Considering Lower Back Surgery? Explore Your Options

Are you contemplating lower back surgery to alleviate persistent pain? It’s crucial to understand your options and the advancements in surgical techniques that could offer relief. This guide provides essential insights into lower back surgery, helping you make an informed decision.

Understanding Lower Back Surgery

Lower back surgery is often considered when non-invasive treatments fail to provide relief from chronic back pain. Surgical options vary depending on the cause of pain, ranging from minimally invasive procedures to more complex surgeries like spinal fusion or disc replacement.

Advancements in Surgical Techniques

Recent years have seen significant advancements in lower back surgery, improving safety, reducing recovery times, and increasing success rates. Techniques like laser surgery, robotic-assisted surgery, and microdiscectomy are now more common, offering precise treatment with minimal impact on the body.

When to Consider Surgery

Surgery is typically recommended for conditions that have not responded to conservative treatments, such as chiropractic, medication, or injections. Common reasons include herniated discs, spinal stenosis, or degenerative disc disease. It’s essential to consult with a specialist to determine if surgery is the best course of action for your specific condition.

1. 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.

2. Constant Lower Back Pain

• Constant lower back pain that doesn’t change with movement is something that needs to be looked at more deeply. Inflammation is fairly common but it’s the pain that keeps you up at night that is getting worse that surgery needs to be considered.

3. 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 then this is a major problem and is a medical emergency. Lower back pain with bowel incontinence or constipation 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.

4. Foot Drop with Lower Back Pain

• Foot drop that is not improving or getting worse needs to be looked at urgently to determine if the pressure on the sciatic nerve is causing permanent damage. A baseline test neurological exam would be needed to determine if that’s the case. You can also monitor the situation and have someone take a video of you walking to determine if your foot drop while walking is getting worse or staying the same.

5. Lower Back Pain Gets Better But Leg Pain Increases

• Leg pain increasing but lower back getting better or disappearing means your problem is getting worse. It may not indicate that surgery is necessary but it may lead to the need for surgery. This is a time to go to your chiropractor to discuss the situation.

Preparing for Surgery

Preparation is key to a successful surgery and recovery. This may include physical conditioning, quitting smoking, or adjusting medications. Your healthcare provider will guide you through the necessary steps to ensure you’re ready for the procedure.

Recovery and Rehabilitation

Recovery varies by individual and the type of surgery performed. Rehabilitation plays a crucial role in regaining strength and mobility. A tailored rehab program, often involving physical therapy, is essential for a successful recovery.

Making an Informed Decision

Choosing lower back surgery is a significant decision. It’s important to weigh the potential benefits against the risks and recovery time. Discussing all options with your healthcare provider, including the latest surgical advancements, will help you make an informed choice.

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, India or UK (private/public) where there is private health care you are more likely to get surgery when you don’t need it. [1] (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-needed 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 of 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 confirm the diagnosis and have 3-4 differential diagnoses (alternative diagnosis). I usually take about 30 minutes for a full examination.

Q #2: Did your doctor do a neurological examination?

One of 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.

 See Also: Finding The Best Chiropractor In Your City

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 kneecap.
• Muscle Testing: In muscle testing, your leg strength can be evaluated through specific movements, such as standing on your toes or heels. Another method involves attempting to move your foot while the doctor endeavours to keep it still. These tests provide valuable insights into the strength and functionality of your leg muscles which is a reflection on the state of your nerves.
• 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 a 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. [2]-[5] 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.

Red Flag: Not All Disc Issues Equal Pain

It’s a startling fact: 40% of individuals without any pain harbour disc protrusions, and even 18% exhibit disc extrusions, an advanced form of disc herniation [2]-[5]. Astonishingly, these individuals experience no pain. This revelation underscores a critical point – what’s visible on an MRI might not necessarily be the source of your pain.

This insight into painless disc irregularities sheds light on the alarming statistic that 50% of low back disc surgeries fail. Understanding that the correlation between what’s observed on imaging and the experience of pain isn’t absolute is crucial in navigating decisions about medical interventions for disc-related issues.

See Also: Why Disc Herniation Surgery Success Rate Is 50%

With no neurological examination and just an MRI, you may be getting unnecessary surgery.[1]  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.[8]

See Also: MRI CT Scan & X-rays: What’s Best For My Pain

Q #4: Did your surgeon recommend surgery without recommending conservative care?

Red Flag: If you haven’t been recommended conservative care by a chiropractor 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.”[6]

This means a large proportion of medical doctors aren’t following clinical guidelines for the treatment of lower back pain and recommend lower back surgery too early.

To not recommend conservative care first is a red flag. If your diagnosis is 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 commissioned 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 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.

Research

[1]Spinal fusions serve as a 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

[2] Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373

[3]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

[4] 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

[5]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

[6] AMA Intern Med. 2013;173(17):1573-1581. doi:10.1001/jamainternmed.2013.8992.

[7]BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.a143 (Published 12 June 2008) Cite this as: BMJ 2008;336:1355

[8] http://oig.hhs.gov/oei/reports/oei-01-11-00660.asp