Patients who are in pain may consider low back fusion surgery because they believe that it may be the fastest and most reliable way to get out of pain and back to work and to a more normal life. That is a very wrong assumption according to a study by the Ohio Bureau of Worker’s Compensation published in a 2010 issue of the medical journal Spine.
The study was composed of patients with similar conditions who either received surgery (the experimental group) or received non-surgical care (the control group). The conditions of the patients included disc/spine degeneration, disc herniation, and/or radiculopathy (nerve pressure from the spine and/or disc}. Patients with these conditions experience back pain and restricted movement, often accompanied by muscle spasms and swelling. In addition, many had nerve compression which causes pain, numbness or tingling, weakness, impaired strength and poor reflexes in the lower body and/or the legs and feet. Nerve pressure may lead to the legs feeling unreliable and a tendency to stumble and possibly fall. After following the patients for 2 years, the researchers found that:
Non-surgically treated patients returned to work more than twice as often as the surgically treated patients. 67% of people treated without surgery were working while only 26% of surgical patients returned to work.
11% of the surgical patients became permanently disabled while only 2% of the controls did.
17 surgical patients died compared to 11 controls by the end of the study.
Pain was generally not relieved by the surgery and even increased. 76 % of surgical patients continued using potentially addictive opioid pain medication after surgery. Daily opioid use increased by 41% in the patients who received surgery.
Surgical patients lost 1140 days from work, while the non-surgically treated patients lost only 316.
This is why I advise nearly all of my disc, nerve pain and spinal degeneration patients to stay with a course of at least 3 months of regular flexion distraction, meningeal release and spinal adjustment treatments before considering spinal surgery. Improving the alignment and motion of the joints and decompressing the discs and nerves improves comfort and allows for better healing. Nerve pain and swelling are reduced because the nerves are decompressed when the joint and disc alignment and motion improve. In addition, first aid therapies applied in the office and at home can provide substantial relief to swollen nerves and joint capsules. Patients often begin to have significant relief within a few days or weeks of care. Nerves, discs and ligaments are fairly slow healing tissues compared to muscles and bones. They will take some time to heal and stabilize whether the treatment is surgical or non-surgical.
The body has a truly amazing ability to heal and to adapt when provided with the right types of care. I love what I do because I get to witness this miracle all of the time.
Remember that spinal fusion surgery is not a quick fix. Even the 24% -26% of surgical patients who eventually achieved pain relief and regained function required substantial time, often about 12 months, for rehab and healing. Irritated nerves can also be quite slow to heal. The final outcome may not be clear for over a year from any treatment. The mechanics of the entire spine including the neck are altered by spinal fusion and every joint and muscle in the spine must adapt. Pain may be worse after the fusion due to the new abnormal stresses on arthritic spinal joints, other weak or damaged discs, or other old spinal injuries.
This is the reason we say to use "Chiropractic First, Drugs Second, Surgery Last.".
There is a significant exception to this rule: people who are experiencing trouble controlling their bowels or bladder related to a spine problem. This is a serious sign. People with this condition need to be evaluated by a surgeon immediately.
Otherwise, begin with chiropractic. It is not unusual for us to see people who are not able to walk in on their own power at the first visit. These same people often are able to achieve lasting pain relief, improved function, and are able to return to work and recreation with few problems. Chiropractic care costs less, is safer, faster and provides a more reliable return to an active life. There is no better value or easier path to recovery.
