Risks vs Benefits of Spinal Surgery

The public perception of the Art of Medicine is highly influenced by many factors. For example, I come across individuals on a daily basis that think real world medicinal practice is the same as it is on television. On television medical dramas, five minutes into an episode and the doctors come up with an obscure diagnosis that would have taken “real life medicine” three to six months to diagnose, let alone finish any sort of treatment. The TV docs heroically manage to pull off a cure before the end of the episode.

The long and short o it is that symptoms like back pain and headache are extremely common. It is almost impossible to draw a definitive diagnosis based on one type of symptom alone, particularly involving the most common complaints.

People seem to associate back pain with some type of surgical solution. In fact, the statistics are interesting– Of all the people that have had back surgery for the purpose of relieving back pain, only one third of these patients report symptomatic improvements post surgery.

For example, let’s consider an individual suffering from vertebrogenic backache, meaning the back pain is due to issues within the bony vertebra of the spine.

Vertebrae stack like cinder blocks, and they are intended to stack and balance evenly on each other.However, cinder blocks are not solid, and neither are vertebrae. The cells of open space within a cinder block are what gives the block strength. They are stronger being hollow than if they were solid. The vertebral structure in the human back functions in the same way. Each piece, each vertebrae, is built upon the one below, much like a stack of cinder blocks with holes in them— However, the porous structural elements in vertebrae also provide the protective gateway housing the spinal cord. The areas of the spine wehre the nerves travel through the vertebrae, or the posterior portion, is the portion of the spine that requires support from surrounding spinal structures in order to maintain desired function. In the spinal column, areas providing some type of support and/or protection serve an intended purpose. The intricate inner-workings of the spine, and the countless structures therein, do not exist and function by accident, or without intended function.

When surgery is done on the back, important structural elements are being chipped away. A simple laminectomy reduces function of one-half of the spine’s support system. Increased flexibility of the spine is a common by-product of having a laminectomy, and flexibility is not always a good thing. The spine does have to be flexible enough to give a little with the weather, so to speak, but having it fall over lacking sufficient rigidity or support, is not a happy ending.

Arthritis, the formation of bone spicules above and below a joint, is the condition that often leads to surgery Number 2, often called a “fusion.” Surgical laminectomy leads to eventual surgical fusion of the spine, which then leads to fusion at higher and lower levels.

The better surgeons avoid doing fusion procedures all together, but there are inexperienced surgeons out there willing to perform whatever surgery is asked of them. What the more experienced surgeons know, is not to operate on a back due to symptoms of pain alone.

Operating on someone to fix their back pain is a lost cause– Without fail, surgery will cause more pain, and more issues down the line. Sometimes this pain is different in nature, but sometimes it is much worse.

The only reason to operate on a spine is to regain natural ability, or to prevent the loss of function. Only in these special case scenarios, is spinal surgery a reasonable alternative; Ambulation with pain is better than no ambulation at all.

How can you determine if an individual’s back pain is actually originating in the nerves located in the back itself? Disc injuries are not the only culprit that causes back pain. The human body is composed of seventy percent muscle, meaning the origin of the pain is more likely to be muscular in origin than nerve related.

Having backache as a symptom does not always mean that is the actual location of the problem. Kidney infections can manifest symptoms of backache, as well as prostatitis, hepatitis, pancreatitis, and/or the presence of kidney stones. All  of those disorders can manifest symptoms including chronic back pain even though that is not where the problem lies.

Back pain as a symptom is often the reason doctors order tests such as MRIs or CAT scans for their patients. The results of such tests can be misinterpreted and lead to unnecessary surgeries being performed. Because MRI and/or CAT scan findings do not imply causality, surgery should not be the default treatment based solely on those particular tests.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.