Surgical Indicators for Low Back Pain
I recently read an article on the alternatives to surgery for back pain. The article discusses the cases of two men; Steve Pagani, a junior high principal, and David Fischer, an avid mountain biker. After suffering from back pain, both men sought the advice of Dr. Kenneth Light, a San Francisco orthopedic surgeon.
One was treated with physical therapy and medications, while the other underwent a successful disc replacement. According to Dr. Light, there are a couple of indicators for doing surgery;
- First, is the problem severe and life-altering?
- Second, can the surgeon trace the pain to a likely source?
I think there are others. In a prior article in CID Review described a study that provides early predictors of lumbar spine surgery after an occupational injury. The study, titled “Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State” appeared in the journal Spine. According to the study, the following items were associated with a reduced likelihood of surgery;
- less than 35 years of age,
- women,
- Hispanics, and
- those whose first provider was a chiropractor.
The authors (Keeney et al) concluded that there was a very strong association between the likelihood of surgery and the type of first provider that was seen. Of those individuals who initially saw a surgeon, 42.7% eventually had surgery. Reminds me of an old saying… “To the man with a hammer in his hand, everything looks like a nail.” Not surprisingly, only 1.5% of those who first saw a chiropractor had surgery. I ant to emphasize the obvious – chiropractors helped the patient enough so that the option of a procedure as invasive as surgery was no longer a consideration!
CID Review also posted about a list of surgical indicators in the case of low back pain.
Surgical Indicators for Low Back Pain
- progressive neurological deficits – the problem is getting worse,
- pain that prevents the patient from participating in normal activities – similar to the first indicator from Dr. Light,
- intolerable pain that has failed to respond to conservative treatments – Dr. Light says most lower back pain cases resolve themselves in the first three months with a combination of rest and medication,
- anatomical lesions – again, similar to that of Dr. Light, and
- a positive patient attitude.
Before any consideration for surgery, it should also be noted that the type of compensation also appears to make a difference to the outcome. In other words, those individuals who have “something to gain” from their injury don’t seem to do as well.
Since this post is about back surgery, I would like to suggest a book by Dr. David Hanscom, a spine surgeon at the Swedish Hospital in Seattle. The book is titled, Back in Control: A spine surgeon’s roadmap out of chronic pain.
via Blogger http://chiropractic-lane.blogspot.com/2013/07/surgical-indicators-for-low-back-pain.html
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