Beware Of Lower Back Surgery: Guide To Lower Back Surgery
Have you been told you need lower back surgery for your chronic low back pain?
Are you contemplating lower back surgery?
In this issue of Bodi Empowerment I give you the tools to help you decide if you are a candidate for lower back surgery OR if you would benefit more from a lower back rehabilitation program, by a chiropractor or physiotherapist.
When Lower Back Surgery Is Needed
Fever Linked to Lower Back Pain
- A chronic lower back pain episode with fever maybe just the flu. A more sinister problem is when you have flu caused by infection in the lower back. If you’re diabetic or your immune system is suppressed that fever might be something more serious. and may require you to have lower back surgery.
Constant Lower Back Pain
- Fever with lower back pain that doesn’t change with movement is something that needs to be looked at more deeply. You need to get his looked at ASAP and yes you just might need lower back surgery if the pain is due to an infection.
- Constant low back pain without fever that doesn’t change with movement is also something that needs be examined right away.
Bowel & Bladder Problems With Lower Back Pain
- If you are having lower back pain and also having bladder problems such as incontinence (can’t hold it in), dribbling or can’t urinate than this is major problem. Lower back pain with bowel incontinence or inability to move your bowels (can’t go) are also signs that there is disc pressure on the nerves in your lower back that go to the bowel or bladder. With these symptoms you may be a candidate for lower back surgery.
- If you don’t have any of the more sinister low back problems be thankful.
Is Your Doctor Doing A Good Job?
To find out you have to ask yourself a few questions.
What financial interest does my doctor have?
If you live in the USA or UK (private/public) where there is private health care you are more likely to get surgery when you don’t need it.  (Washington Post ) If you are in a country with government funded health care like Canada the opposite is true. You may wait many months even up to 2 years for much need lower back surgery.
Q #1: Did your doctor spend enough time to ask about your chronic lower back pain?
A doctor cannot diagnose your lower back in five minutes.
With 18 years experience as a chiropractor I often look at how the patient gets up from the waiting room chair and watch how they walk to the examination room. This often tells me what is likely wrong.
My point is that sometimes I might have a diagnosis in mind even before the patient has entered the examination room, but it takes a lot longer to actually confirm the diagnosis and have 3-4 differential diagnosis (alternative diagnosis). I usually take about 30 minutes for a full examination.
Q #2: Did your doctor do a neurological examination?
One the key examinations is the neurological examination. This examination often tells you where the problem is coming from. If you have pain down one leg or both, this test must be done.
Your doctor does this by checking:
- Reflexes: Check reflexes with a reflex hammer. She/he will tap your achilles, and the knee just below the knee cap.
- Muscle Testing: Check your muscle strength of your legs either by making you stand on your toe than heels or by making you move your foot while the doctor tries to hold your foot still.
- Sensitivity: Check your light touch, vibration or sharp/dull senses by making you close your eyes and touching various areas of your foot and leg and seeing if you can feel a difference. Your doctor may use a tuning fork to see if you can feel vibration in various areas of your foot. Finally your ability to discriminate sharp and dull might be tested with a pin and a dull object while your eyes are closed. Usually one of these tests for sensitivity is enough.
These tests must be done to help determine what the diagnosis is and recommend lower back surgery.
Q # 3: Did your surgeon just look at your MRI and conclude you need lower back surgery?
Red Flag: The fact is 40% of people with No Pain have disc protrusions and 18% have disc extrusions which is a severe form of disc herniation. - Remember these people have No Pain. What this means is that what you see on a MRI may not be causing you pain. That’s why 50% of low back disc surgeries fail.
With no neurological examination and just an MRI you may be getting unnecessary surgery. A thorough examination is in order.
A study by the US Department of Health and Human Services concluded that the rise in spinal fusion surgeries is likely driven partly by financial incentives.
Q #4: Did your surgeon recommend surgery without recommending conservative care?
Red Flag: If you haven’t been recommended conservative care from a chiroprator or physiotherapist before lower back surgery, this is a serious red flag.
“Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care.”
This means are large proportion of medical doctors aren’t following clinical guidelines for treatment of lower back pain and recommendating conservative care before even thinking about lower back surgery.
To not recommend conservative care first is a red flag. If your diagnosis are one of the following
- Osteoarthritis (Wear and Tear Arthritis)
- Degenerative disc disease
- Lumbar disc herniation
- Lumbar Lateral Stenosis
Lower Back Surgery Maybe Helpful For:
- Spinal Fracture – Some types of fractures can be left alone as they cause little to no pain while others fractures are painful or can potentially cause paralysis
- Infection of your spine
- Disc Herniations in which conservative treatment was not helpful
- Severe Degenerative Disc Disease which has not responded to conservative care
- Spinal Stenosis /Lateral Stenosis that has not responded to conservative care
- Spondylolisthesis: Foward slippage of one vertebrae which has not responded to conservative care.
- Scoliosis: which has not responded to conservative care
Three studies commisioned by Medicare found that spinal fusion surgery (low back surgery) was not helpful for degenerative disc disease. One study did find it helpful but it was funded by spinal surgery equipment maker Acromed and Ossano Scandinavia. You would be surprised at how many “research studies” funded by industry show favourable results for their cause.
I recommend trying chiropractic, physiotherapy, and acupuncture as all of these have been found to be helpful for many low back conditions.
Tell us what you think in the comments below and like us on Facebook. This Toronto Downtown Chiropractor will answer all questions in the comments section.
Spinal fusions serve as case study for debate over when certain surgeries are necessary, Washington Post. http://www.washingtonpost.com/business/economy/spinal-fusions-serve-as-case-study-for-debate-over-when-certain-surgeries-are-necessary/2013/10/27/5f015efa-25ff-11e3-b3e9-d97fb087acd6_story.html
 Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373
Boden SD et al. “Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” J Bone Joint Surg Am 1990; 72A:403-408
 Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666
Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625
 AMA Intern Med. 2013;173(17):1573-1581. doi:10.1001/jamainternmed.2013.8992.
BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.a143 (Published 12 June 2008) Cite this as: BMJ 2008;336:1355
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