Fed up with back pain? Surgery seems such a convenient answer to our prayers. But is it?

Could surgery be the solution to your back pain worries, particularly that pesky lower back pain?

[There are probably some acute cases where surgery is likely warranted, particularly neck and upper back fractures due to impact/systemic infections where motor and/or sensory nerves are being severely compromised with significant loss of strength and/or proprioception. I am not addressing these specific cases here]

Frankly, in general, it is unlikely to be much help.

1. People given epidural anaesthesia for any reason (including back pain) complained of back pain afterwards

Epidural anaesthesia for pain relief during childbirth and for outpatient ‘awake’ surgery has been found to cause a high incidence of long-term back pain. It seems the cause is bad posture for some time during and after surgery, often without realising.

On the other hand, in a study of 9000 patients given epidurals for surgery other than childbirth, one in 50 complained of backache afterward.

Hysterectomy surgery in particular has been implicated in back pain (and other nasty complications) in women

2. Back Surgery Has a POOR TRACK RECORD for “Fixing” Back Pain or Even Just for “Postoperative Happiness”

What if you ALREADY have back pain, have had it for a while and are frankly “fed up” with it? Surely it could not get any worse anyway? Well…

Professor Gordon Waddell, a renowned Scottish orthopaedic and author of The Back Pain Revolution (Churchill Livingston, 1999), doesn’t like to mince words. “Back surgery,” he once remarked, “has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”

The latest evidence shows that the figures have hardly improved.

For back patients who undergo surgery:

• 15-20% will fall into the category of ‘the failed back’, the official term for people with chronic, considerable back pain that doctors cannot fix.
• Considering that half a million patients go under the knife in the US every year, that means that up to 100,000 people a year emerge from back surgery every year in considerably more pain than they were before they went to their doctor – and this is in the US only!

Back-pain treatments has traditionally followed fashionable ideas relating to theories about the cause of the pain… sacroiliac joint, joint facets and so on.

The most popular operations currently include:

• laminectomy, where nearby bone and/or ligaments are removed to give the nerve branching off the central spinal cord more space to move without getting trapped by the spine
• discectomy, removing all or part of a bulging or ‘slipped’ disc, the cushion separating each vertebra from another, that presses spinal nerve, causing back pain
• disc replacement, where the disc is replaced by an artificial implant made of metal and plastic
• fusion, where a degenerated disc is removed and the vertebrae above and below it are joined together, leaving that segment of the spine locked in position

Recent major reviews of all the evidence for the various kinds of surgery for back pain show that, like their predecessors, all these latest operations offer minimal advantages over doing nothing or undergoing rehabilitation.

How well does fusion work?

Actually, fusion usually makes things worse

In a 2010 study, researchers studied the records for 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, where a nerve is pinched or irritated, causing tingling and weakness of the limbs.

Two years after surgery:

• only 26% of those who had had surgery had returned to work, whereas
• 67% of patients who did not have surgery had returned to work

Of the patients who had had fusion surgery:

• 36% had complications
• 27% required another operation
• 11% were permanently disabled (compared with only 2 per cent of patients not having surgery)
• 17 had died (compared with 11 of the controls).

After surgery, there was a 41% increase in the use of painkillers like morphine, while around 75% of patients continue taking opiates after surgery.

“Lumbar fusion . . . is associated with significant increase in disability,”  the researchers declared

Does Tiger Woods know, has he ever looked at these stats? He first had a microdiscectomy in 2014, then two other back surgeries and in April 2017 he had a fusion . This shows that even being a top level athlete and having lots of money to spend on securing “the best surgeons” are no guarantees that you can find an easy surgical solution to your back troubles!

By cause of pain:

• When two independent reviewers surveyed all the available evidence on all major procedures, those patients with low back pain and common degenerative changes who’d undergone fusion fared no better than those who had intensive rehabilitation, with less than half having optimal outcomes
• Disc problems and spinal stenosis (narrowing of the spaces in the spine, causing pressure on the spinal cord and nerves): patients on average experience improvement either with or without surgery. A study comparing fusion with intensive rehabilitation concluded that surgery only provides “short-term benefits” which “diminish with long-term follow-up
• Surgery for slipped disc. The jury is out (See for details)
• Disc replacement.

A Cochrane review of seven studies comparing fusion with disc replacement in a total of 1,474 patients, those getting their discs replaced had slightly better outcomes than those being fused, but the differences were NOT significant. The researchers cautioned, “because we believe that harm and complications may occur after years, we believe that the spine surgery community should be prudent about adopting this technology on a large scale”

• Laminectomy – no good evidence

While surgeons have a whole palette of laminectomy techniques, when a group of Cochrane researchers compared three new surgical techniques with the ‘gold-standard’ laminectomy, they found no differences between any of them, plus such poor study designs that they could not determine surgical outcomes in many instances.

A recent Cochrane review of randomized controlled trials found that surgery had little benefit but also had serious side effects in 10-24% of cases. These side effects included:

• spinal fractures
• coronary ischaemia (narrowed heart blood vessels)
• respiratory distress
• blood clots
• stroke
• death due to fluid accumulation in the lungs

Non-surgical (conservative) management of back pain

• A recent Cochrane review of randomized controlled trials compared surgery for spinal stenosis with non-surgical management. Although the studies were high quality, the researchers could find little benefit with surgery and, instead, found evidence of serious side-effects in 10–24% of surgery cases compared with none when patients were managed conservatively (no surgery).
• I remember reading a couple of years back in an article that Tiger Woods (now caught up in a series of expensive back surgeries) wished he had never had that first back surgery.
• Surgical back solutions should at best be seen as “the last resort”. Most people can do much more than they think via conservative approaches that will require them to work for it, but will be much better for their bodies in the short, mid and long term.
• Conservative management (“reduction”) of back pain beats the alternative in my opinion. More on this in another article. Stay tuned!

Emanuela – www.pilatesfitness.co.uk

References

https://wddty.com/magazine/1993/december/back-pain-the-dangers-of-surgery-2.html

https://www.wddty.com/magazine/2015/december/hysterectomys-dirty-little-secret-back-pain.html

https://www.wddty.com/magazine/2016/may/so-you-think-you-need-back-surgery.html

http://www.latimes.com/sports/more/la-sp-tiger-woods-back-surgery-20170420-story.html