Surgery not the definitive answer
David Hanscom is an orthopaedic surgeon based in Seattle, who has been performing complex spinal surgery since 1986. In this time, he has amassed significant expertise in treating both adult and paediatric patients with a wide range of spinal conditions, including deformities, fractures, tumours and infections.
He spends a large part of his practice devoted to helping patients who have suffered multiple failed spinal surgeries. Through his observations, David learned that the central nervous system is the key player in the development of chronic pain and that most spinal surgeries should never be performed.
I am witnessing a disturbing trend of major spinal surgeries being performed on spines that are normal. I want to be clear that a ‘normal’ 60 year-old spine does not look the same as a ‘normal’ 20 year-old spine. As you age, the discs between the vertebrae lose water content, narrow down, and form bone spurs around the edges. It has been well documented that all of these changes are consistent with the aging process. By the time you are over 60 these degenerative findings are present in 100% of people – most of whom do not suffer from chronic back pain. Research has documented that there is essentially no connection between disc degeneration and back pain. The term ‘degenerative disc disease’ is not accurate. Disc degeneration is not a disease and does not cause pain; it’s just part of normal aging, like grey hair.
What is puzzling is that, despite there being no evidence to support the connection between disc degeneration and pain, there are hundreds of thousands of spinal fusions being performed for back pain in America every year based on the MRI scan showing disc degeneration.
Research shows that over half of patients have significant improvement six months after a fusion for lower back pain, but by two years this number drops to less than a third. Additionally, the re-operation rate is 15-20% within the first year, there is over a 30% chance of having increased pain after surgery, and even a higher chance that you may enter the terrible reality of becoming a ‘failed back surgery syndrome’ patient – condemned to suffer crippling pain for the rest of your life. Your capacity to thrive and enjoy your life shrinks to less than zero and your life becomes one of just surviving the adversity caused by pain.
Unfortunately, there is a feeling amongst patients and professionals that surgery is the ‘definitive’ answer or the ‘last resort’. It is definitive only if an anatomical abnormality causing the corresponding matching symptoms can be identified. I can only fix what I can see. Otherwise surgery is not a choice at all.
How has the medical profession reached the point of thinking that operating on normally aging spines with a 75% failure rate can be considered a definitive solution for lower back pain?
Full article published in print and online in the June 2015 issue of TalkBack magazine. Sign up to the FREE monthly e-newsletter below to stay updated!