Back Pain and Surgery
A new study in Australia in The Conversation AU by Machado, Lin and Harris 2018, has shown that treatment for back pain costs $5 billion Australian per year and this figure is rising annually. Most of this is spent on surgical procedures like spinal fusion.
Spinal fusion is an operation whereby bone is taken from part of the body – usually the pelvic bone as it is rich in blood – and it is grafted between the bones of the area in the spine thought to be causing the pain. Thus the area can no longer move and should not be able to cause further pain. This sounds logical, doesn’t it? If you cannot move an area that gives you pain when you move either locally or in along the nerve that exits from that site, then you should not irritate the area or the nerve and thus you will no longer be in pain. Or they perform decompression which should remove pressure on the nerve, so how can it continue to hurt?
The big problem is that it often DOES continue to hurt and the research says that compression or fusion, are of little benefit or actually lead to harm. This is according to Choosing Wisely – the campaign to educate medical professionals and the public about tests, treatments and procedures that have little benefit.
Sometimes the two procedures are carried out at the same time. Rates of spinal fusion have continually risen worldwide and in USA rates of spinal fusion more than doubled between 2000 and 2009, whilst in Australia in the private sector, rates rose by 167% between 1997 and 2006. However, in UK you are eight times less likely to undergo spinal fusion than in USA.
The older we get then the discs between the vertebrae tend to dry out and shrink and as well as the fact that we become stiffer and less able to move freely, the size of the holes out of which the nerves leave the spine to go into the legs to give innervation to the muscles of the legs and the lower trunk is reduced, which is called spinal stenosis. When we walk we need increased innervation to the muscles of the legs and if the nerve is compromised as it exits the spine by that stenosis or narrowing, then the nerve cannot supply enough nerve impulses to keep the legs walking. This means that we need to sit down frequently to allow the nerve to recover so that we can then continue to walk.
Spinal fusion has been used more frequently recently to try to relieve the pressure on the nerve – but it frequently does not help.
The trouble is that however logical these procedures sound, they often do not help the patients’ symptoms, so why on earth would you put someone through a serious operation for so little reward?
The fact is that around one in five patients who have spinal fusion will have revision surgery within ten years.
What Should Be Done
There needs to be more research to investigate the value of these surgeries. At the moment, research is focussed on different ways to perform the surgery rather than whether they work.
Due to the fact that there is very little evidence that surgery helps, it was concluded that patients should consider other evidence based treatments such as chiropractic or other manual therapy, exercise therapy or cognitive behavioural therapy. They are just as likely to help without putting you through surgery that often does not help at all!
How Can We Help You?
We can help you with exercises, manual treatment of your back, advice on how to best perform activities of daily living; encourage you to be able to cope with the problem rather than let it rule your life. It may require a bit of effort on your part but if the results are the same as surgery and you haven’t had to undergo surgery with all its risks, it must be worth a bit of work, surely?