How do you know if back surgery is appropriate? Get a second opinion

A Second Opinion post on 10/21/2014.   Topics: 

back surgery

During any three-month period, about 25 percent of adults in the U.S. experience at least one day of back pain, making this ailment one of the most commonly reported health problems. If you experience back pain, getting an accurate diagnosis is the first step.

For most conditions that cause back pain, your doctor is likely to start with conservative diagnostics which most often are limited to a detailed conversation about the history of your pain and a thorough physical exam. X-rays and MRIs may be helpful, but only if there has been significant trauma or if there are symptoms and signs of nerve impingement. Even with an abnormal MRI, in most cases the initial treatment is conservative–exercise, medication, physical therapy or chiropractics. Some people require localized cortisone injections. The vast majority of patients responds to these measures and do not need surgery for pain relief.

Surgery can be beneficial for certain people who fail conservative therapy or who have significant nerve impingement that is likely to respond to surgical decompression. But surgery tends to be over-prescribed and many patients end up post-op no better than they were before. Unneeded surgery can lead to longer recovery times and surgical complications, not to mention unnecessary medical spending. If your doctor recommends back surgery, you should get a second opinion before deciding whether to have the surgery. Except in the most serious cases, you have time to try other therapies first; you are no worse off if they fail and much better off if you are pain free and have avoided an unnecessary surgery.

One team of scientists from the Albert Einstein College of Medicine and Columbia University suggested that persistent pain cannot be the only criteria used to prescribe surgery. In a paper published in Surgical Neurology International, they argued that, in cases when radiological scans find no abnormal results or when there are no neurological problems, no surgical procedure will be beneficial.

To get an idea of how often unnecessary back surgery is recommended, the researchers looked at 274 patients who were seen by one of the study’s authors, a neurosurgeon, and who had also consulted with other surgeons. If any of the outside surgeons suggested operating based only on back pain without neurological deficits and without significant abnormal radiological findings, the study authors recorded it as an unnecessary recommendation. Overall, 17.2 percent of patients received inappropriate advice to operate.

Although this single study cannot be taken to represent any nationwide trend, it is indicative of a problem that may exist in practices across the country. This is problematic because any back surgery comes with a risk of complications, which may include wound infections, nerve damage, bleeding, blood clots, stroke and pneumonia.

Back pain has several causes
The back consists of numerous muscles, the vertebrae that house the spinal cord and nerves, the disks that cushion the spaces between the vertebrae and the ligaments that connect the vertebrae. Back pain can be the result of illness or injury to any of these structures.

Causes can include:

  • Muscle spasms
  • Rupture or hernia of any intervertebral disks
  • Ligament tears or broken vertebrae from physical trauma
  • Arthritis
  • Osteoporosis
  • Infection
  • Tumor

Is back surgery really necessary?
There is a variety of non-surgical treatment options available to people with back pain. The choice of treatment will depend on what the cause of the pain is. For example, hot and cold treatments can alleviate muscle pain and inflammation, and physical therapy, exercise, chiropractics or local injections may help relieve the pressure caused by bulging intervertebral disks. Medications, including non-steroidal anti-inflammatories and nerve block injections, can also help with some types of chronic back pain. Typically, surgery becomes a more appropriate option when conservative treatments fail or the cause is a structural impingement that can be surgically decompressed.

If your doctors recommend back surgery, you’ll want to explore all options and make an informed decision. Getting a second opinion is essential to that decision. Talk to a health advisor, who can direct you to specialists to help ensure you receive an accurate diagnosis and understand the risks and benefits of all treatment options.


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