Do You Really Need Back Surgery?

By Dr. Rick Morris

Aaron H. has congenital spinal stenosis and two disc herniations.  He opted for surgery and had two of them.  When the third surgery was deemed necessary, he opted for a different form of treatment.  Listen to his story, it may change your life.

I’ve been to every doctor in L.A…

I’ve tried Acupuncture, Chiropractic, Massage, Yoga, injections and medications--nothing really helped.

One of the surgeons suggested surgery to “fix” the problem, while the other felt I should wait or possibly not have it at all. I’ve heard a lot of horror stories and even the type of surgery both surgeons suggested, were not the same. What should I do?

Why Can’t My Doctors Even Agree On Whether I Need Back Surgery?

Back surgery is unlike an appendectomy, heart valve replacement or removal of a cancerous lesion. These surgical procedures routinely work. In other words, there’s little doubt the appendix is infected, the heart valve is incompetent or the cancer is dangerous and needs to be removed. So when the surgery is performed properly, the chance for success is high.

Spinal surgery doesn’t come with that same level of confidence. In fact, no other surgery has a syndrome named for its failures—Failed Back Surgery Syndrome. It’s reported that 10-40 percent of back surgery patients fall into this category and develop intractable pain and functional incapacitation after the surgery.

Not only are back surgery results less favorable than most surgeries, the risks are often higher. The most serious consequences include:

  • Nerve Damage
  • Paralysis
  • Blood Loss
  • Blood Clots (which may cause a stroke or heart attack)
  • Spinal fluid Leaks
  • Death

The chance of severe or life threatening events are approximately 5% (the incidence of infection, alone, is 2%). But, that’s not the only problem. Its long-term success rate is exceptionally poor. This is the main reason most doctors postpone back surgery as long as they can. Some are better trained at non-surgical alternatives, are more conservative and will recommend those options; while others believe their surgical outcomes are better than those published in the medical literature, and will more quickly schedule surgery.

Why Do Back Surgeries Have Such Inconsistent and Poor Outcomes?

Most doctors try not to admit this, but they are rarely sure of the exact cause of your pain. They may believe it’s a pinched nerve, a herniated disc or spinal stenosis since they see it on an MRI; but, they know the real cause of your pain may not even be visible on your MRI.

Doctors are greatly influenced by your MRI findings, even though most studies have shown them to be only about 50% accurate in determining the cause of your pain. In other words, MRIs show abnormal tissue, but not pain.  So we try to correlate the exam findings and your symptoms with your MRI.  But there are many pain sensitive areas in your spine and once the area is cut, you may develop a new one.

These are the most common reasons for poor surgical outcomes:

  • Healthy tissue is cut or removed while leaving the pain producing tissues behind.
  • The surgery removed the pressure from an injured nerve, but later scar tissue formed from the surgery causing greater nerve compression than before.
  • The cut muscles or scar tissue that formed, from the surgery, changed the normal spinal mechanics leading to increased spinal degeneration and pain.
  • The mechanical abnormalities that caused the disc herniation, degeneration or spurring, were never properly treated so the problem just returns.

Lynn Johnson, MD, moderator of the American Academy of Pain Medicine, cautions, “Just about any approach is better than having surgery, because all the studies have shown that, if you take a surgical population and non-surgical population, they all seem to do the same in five years.” Many studies have agreed—5 and 10 years following back surgery, those patients were no better than those who didn’t have surgery.

How Does The Spinal Surgery Your Doctor's Recommending Rate?

All spinal surgeries haven’t different rates of success and failure. Take a look at those that perform the best and the worst.

Spine Surgeries With The Highest Risks of Complications:

  • Fusions
  • Treating multiple spinal segments
  • Open operations (i.e. cutting through muscle and ligaments)
  • Those requiring general anesthesia
  • Laminectomies

Spine Surgeries With The Lowest Risks of Complications include:

  • Microdiscectomies
  • Treating only a single spinal segment
  • Closed procedures (not cutting through the muscles and ligaments)
  • Those not requiring general anesthesia

Spine Surgeries With The Best Outcomes:

  • A microdiscectomy at a single level with severe pain radiating to one of the legs.
  • A segment of the spine that is “hypermobile and unstable” as demonstrated by motion x-rays.
  • Kyphoplasty to treat a severe compression fracture.

Spine Surgeries That Are Usually Necessary, But Have Higher Risks:

  • Spinal decompression surgery when there is spinal cord damage or severe spinal cord compression that doesn’t respond to non-surgical spinal decompression.
  • Spur removal in the neck that is causing spinal nerve or spinal cord pressure, and non-surgical approaches didn't work.

Least Effective and Not Usually Recommended Spinal Surgeries:

  • Laminectomies for spinal stenosis
  • Discectomies for low back pain
  • Fusions for degenerative joint disease (spinal arthritis).

As I’ve said, spine surgery can be effective and necessary; but, it should be used only as a last treatment option. Be sure to speak with us at The Morris Spinal Stenosis and Disc Center first to see if there is a better, non-surgical method. If you are one of the 5% that need surgery, we’ll help you find the best surgeon and surgical procedure for you.