachemson, M.D., Ph.D., and Sohail K. Mirza, M.D. New England Journal Med February 12, 2004 p722)

While a paper titled What Evidence Exists on the Clinical Effectiveness of Lumbar Spine Surgery? states that there is considerable evidence of the clinical effectiveness of discectomy for carefully selected patients and that discectomy provides faster relief from the acute attack, there is no acceptable evidence of the efficacy of any form of decompression for degenerative lumbar spondylosis or spinal stenosis. There is no acceptable evidence of the efficacy of any form of fusion for degenerative lumbar spondylosis, back pain, or “instability.” (What Evidence Exists on the Clinical Effectiveness of Lumbar Spine Surgery? The Cochrane Review of Surgery for Lumbar Disc Prolapse and Degenerative Lumbar Spondylosis (J. N. Alastair Gibson, MD, FRCS, Inga C. Grant, MSc, and Gordon Waddell, DSc, MD, FRCS) SPINE Volume 24, Number 17, pp 1820 –1832 ©1999, Lippincott Williams & Wilkins, Inc.)

The long-term outcomes of surgical and nonsurgical management were assessed after 8 to 10 Year in one research paper and in summary this paper says that although surgery is an accepted, commonly performed treatment for lumbar spinal stenosis, there is little evidence to support the relative benefits of surgery compared with nonsurgical treatments. The goal of the current study is to assess the relative benefits of surgical and nonsurgical treatment over a 10-year follow-up period using a broad range of validated patient-reported outcome measures.

Among patients completing 8- to 10-year follow-up, low back pain and satisfaction were similar among patients initially treated surgically or nonsurgically. However, surgically treated patients reported greater improvement in leg symptoms and backrelated functional status than nonsurgically treated patients. Long-term outcomes according to actual treatment received did not differ for those treated surgically or nonsurgically, mainly because of poorer outcomes associated with individuals undergoing additional surgical procedures than among those continuing with their initial treatment.

The study continues by stating that for patients with lumbar spinal stenosis, the relative benefits of initial surgical compared with nonsurgical treatment in terms of low back pain relief, predominant symptom improvement, and satisfaction with the current state seen at 1 and 4-year follow-up were no longer present after 8 to 10 years. (Long-Term Outcomes of Surgical and Nonsurgical Management of Lumbar Spinal Stenosis: 8 to 10 Year Results from the Maine Lumbar Spine Study (Steven J. Atlas, MD, MPH,* Robert B. Keller, MD,† Yen A. Wu, MPH,* Richard A. Deyo, MD, MPH,‡ and Daniel E. Singer, MD* )SPINE Volume 30, Number 8, pp 936 –943 ©2005, Lippincott Williams & Wilkins, Inc.)

I have attempted to summarise this research particularly for those considering back surgery. My intention is to challenge you to look a little deeper before agreeing to any procedure, schedule of care or before purchasing any product.

Whether you are considering surgery, seeing a chiropractor, a physiotherapist or personal trainer it is critical we assess our health goals and then consider if the advice we are receiving and the research we have gathered align.

During a lifetime we have two sets of teeth, baby and adult. During a lifetime we have only one spine. A spine that houses and influences the master control system of the body – the nervous system. Any decision we make that may influence the health of our spine requires that we spend considerable time investigating and researching our care options rather then latching onto what seems like the quickest and easiest fix.
Please see the next blog on how chiropractic has proven itself to be safe and effective for strengthen spinal health.

Wishing you exceptional health.

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