Are You Kidding Me?

Patients and physicians are not making logical or reasonable decisions regarding spine surgery. I have watched this phenomenon for almost 30 years and it’s getting disturbingly worse.

 

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To solve a problem in the mechanical realm you must specifically identify it before you can fix it. The same holds true in your body except you have the added dimension of pain. Somehow, this premise is not sinking in with many surgeons.

In order to feel pain, a pain impulse must exceed the pain threshold. It doesn’t matter whether the signal arises from inflammation, bone spur, infection or a prior pain pathway. However, the only scenario that would make surgery an option is if you can identify the anatomical abnormality causing the matching symptoms. Avoiding Surgery by Raising the Pain Threshold

Sciatica Without a Cause

I was recently on the phone with a gentleman who had felt pain down his leg for almost a year. Because the symptoms were so classic I was sure that surgery was the answer. I ordered a myelogram followed by a CAT scan of his lumbar spine and was surprised to find the results showed a totally normal spine. There was no blockage to the flow of the dye in the nerve roots, which means that there was not any mechanical compression.

Certain that surgery was not the answer to his pain, I gave him my book plus the link to my website and explained that it outlined a framework of care so he could organize his own healing. When I called him a few days later, he told me he was declining my suggestions for a non-surgical remedy. He had already done “pain management,” and was going to have the surgery offered by a local surgeon. The surgery was being done to decompress a nerve that was not compressed. He had not looked at any of the tools I suggested that could stimulate the brain to create new healing pathways.

Phantom Surgery

Think about this. Why was a surgeon offering to perform surgery when he couldn’t identify the source of the problem? There isn’t a shred of evidence that says that this is a good idea. None. If the surgeon had offered this option while sitting for his oral board examination for neurosurgery, he would have been automatically failed for giving a dangerous answer. Yet in practice, he or she can do whatever they want and patients tend to trust their doctors. Video: Get It Right the First Time

 

Second, it’s been demonstrated in multiple research studies that any uncomplicated surgical procedure can induce chronic pain as a complication of the procedure. (1) These are surgeries performed for straightforward problems such as hernia repairs or gallbladder removals. The risk is as high as 40% for having unrelenting pain for up to a year and 5-10% of the time it is permanent. I don’t believe I have ever heard a surgeon mention this possibility as a complication. The risk factors include depression, anxiety, and pre-existing chronic pain. The chances of making him worse are higher than making him better. Am I Operating on Your Pain or Anxiety?

Third, why should he take the word of one surgeon who gets paid well to perform surgery without really checking this out in depth? Patients often seem to put in less time making a decision about proceeding with surgery than they do doing the research on buying a car.  A large part of my practice is spent performing surgery to salvage prior surgery. In the majority of the cases the original operation should not have been done. He’s headed down this same path. Why is it OK for the medical profession to offer him an operation without any basis?  Know Your Surgeon – Before Surgery

 

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Fourth, surgery always carries risks – even the simplest of them. I will never forget the story of an airline pilot who had cut a tendon in his finger with a wine opener. An anesthetic technique was used that numbs up the entire arm. The tourniquet broke that was intended to hold the IV anesthetic within his arm. As the medication entered the rest of his body it stopped his heart and he died. Patients somehow think a complication will not happen to them. You’re wrong. They happen and they’re unpredictable. I’ve witnessed every possible complication of spine surgery and over 30 years of performing surgery have had most of them occur in my patients.

Fifth, why’s it so hard to understand that when you are under stress that your body secretes stress hormones such as adrenalin and cortisol? These chemical reactions lower your pain threshold. (2) The logical solution is to calm down your nervous system, de-adrenalize your body and the pain threshold will return to its normal level. Adding on the additional stress of surgery is the wrong answer.  Anxiety, Anger, and Adrenaline

Surgical Patients Avoiding Surgery

We presented a paper in Argentina that documented 37 patients with severe structural spinal problems whose pain resolved without surgery. They had diligently engaged in the concepts that calm down the nervous system that are outlined on this website. When they came in for their final visit to finish the preparations for surgery, the pain had resolved and they cancelled their case. All of them had obvious severe structural problems that would have done well with surgery. But why undergo surgery when there are no symptoms? So, I am watching these patients dramatically improve while I am also observing multiple patients having surgery done or recommended on normally aging spines. DOC – A Framework of Care

Why did he not engage in these simple concepts to create the neurological shift that consistently happens? All of us who utilize these strategies feel that over 80% of patients will respond at some point. What’s the risk of learning about pain, getting better sleep, doing a little writing and meditating? None. We have witnessed hundreds of patients significantly improve or become pain free. The major obstacle to healing is simply a patient’s willingness to engage.

What about your life? I am seeing a high percent of patients that have experienced major losses about the time his or her symptoms began. The hits are huge such as loss of a job, retirement, death of a spouse or child, etc. What is your life like? Do you really think you can make a rational decision in the face of a high level of adversity? Almost all of my patients have quickly seen the link between pain and stress. You’re also vulnerable to suggestion when under crushing stress.

Surgery on a normal spine

An East Coast colleague sent this set of films to me. This is a lumbar MR of a middle-aged woman with back pain. This is a normal scan for her age and actually better than most. There is good maintenance of the disc height and minimal degeneration. Additionally, it’s well documented that disc degeneration is not a source of back pain. A better term for “degenerative disc disease” would be “normally aging discs”. She is also markedly overweight. I don’t know any details of her non-operative care. It doesn’t matter because this not a spine that warrants surgery. There is no identifiable source of pain.
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For reasons that are unclear, she underwent a prolonged surgery with enough blood loss that she ended up in the intensive care unit. This isn’t a great film but you can see the hardware in her spine from having a two-level fusion from her 4th lumbar vertebra to the sacrum. The chances of this surgery solving her pain long-term is less than 10% in light of the fact she isn’t in good physical shape. As mentioned above, the chances of making her pain worse are 20-40%. (1) There is a high chance of a wound breakdown with her being so overweight. There is also the long-term issue of her spine breaking down at the top of the fusion. The estimated cost of the surgery is between 50 to 100 thousand dollars.

 

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Buyer Beware

Right now, the world of medicine is playing a dangerous game with you. You’re being offered procedures for problems that don’t exist and no data to support them. It’s been documented in over a 1000 medical articles that anxiety and depression are major factors in predicting a poor surgical outcome. Yet another recent paper showed that less than 10% of surgeons are assessing them before making a decision to perform surgery. (4) Often an operation is offered on the first visit.

Several metaphors come to mind while pondering this scenario. One is playing the game of charades. Or what about the Wizard of Oz? Another that comes to mind is the famous tale of “The Emperor Has No Clothes”. Physicians are smarter than this and so are you. What’s going on? Medicine has got to clean up its own act and it’s a discussion well beyond the scope of this article. In the meantime, you need to wake up and take responsibility for your own life and health. You may be walking into a Venus Fly Trap.

 

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I’m seeing surgeries being performed or recommended on normal spines every week. Are you kidding me? Where’s our medical profession headed?

  1. Ballantyne J, et al. Chronic pain after surgery or injury. IASP (2011); 19: 1-5.
  2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience(2011); 185: 166-173.
  3. Boden SD, et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.” J Bone Joint Surg (1990); 72:403– 8.
  4. Young AK, et al. “Assessment of presurgical psychological screening in patients undergoing spine surgery.” Journal Spinal Disorders Tech (2014); 27: 76-79.