Contemplating Surgery?

I know you want to know what I think. But, the best way to tell you what I think is to find out what you know; then see what a consensus of experts think! So first, I have a few questions for you.

What do orthopedic professors and researchers say about spine surgery? Anthony DePalma, M.D., and Richard Rothman, M.D., Ph.D., Professors of Orthopedic Surgery, Jefferson Medical College, Thomas Jefferson University say: "No operation in any field of surgery leaves in its wake more human wreckage than surgery on the lumbar discs. The situation becomes even more pathetic in the realization that at the start, in most instances, is a healthy, self-sufficient individual. Many of these patients are subjected to numerous operations, and after each operation the patient is worse." (The Intervertebral Disc.2000 WB Saunders Philadelphia, PA; 347)

What is the water content of the nucleus of your intervertebral discs? Normally they are 88% water. So, when the disc looses more than 3% of its water, it loses the ability to mix and remix the proteoglycan aggregate in the nucleus and loses its gel like properties. Spinal disc's gel that loses fluids becomes brittle and fractures if the fluids are not replaced as well as mixed and remixed daily. A 'perfect gel' in the disc nucleus is essential for symmetry and usual transfer of the body's weight from the vertebra above to the one below. (Bernini PA, Wiesel SW, Rothman RH. The Aging Lumbar Spine 1982 WB Saunders Philadelphia, PA)

Has anyone taught you the importance of, and how to mix the proteoglycan aggregate in your discs? It's kind of a rhetorical question as I know they have not. Even if you have had surgery, or will choose to have surgery before learning this; you MUST do it after. When the spinal disc looses water content, the joint narrows and the weight bearing is transferred to the posterior joints. With this alteration in joint nutrition, the nutrition delivery to the vertebral bodies is impeded, causing osteoporosis and compression fracture and collapse with associated loss of function, chronic soreness, stiffness, and debilitating pain. (Kapandji IA. The Physiology of the Joints, Vol 3: The Trunk and Vertebral Column. 2nd ed. LH Honore 1974 Churchill Livingstone New York)

If you have tried Chiropractic did you perform "warm-up" maneuvers prior to and "loading" maneuvers following your mobilizations? Again, probably not. What you don't know is that without 'warming-up' the red (muscle / vascular) tissues and the white (ligament / tendon / disc / non-vascular) tissues, the body will respond to the chiropractic mobilization procedures by returning to the pre-mobilization position and tension within two hours post treatment. This negates any postural correction and results in the patient becoming dependant upon repetitive mobilizations for temporary relief of symptoms, instead of long term relief from reversing the degenerative cascade of the tissues with proper rehabilitation maneuvers. These 'warm-up' and 'loading' maneuvers are vital because ligaments, discs, cartilage, and tendons have holding energy when not in motion. Loading and unloading cycles, through compression and traction, cause the temporary loss of this energy. This is called hysteresis. Hysteresis changes the nucleus pulposus of the discs from hydro-gel, a Jell-O like substance with resistance to positional change, into hydro-sol, a water-like solution with limited resistance to positional change. (Divorak J, Divorak V. Manual Medicine Diagnostics, 2nd ed. 1990 WB Saunders Philadelphia, PA; 1304, 1312.)

Have you been performing these rehab maneuvers? If not, you haven't been doing what is necessary to correct your spine.

Have you considered what the research really says about the various spinal disc treatment options? Chou, R et al; Interventional Therapies, surgery, and interdisciplinary rehabilitation for low back pain; and evidence - based clinical practice guideline from the American pain Society. SPINE 34 (10), May 1, 2009

Spinal manipulation is recommended by the American Pain Society and the American College of physicians for primary care of low back pain. Prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermal coagulation are not effective. Epidural steroid injections give short-term but not long-term relief of pain. Spinal cord stimulation is moderately effective for failed back surgery syndrome with persistent Radiculopathy, though device related complications are common. Surgery for leg pain (Radiculopathy) with herniated lumbar disc in symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up. For patients with no leg pain, with disc degeneration, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy.

Nguyen Trang H.; Randolph, David D.; Talmage, James; Succop, Paul; Travis, Russell. Long-term outcomes of lumbar fusion among workers compensation subjects: and historical cohort study. SPINE, POST AUTHOR CORRECTIONS, 23 August 2010

725 lumbar fusion cases were compared to 725 controls that were randomly selected from a pool of workers comp subjects with chronic low back pain diagnoses with dates of injury between January 1, 1999 and December 31, 2001. The study ended on January 31, 2006. The main outcomes were reported as return to work (RTW) status two years after the date of injury (for controls) or two years after date of surgery (for cases). Disability, re-operations, complications, opioid usage, and deaths were also determined.

Two years after fusion surgery, 26% (n = 188) of fusion cases had RTW, while 67% (n = 483) of nonsurgical controls had RTW. The reoperation rate was 27% (n = 194) for surgical patients and 36% of lumbar fusion subjects had complications. Permanent disability rates were 11% (n = 82) for surgical cases and 2% (n = 11) for nonoperative controls. For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n = 550) of cases continuing opioid use after surgery. The total number of days off work was more prolonged for surgical cases compared to controls, 1140 and 316 days, respectively. Conclusion: lumbar fusion for the diagnosis of disc degeneration, disc herniation, and/or Radiculopathy any Worker's Comp. setting is associated with significant increase in disability, opiate use, prolonged work loss, reoperation, and poor RTW status.

Now, let's get serious!!! The fact is, you may not "need" disc surgery.

What all of the above proves is that what you don't know can hurt you! Except for spinal cord compression (usually demonstrated by loss of bowel or bladder control) or down going neurologic signs like 'foot drop', a clinical course of conservative integrated chiropractic and physical medicine rehabilitation is the proven first step in treatment. It is not my purpose here to explain why this is not usually the case or why there were 1,750,000 spine surgeries in 2005 at a cost of 26 billion dollars.

Now, let's talk about you. I don't know your situation; but I do know ours. We have a very unique reputation in that patients will come to us for an honest answer. Every month I have at least one person who comes in because they were told by a friend or relative that we would tell them whether we could help them or not. No strings, no dog and pony show, simply an honest evaluation of your history, examination findings, x-rays and MRI's. If I can help you, I'll tell you. If I can't help you, I'll tell you what I think your next step should be.

What should your next step be? You should call the clinic right now to schedule your initial consultation and examination. We have helped people who have had recent spinal trauma, and patients with 20 long years of pain and disability history. The most common statement from the long term pain patient is: "I wish I would have come here years ago!" And the most common statement from the recent trauma patient is: "I'm glad I didn't wait!" What ever your situation, you can use both of these statements if you take action today.

I'm looking forward to meeting, and serving you.

Perry L. Lyons, D.C. DABFP