Myth 6: The Spine Surgery Debacle
The rapid and enthusiastic expansion of disc surgery soon exposed its limitations and failures. It was accused of leaving more tragic human wreckage in its wake than any other operation in history.
–Allan & Waddell, A Historical Perspective On Low Back Pain and Disability, 1989
Surgery is the sacred cow of our healthcare system and surgeons are the sacred cowboys who milk it.
–David Spodick, MD, professor at the University of Massachusetts
Whether you like it or not, if you’re in pain long enough, eventually you’ll find yourself in a surgeon’s office instead of a Chiropractor of Little Falls MN. It’s there that some pain sufferers are told to go under the knife because it’s their best option for relief. Others are told that it’s their only option. It’s all a lie. The truth is that surgery is the worst option, period.
What pain sufferers aren’t told is that by trying to cut out the pain, they’re really cutting away their only chance of ever becoming pain-free. Let me, as a Chiropractor of Little Falls MN, show you why.
The idea behind a spinal fusion is not complicated: if a spinal joint is causing trouble, bind it to the good joints neighboring it. That way, it can’t be trouble anymore or so this Chiropractor of Little Falls MN hoped. When fusions first arrived on the scene, they were touted as the perfect fix for back and neck pain. It didn’t take long before the number of spinal fusion procedures skyrocketed.
This was fine, except that years later, after millions of operations had been performed, one very real, very permanent problem began to surface. Many spinal surgery patients learned the hard way that however bad your back and neck was before, after a fusion it can be much worse.
In 2011, the journal Spine published an article where researchers reviewed the records of 1,450 patients who were suffering from disc degeneration, disc herniation, or radiculopathy—a nerve condition that causes tingling, numbness, pain, or weakness in the limbs. What they found was shocking: having a spinal fusion increases the risk of being permanently disabled by 500 percent.
That doesn’t sound like a “perfect fix” to me or any other Chiropractor of Little Falls MN.
These 1,450 patients were people whose pain was so bad they couldn’t work, so when the researchers looked to see how many people had returned to work after spinal fusion surgery, they discovered that 74 percent of those who had the operation still weren’t back to work two years later.
Not only that, they found that over a quarter of spinal fusion patients had to have additional surgeries. (44) Considering that success rates plummet to 30 percent after a second spine surgery, 15 percent after a third, and approximately 5 percent after a fourth (45), you may start to wonder why spinal fusions are done at all. That’s a good question with a not-so-nice answer. But before I tell you what it is, let’s look at the other kind of spinal surgery are options instead of seeing a Chiropractor of Little Falls MN.
-Ectomy: Suffix Meaning “The Surgical Removal of”
Instead of fusing segments, the other form of spinal surgery involves cutting away parts of the spine in the hope of relieving pain. Here are the most common types:
* Disc-ectomy: When a piece of your intervertebral disc (spinal cushion) gets chopped off. Usually done when there’s a herniation or bulged disc.
* Lamin-ectomy: When bone located on the back part of the spinal column is removed. Usually due to a disc problem or degeneration.
* Foramen-ectomy: When bone or tissue clogging the passageway for the nerve gets drilled clean. While this type of spinal surgery may (or may not) temporarily relieve pain, in the long run, it eats away at your spine like rust on a car, and that fact is often not emphasized when the surgery option is being discussed. This erosion of the spine has a name:
Transitional Syndrome/Adjacent Segment Disease
To understand this, you’ll need a crash course on the back and neck. So sit up straight and pay attention, pretend you’re going to be a Chiropractor of Little Falls MN. Your spine is a repeating chain of vertebrae and cartilage. Each segment works with the neighboring segments to absorb stress brought on by sitting, bending, lifting, etc. This is important because by each piece absorbing a little, no one piece has to absorb a lot—an essential process to having a pain free back and neck.
Surgery disrupts this and makes the healthing with a Chiropractor of Little Falls MN much harder.
When you cut through muscles and ligaments and cut out cartilage and bone, that specific spot ceases to do its part of absorbing stress. When one part of the chain does not work properly, the stress gets transferred or “transitions” somewhere else—the neighboring joints.
Where once the problem was limited to one, two, or maybe three areas, now it spreads like an infection up and down the entire spine. Bone spurs grow like weeds, discs tear and herniate, the passageways for nerves get clogged, and arthritis runs rampant. (47)
You see, this “transference” takes place after spinal surgery in which a neck or back problem goes to other places. If it goes to adjacent segments of the spine, it’s called Adjacent Segment Disease. If it goes to the extremities (shoulders, arms, hips, and legs) it’s called Transitional Syndrome. It may take months or years, but no matter how skilled the surgeon is it is not a question of if this happens, but only a matter of when and how badly it happens.
Believe it or not, that’s actually the best-case scenario. There are some cases where pain doesn’t transition at all. It actually never leaves.
Failed Back Surgery Syndrome
What is it? It is just as it sounds. A person goes into surgery and comes out with the same level of pain or worse. Bluntly said, the operation didn’t work, you would of had better luck seeing a Chiropractor of Little Falls MN.
“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate.”
—July 2004 “The Back Letter” (a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, DC)
Be careful not to let the simplicity of the name undersell its meaning. Have you ever heard of “failed heart-surgery syndrome”? “Failed kidney-surgery syndrome”? Or “failed knee-surgery syndrome”? No, you haven’t, because they don’t exist. “Failed Back Surgery Syndrome isn’t a random slang term christened by an upset patient. It is an official diagnosis handed down from medical regulators. This disturbingly poor outcome has happened to thousands of people over the years that eventually it had to be recognized. That’s a lot of necks, backs, and lives ruined that a Chiropractor of Little Falls MN now has a slim chance to fix.
No other type of surgery in the world has an actual diagnosis due to its history of poor results… that award goes to spinal surgery alone.
Another Nail in the Coffin
A study conducted in 1999, and published in the Journal of Bone and Joint Surgery, took an interesting approach to the problem of spinal surgery. Researchers compared regions where they were doing a lot of spinal surgeries to those doing only a few. This is what they found: the best outcomes for back pain occurred where surgery rates were lowest, and the worst results occurred in areas where surgery rates were highest. (47) What does that mean? Wherever and whenever spinal surgery is performed the most, the chances of getting rid of pain is the worst! Bottom line, see a Chiropractor of Little Falls MN for better options.
We could end this section here, but the whole story hasn’t been told yet.
A Deep Cut
According to a 2005 study titled “Evidence-Informed Management of Chronic Low Back Pain.” outside of serious structural disease like an infection, tumor, or such severe spinal deterioration that your life is at risk, there are no clear guidelines telling doctors to perform spinal surgery to relieve back pain. (48) Zero. None. Nada. Zilch.
While this may be news to you, this has been known in the medical community for quite some time. But guess what’s happening? Despite an epidemic of failed spinal surgeries, people are still going under the knife and doing it in large numbers. Between the years 1992-2007, Medicare spending on spinal surgeries more than doubled. (49) In 2012, over a million spinal surgeries were performed across the nation officially making it the most common type of surgery. (50)
This isn’t going unnoticed. Many people “in the know” realize something isn’t right. One group of researchers said that, “There remains little or no medical, clinical, or surgical evidence to support such variability.”(49) Don’t breeze by that statement. They’re saying that there really isn’t any evidence that justifies all of these spine surgeries being performed.
Why are they still being done so often instead of seeing a Chiropractor of Little Falls MN?
The nice answer: Our aging population is plainly more willing to accept spinal surgery as a good option because they’re trying to stay active.
The not-so-nice answer: The spinal surgery industry has become more about the bottom line than your neck and back.
Cut to the Chase
How has money—that is literally coming off the backs of pain sufferers—become a driving force for spinal surgery?
* Surgeons get paid more for doing more complex surgeries. It only makes sense. The more difficult the surgery, the more a surgeon should get paid for his skills. The problem is that these more complex surgeries are being performed when simpler, less expensive, and just as effective options are available. Richard Deyo, pain researcher, notes that possibly up to 50 percent of these more complex surgeries being done are unnecessary. (51) That’s more than just a few overzealous surgeons.
* The hardware used is a goldmine. “You can easily put $30,000 into a person during a fusion surgery,” notes Charles Rosen, a spine surgeon at the University of California who created a group to combat what it sees as conflicts of interest in spine surgery. What kind of profit margins are the manufacturers of spine surgery hardware looking at? Consider this: the screws used to drill into bone, called pedicle screws, can be manufactured for less than $100 and are sold for $1000 to $2000 apiece. (52) That’s a lot of profit.
* Physician owned distributorships. This is a business that a doctor is an investor in, and distributor of, the devices or hardware he may put into his patients. While it is a legal arrangement, the Department of Health and Human Services’ Office of Inspector General has concluded that these distributorships are “inherently suspect,” and issued fraud alerts in 2006 and 2013. (53)
You’re probably reeling from all of this information. It’s shocking I know, but it’s true. It’s equally true that there are some fine spine surgeons who operate (in every sense of the word) with honesty and integrity, using all of the skills and experience they have acquired. And they have nothing but their patients’ best interests at heart. Having said that, it seems there are some bad apples in the bunch, but you’re now armed by this Chiropractor of Little Falls MN with some vital information to help you make informed decisions about your own health.
The Final Cut
In her book, A Nation in Pain, author Judy Foreman got it right when she wrote, “The majority of surgery patients do not have an optimal outcome. That is, having minimal-to-no pain, reduction of pain medications, and a return to high-level functioning.”
Every time a new patient comes to my office, and on their intake form, they have checked “yes” to having had spinal surgery, I’m reminded of this pain myth, all the people it’s affected, and the simple truth behind it.
* MYTH: Spinal surgery is your best or only option for pain relief.
Two peas in a pod. Spinal fusions bind joints together while “ectomies” remove pieces of the spine, both in the hope of relieving pain. While they can help in cases of severe instability, infection, or a tumor, for back and neck pain their track record is terrible.
Cut in and cut away. By cutting into the spine, you disrupt its ability to absorb stress, and doing so ultimately leads to more problems and potentially much more pain.
The power of money. There are financial incentives for surgeons and hospitals to operate that is undoubtedly linked to the massive number of spinal surgeries being performed.
* TRUTH: Spinal surgery is the worst option when it comes to relieving back and neck pain and should only be considered when all other avenues have been thoroughly exhausted, if at all as this Chiropractor of Little Falls MN would recommend.
- Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects: A Historical Cohort Study. Spine 36 (4) pp320-332.
- Martin BI, Mirza SK, Comstock BA et al. Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine 2007; 32:382-387.
- Motion Compensation Associated with Single-Level Cervical Fusion: Where Does the Lost Motion Go? Spine Volume 31 (21) Oct 1, 2006 pp. 2439-2448, Schwab, John S., MSc; DiAngelo, Denis J., PhD; Foley, Kevin T. MD,
- Keller RB, Atlas SJ, Soule DN, Singer DE, Deyo RA. Relations hip between rates and outcomes of operative treatment for lumbar disc herniation and spinal stenosis. Journal of Bone Joint Surgery 1999; 81:752- 62.
- Don and Caragee. Evidence-informed management of chronic low back pain with surgery. The Spine Journal 8. Pp. 114:120
- United States Trends and Regional Variations in Lumbar Spine Surgery: 1992-2003 James N. Weinstein, DO, MS; Jon D. Lurie, MD, MS; Patrick Olson, MD; Kristen K. Bronner, MS; Elliott S. Fisher, PhD; and Tamara S Morgan, MA.
- Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012 #186. Accessed October 29, 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Op erating-Room-Procedures-United-States-2012.jsp
- Spinal Fusions Serve as Case Study for Debate over When Certain Surgeries Are Necessary. Washington Post.Accessed October 4, 2016. https://www.washingtonpost.com/business/econ omy/spinal-fusions-serve-as-case-study-for-debate-over-when-certain-surgeries-are-necessary/2013/10/27/5f015efa-25ff-11e3-b3e9-d97fb087acd6_story.html.
- Carreyrou, John, and Tom Mcginty. Top Spine Surgeons Reap Royalties, Medicare Bounty. WSJ.com. December 20, 2010. Ac-cessed October 04, 2016. wsj.com/articles.
- KPCC, 89.3. Selling the Spine: Doctors Profit in the OR, but at Whose Expense? 89.3 KPCC. Accessed October 04, 2016. http://projects.scpr.org/longreads/selling-the-spine/.