There is a time and place for surgery. I think few would argue this point. But I have seen patients have imaging, injections and surgery for cases that never should’ve been considered a surgical case.
Of course, whether or not they are a surgical case is merely my personal opinion. Since I’m NOT a surgeon, and I’m JUST a chiropractor, I could not even begin to know which cases of low back pain are or are not surgical cases. Given something as invasive, dangerous and permanent as spinal surgery, surgeons are the ones that can do the tests to definitively know whether or not a patient’s low back pain is surgical or not.
Spinal fusion involves slicing into the tissues surrounding the spinal column and then using either a special cement or titanium hardware to lock two (or more) spinal segments together so that they no longer move. The costs are staggering and the recovery, from the patient’s standpoint, is a major deal.
Again, good thing the surgeons can tell when someone needs surgery or not by doing the correct tests.
Ok. So you know where this is going. This particular study looked at just how accurate commonly used tests were at determining whether or not someone was going to have a good outcome from a spinal fusion for low back pain. Specifically, researchers looked across 10 studies to see whether these tests were actually useful:
- Findings on MRI
- Provocative discography (an irritant is injected into the disc; if it hurts, that must be the problem)
- Facet joint blocks (the spinal joints are injected with an anesthetic; if it helps, that must be the problem)
- Orthosis immobilization (using a brace to immobilize the lumbar spine; if it helps, the area needs to be fused)
- Temporary external fixation (a temporary metallic brace is screwed into parts of your vertebrae)
So what did the authors say after looking at all these tools to determine is lumbar spinal fusion was going to have a good outcome?
No subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.
In other words, it’s a crap shoot.
The bottom line is that, if surgery has been recommended to fuse your lumbar spine and the surgeon looks you in the eye and says he or she is confident this is the right thing to do, it’s time to find another one. Before you go on to surgery, have you REALLY tried everything? Has chiropractic been used? Soft tissue treatments like Graston, ART or Fascial Manipulation? Yoga? Massage? Rehab?
If you can’t answer yes to ALL of the above, it’s not time for surgery. Surgery should be the absolute last possible option that you should consider because no one can predict the outcome for your situation.