Back Surgery: There are Other Options
Third only to tubal ligation and cesarean section for surgical hospitalization is spinal
surgery. With back pain affecting up to 80% of the population at some time in their lives,
this high rate of surgery is not surprising--EXCEPT that many feel spinal surgery is used
excessively and when indications for surgery are either not clear or non-existent. With
arguments against spinal surgery ranging from "few surgeries are proven
effective" to a lack of consensus as to when surgery is appropriate, the ongoing
debate has drawn much attention, even into the world of the layperson.
But this is not to say that spinal surgery has no purpose. Few would argue against the need for surgery following spinal fracture or for the removal of tumors or cancer. There are instances, however, when medical consensus rules for back surgery, for "instability" for example, when no clinical consensus on the definition of instability exists. At least one study has shown that disc herniation, though often given as a reason for surgery, is common in asymptomatic people and may even be "normal," causing experts to question whether the disc herniation is in fact the cause of the pain. Adding further to this question is the fact that many surgeries to correct disc herniation do not result in the resolution of pain. Herein lies the problem--a problem ultimately for the patient.
A majority of back pain episodes have no known biological/mechanical cause of pain. Though many cases of back pain will resolve on their own, moderate to severe cases do require professional health care intervention. If you suffer from back pain that continues for longer than 24 to 48 hours, seek care to rule out serious pathology and to begin recovery.
So how does the patient with back pain know that surgery is the recommended, most effective method of treatment, and what are viable options to try before agreeing to surgery?
The Viable Options:
Spinal Manipulation
Spinal manipulation or adjustment is perhaps one of the best studied treatments for low
back pain. The U.S. Department of Health and Human Services released a clinical practice
guideline for the treatment of acute low back problems in adults, through the Agency for
Health Care Policy and Research (AHCPR), that recommends spinal manipulation as a first
line of treatment for low back pain. The British Government also released a guideline that
reflected the U.S. consensus.
Some evidence exists that spinal manipulation, as performed by chiropractors, is effective for two to three years. Many other studies have shown spinal manipulation to be effective for the treatment of low back pain--both chronic and acute cases.
Never allow an untrained person to manipulate you. Besides the person not knowing what he or she is doing, only the trained professional may find manipulation contraindicated. Only Doctors of Chiropractic and Doctors of Osteopathy are extensively and formally trained in manipulation in their professional colleges. A study by the RAND Corporation found that 94% of all manipulations or adjustments performed in the U.S. are performed by chiropractors.
Medications
Some people may find pain relief through the use of non-steroidal anti-inflammatory drugs
(NSAIDs), and it is a recommended form of pain management from the AHCPR guidelines. The
problem with using NSAIDs, however, is that the pain is simply covered up, without the
benefit of knowing what caused the pain. All drugs are associated with side effects and
should be used with caution. If you have chronic back pain, long term drug use may lead to
other serious problems. In fact, the U.S. Food and Drug Administration estimates that
10,000 to 20,000 people die each year from stomach problems caused by NSAID use. Some
studies have found that NSAIDS may speed joint destruction, a side effect that may worsen
your back pain if it involves spinal joints.
One researcher noted that the "potential NSAID benefits are counterbalanced by their well-established and predictable toxicity.
The use of muscle relaxants, steroids, and anti-depressants have not been found effective for the treatment of acute low back pain. The AHCPR Guideline for the Treatment of Acute Low Back Problems in Adults recommends that these NOT be used.
Exercise
Some studies have shown that exercise can improve physical function and depression, which
is sometimes a problem with chronic low back pain. Exercise is also recommended following
episodes of acute low back pain. Benefits of exercise for low back pain include: increased
bone, tendon, ligament, and muscle strength, better oxidation of skeletal muscle, improved
coordination and control, increased efficiency of body mechanics, and improvement in
cardiovascular and respiratory function. Movement also increases the amount of nutrient
rich fluid through the spinal joint surfaces, and prevents the formation of scar tissue.
Exercise has also been shown to increase levels of endorphins, the body’s natural
pain killers, in the blood and cerebrospinal fluid.
Though those with low back pain were once told to remain in bed for extended periods of time, extended bed rest is no longer recommended. Long periods of inactivity lead to decreases in strength, flexibility, and often to symptoms of depression. Aerobic exercise, exercise that increases your heart rate and causes perspiration, has not shown as many benefits specifically for low back pain, but a good exercise program will involve both strength training and aerobic exercise. Warm-up and stretching exercises should be done before all types of exercise. If you suffer from back pain, or any other condition, a qualified health care professional should be consulted before an exercise program is begun, to insure the appropriateness of the workout for your condition.
Physical Therapies
Physical modalities are used to reduce inflammation and joint stiffness and to relieve
pain and other physical symptoms. These modalities include ice, heat, massage, ultrasound,
electrical stimulation, and others. Though few quality studies have been done to show the
effectiveness of these therapies, many people report benefits and there are few known side
effects. Some of these therapies can be used at home--such as ice and heat--and there is
no harm in seeing if they relieve your pain symptoms.
Psychological Counseling
This is in no way an inference that back pain "is all in your head." Anyone who
has experienced back pain knows all-too-well that the pain is real. But what research and
observation have shown is that back pain, especially chronic back pain, can lead to
depression, loss of self-esteem, stress, and feelings of hopelessness. Other studies have
linked back pain to job dissatisfaction, some believing that factors such as these play a
greater role in back pain than biomechanical factors. If you suffer from unexplainable
back pain, you may want to consider psychological counseling (once organic cause has been
ruled out), not because you have any mental problem, but because your pain may be related
to areas of stress or dissatisfaction.
Understand Back Pain
While most people would prefer to manage pain through one of the above options, it is
nevertheless important to remember that in a vast majority of cases, back pain will
improve with time, it is rarely life threatening, and activity can often be resumed or
continued at a regular pace. One study found that people who understood that their pain
was not caused by something "serious" and that they should continue activities
as normally as possible, improved faster than those receiving regular care. The idea is
that many patients believe that back pain will worsen until they are either home bound or
confined to a wheelchair so they take great precautions to avoid movements that they
believe will aggravate the condition. After being told that the condition is in fact
benign and self-limiting and that lack of movement is contraindicated for the condition,
the patients resumed normal activity and relieved the vicious cycle of pain, muscle
tension caused by fear of pain, and more pain.
If you opt for surgery, know that if it fails, you may not then be able to try conservative care for the pain. In other instances, conservative care (such as chiropractic) can help you deal with changes your body must make following surgery. For example, if you have had lumbar fusion, the fused vertebrae can not be manipulated. The other vertebrae--that are now compensating for this lack of movement--will need extra care and can be manipulated.
Surgery will not, as many believe, make your back stronger; in most cases, your back will be weaker. Adaptations will need to be made to daily postures, exercise programs, and possibly occupations. A Doctor of Chiropractic can assist you with your limitations following surgery, and possibly show you how to overcome them.
Questions to ask the doctor when surgery is recommended:
Percutaneous Laser Disc Decompression
Spinecenter Diskectomy
Spineonline ENDOSCOPIC DISCECTOMY
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