In this 200th anniversary year of the birth of Henry David Thoreau, each of us can increase our health and well-being by applying his guidance to our regular exercise activities. Thoreau, one of t ...View Article
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Neck surgery creates permanent impairment of motion
How many times have you heard someone say, "I have a pinched nerve in my neck and I have to have surgery." There are certainly cases where surgery is required, but surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and they have failed). Paul C. McAfee, MD states that "lumbar spine fusion surgery is generally not recommended until a patient has tried 6 to 12 months of adequate non-surgical care." It is alarming to me how many cases of surgical radiculopathy (a "pinched nerve") end up being surgically treated with NO trial of non-surgical care. Hence, this blog post will focus on research that clearly demonstrates that neck surgery does not improve the long-term outcomes of patients with chronic neck pain.
Chronic Neck Pain
Chronic neck pain is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, since many of the neck pain sufferers that I see have had their neck pain "for years," or at least longer than three months. Depending upon the intensity of pain and its effect on a person's ability to go about their daily activities, many people with chronic neck pain will ask their primary care doctor, "Is there anything surgically that can be done?" The desire for a "quick fix" is the common focus for those suffering with neck pain.Unfortunately, according to recent studies there may not be a quick fix, or at least surgery is NOT the answer.
The December 2012 issue of The European Spine Journal reports that spine surgery did not improve the outcomes for patients with chronic neck pain. They additionally pointed to other studies that revealed some very strong reasons NOT to have spine surgery unless every other conservative attempt to control pain had failed. One reason was a higher hospital re-admission rate after spine surgery. Another was that most studies on surgical vs. conservative care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, "The benefit of surgery over conservative care is not clearly demonstrated." It is important to point out to you, the reader, that the research analyzed studies that included patients with and without something called radiculopathy (radiating arm pain/numbness or tingling from a pinched nerve), and myelopathy (people suffering from irritation of the spinal cord creating pain, numbness, weakness in the legs, and potentially bowel and bladder dysfunction).
In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spine manipulation (adjustments) in the treatment of both acute and chronic neck pain with or without radiculopathy. And another author (Bronfort) published similar findings in 2010 in a large United Kingdom-based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine adjustments were effective for neck pain of ANY duration (acute or chronic).
How to Avoid Being a Victim of Failed Back Surgery
If you have chronic back pain, the next four minutes might make a lifetime of difference. Rods and screws in your spine should set off more alarms in your mind than just going through airport security. It's important to understand the cold, hard facts regarding back surgery and its implications.
Each year over 200,000 victims undergo low back surgery. Unfortunately 20-40% will fail the desired outcome. In fact, 10% will be worse after surgery. Actually only 1-4% of back problems require surgery. When you are experiencing severe back pain, it's easy to get talked into surgery. You'll do almost anything to get rid of the pain.
However, most cases will respond to conservative treatment. A surgeon making a living doing surgery may not be very objective as to what treatment is needed. The risks of surgery are minimized while you are cautiously told everything in life has some danger. But surgery of the spine is one of the highest risk procedures.
Surgery should always be a last resort after all conservative methods have been tried.
It's important you know the risks! Too many surgeons have the philosophy, "When in doubt, cut it out." But surgery is far from a panacea. When it comes to surgery, there's no substitute for knowledge. Information on how to avoid it is something you need to know.
What are some of the Factors Leading to Failed Back Surgery?
Degenerative Arthritis: Surgery is high risk if you have this condition, which causes chronic pain, stiffness and inflammation of joints.
Osteoporosis: This condition causes a loss of calcium leaving your bones weak and brittle. You are very susceptible to recurring problems.
Soft Tissue Strength: The success of surgery depends on the strength of the soft tissue supporting the spine. If you have chronic disuse atrophy of the muscles and ligaments, surgery often will not help.
Lifestyle: If your job or activities require repeated bending, lifting or twisting, your spine can easily be re-injured. Sitting all day can cause postural stress and recurring muscle spasms.
Surgeon's Skill: Some surgeons are much more successful than others. It's important to get at least two opinions before agreeing to surgery.
What are some of the Side Effects of Back Surgery?
Infection: It may occur early or late after surgery. Infection may involve bone, muscle, disc space, or the spinal cord. Infection occurs in 1-3% of cases.
Instability of the Low Back: Vertebrae move on top of each other and are interrelated tin function. When a disc is removed, the spine settles. It may cause over-riding of the facet joints. Levels of the spine adjacent to fusions are frequently unstable. If your spine seems to be "giving way," or "slipping out" and twisting back into position, you have instability.
Scar Tissue: A primary factor leading to failed back surgery is scar tissue. This is the cheapest grade of tissue the body uses to repair itself. It is not nearly as strong as normal ligaments, and not as elastic. As a result, scar tissue causes a weakness and stiffness of the spine. Repeat surgery is rarely of significant benefit.
Recurrent Disc Herniation: Most disc surgeries entail removal of only a portion of the disc material. The remaining disc material exits out of the surgical site and results in recurrent disc herniation.
Weak Muscles and Ligaments: A major cause of persistent disability is weak or atrophied muscles and ligaments supporting the spine. The pain is often worse after standing or sitting for prolonged periods of time. Many doctors believe weak muscles and ligaments are the primary cause of pain in failed back surgery. These weak muscles are overworked just maintaining proper posture. There is little to be gained by muscle relaxants. They act primarily on the central nervous system and not on muscle activity. It's also easy to become dependant on drugs.
Instability: Operating on a diseased disc may alleviate nerve pressure but increase instability by removal of some of the boy and ligamentous stabilizers that support the spine.
Metallic Implants: Knodt rods and Harrington rods may cause irritation at the hook sites. Fractures may occur. Scar tissue may form from bunching of the ligaments at the hook sites. Also, the low back loses its normal curve causing a compensatory increase in the curve above the fusion.
Repeated Surgeries: Some patients have painful or abnormal discs n all the five vertebrae of the low back. It is difficult to know where to stop surgery when fusion is contemplated in this setting.
Wrong Diagnosis of Physician Error: Sometimes the pain persists because surgery was performed at the wrong level. Often the real cause of the pain has been misdiagnosed.
Nerve Damage: This may occur during surgery or from prior disc herniation or compression of the nerve from scar tissue. Pain is often severe. It is usually described as a constant dull ache with burning or electric shock sensation or numbness and tingling in the legs. Narcotic analgesics do not alleviate symptoms.
Has Everything Really Been Tried?
Too often the only conservative treatment tried is bed rest, pain pills or muscle relaxants, braces, physiotherapy, or traction. If that doesn't help, surgery is recommended. If the pain is still there, you may have a CAT scan, EMG, MRI, discogram, fluoroscopy or bone scan. No one test gives a complete picture of the problem. Furthermore, none of these diagnostic procedures are completely reliable. One orthopedist said, "We are blind men trying to perceive the elephant from every angle using every useful technique available to obtain the most accurate view."
Identifying the exact source of pain is very difficult, even in the non-operated patient. Orthopedists ask, "What can we do with patients who we are not certain we can help with surgery?" "Are they simply relegated to decreased activity and changing their jobs?" "How important is it to allow individuals to continue an active athletic existence?" These are important questions to ask your doctor.
What if Surgery Fails?
Diagnosing low back pain, once spinal surgery has failed, is very complicated. It is harder to rehabilitate patients with such pain. It is difficult to sort out the psychological subjective symptoms from the physical symptoms. Repeat surgery is more difficult to perform and fraught with complications. The worst person to make a decision whether to re-operate is the surgeon who did the first operation. He wants to correct his failure. His ego is involved; making a totally objective decision clouded.
Diagnostic tests become more difficult to interpret when the patient has had previous surgery. It is hard to differentiate new disc disease from scar tissue on myelograms. It is just as difficult with CAT scan. The rehabilitative efforts in failed surgery cases take more time and effort. It has to be accepted by those paying the bills atat time and money spent on physical and psychological rehabilitation BEFORE re-operating is money well spent. Without such rehabilitation efforts, the second, third and fourth operations, will frequently fail.
There may be post-operative instability pain, joint pain, or degenerative disc pain from another level. As many as 30% of laminectomies fail because of scar tissue or recurrent disc herniations. Once scar tissue entraps the nerve, it is very difficult to retract the nerve from the dense scar tissue during another surgery.
Second operations take much longer due to many potential complications. Infection rates are much higher and risks increase. Tears in the dura surrounding the spinal cord occurs about one in ten re-do operations. This can lead to cerebrospinal fluid fistulas and meningitis. It is well-known that success of surgery DROPS RAPIDLY WITH EACH ADDITIONAL SURGERY. The ultimate aim in many of these complex cases may not be to return the patient to normal.
Following surgery, patients often cannot tolerate prolonged static positions such as sitting or standing. Many complain they cannot kneel, squat or carry things. The failure rate of repeat surgery is nearly 70% with only 17% good results.
Permanent disability can result from loss of mobility, strength, endurance and aerobic capacity.
What is a Safe & Effective Alterative?
THE BIG QUESTION: "How can you turn a painful back into a pain-free back?"
Why is it some people suffer for years with back pain but after a few months of Chiropractic care are 90% better? After living on pills, powders and potions with no results, they get better with simple adjustments to the spine. Successful treatment results from treating the cause of your problem. Chiropractors receive intensive training in the biomechanics of the spine and nervous system. Chiropractors know the spine. Why sacrifice your future health for temporary relief? Too many have never tried the safest method of treating back pain first.
Structure governs function. Malfunction precedes disease. Any structural breakdown will affect your nervous system. When ligaments are injured, the discs swell causing pressure on nerves. The vertebrae shift causing instability and more verve pressure. Chiropractors are trained to adjust the vertebrae back to their normal alignment. That's important because the nervous system controls every function in your body. Damage to verves affects any area that nerves control. It may cause severe headaches, pain or numbness down your arms or legs, or dysfunction of internal organs. Pain is Nature's way of signaling something is wrong. The longer the symptoms are treated with drugs, the more you are gambling with your health.
Chiropractic has a proven track record. In study after study, Chiropractic care got patients back on the job 2-3 times faster at the half the cost of radical care for back pain.
If you have chronic back or neck pain, don't let lack of information keep you from getting well. There is a better way than living on pills and having back surgery. In addition, many Chiropractors are trained in the latest technology in the field of rehabilitation to strengthen your back.
Why settle for only temporary relief? Try the undisputed leaders in treatment of the spine. Make this the turning point in your life. Unless you've fallen in love with surgery, we suggest you try Chiropractic care first. What have you got to lose? Don't wait any longer. Make your appointment today. Remember, if you ignore your health, it will go away.
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