You may think it’s odd to discuss low back pain (LBP) from the perspective of spinal fusion because as chiropractors, we do not perform surgery...so why discuss it? We feel it's very important that we discuss research such as this so we can help our patients make informed treatment decisions. Now, there are certainly times when a surgical procedure for back and leg pain is necessary and appropriate for some patients, but the problem is, there are also some patients who have been told they need spinal surgery, when in fact, they may be better off NOT proceeding with surgery. So, the question is, what happens to those patients who elect not to have surgery vs. those who do choose to proceed with surgery?
That question was addressed in a study where a total of 1450 patients injured at work were followed over a 2-year time frame. There were a total of 725 patients who proceeded with the fusion surgery and the other 750 elected NOT to have the surgery. A fusion surgery can be described as when two or more vertebra are fused together, usually because there are neurological problems such as shooting leg pain, weakness and/or numbness in one or both legs. The conditions treated in this study included herniated disks, degeneration of the disk, and radiating leg pain. There were primarily 3 factors that were compared between the two groups, namely, 1) ability to return to work, 2) disability (the inability to work), and 3) opiate (narcotic) drug use. Other factors compared included the need for re-operations, complications, and death.
The results showed, in general, those who proceeded with surgery had significantly more problems compared to those who did not have surgery. For example, only 26% returned to work, compared to 67% returned to work. The total number of days off work were 1140 vs. 316 days, respectively. There were 17 vs. 11 deaths, respectively and, 27% of the surgical group required re-operations with a 36% complication rate. Also, there was a 41% increase in the use of narcotic medication with 76% continuing the use after surgery.
Again, there are times when surgery is absolutely the right choice. Those times include when there is a loss of bladder or bowel control, progressively worsening neurological symptoms in spite of non-surgical care, and of course, unstable fractures, cancer/tumor and infections, but that’s about it! In other words, if you don’t have one of the before mentioned conditions which do require surgery, don’t be too quick to jump at the chance of “getting it fixed” with surgery. As the study suggests, the post-surgical results favor those who elected NOT to have surgery. Also, when in doubt, don’t trust the opinion of only one surgeon – always get a 2nd or even 3rd opinion. It is also very important to consider your current level of function or, your ability to do your desired tasks...and unless there is a significant loss in that ability, consider additional time with non-surgical treatment. The non-surgical treatment you can expect to receive from chiropractic includes (but may not be limited to) spinal manipulation, spinal disc decompression , exercise training, physical therapy modalities (ice, heat, electrical stimulation, ultrasound, traction, etc.), deep tissue laser therapy , dietary counseling, and job modification information.
We realize you have a choice in who you choose to provide your health-care services. If you, a friend or family member requires care for low back pain or sciatica in San Francisco, especially if back surgery is being considered, we would sincerely appreciate the opportunity to discuss your options.
Source: Nguyen, Trang H. MD, PhD*; Randolph, David C. MD, MPH*; Talmage, James MDâ€ ; Succop, Paul PhD*; Travis, Russell MDâ€¡ Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects: A Historical Cohort Study. Spine: 15 February 2011 - Volume 36 - Issue 4 - p 320-331.