The Catastrophe Index

The danger of falling into the “abyss” is that it makes chronic pain patients more vulnerable to the suggestion of surgery, which is often unnecessary.  Along with the possibility of surgery comes the risk of catastrophe. Here are a few examples. The cases of these patients are not unusual.

  • A 40 year-old fireman with a spinal screw that was inadvertently placed through his right 5th lumbar nerve root during a fusion for lower back pain. The screw caused severe nerve damage and left him with screaming, ongoing nerve pain down the side of his leg.
  • A 50 year-old physical therapist with his skull fused to his upper back for neck pain. Post-surgery, not only was his pain worse, he could not look up or down or rotate his head. Additionally, the plates eroded through the skin on the back of his skull.
  • A 40 year-old factory worker who became paraplegic after a massive disc rupture above a two-level lumbar fusion for lower back pain. Previously, he had undergone seven operations in five years with no significant pain relief.
  • An 18 year-old competitive athlete who lost flexibility in his back, including the ability to twist, after being fused from the middle of his spine to his pelvis. Surgery was recommended to address back pain and a minimal, normal curvature of his spine.

In each of these instances, there was initially no identifiable structural problem that could have been solved by surgery.

A common scenario I encounter is the successful result of a lumbar fusion being over-presented while the risks of the procedure are under-emphasized.  The risks may be mentioned, but comprehending the magnitude of living the rest of your life with a severely damaged spine, having to face surgery after surgery, requires a much different, deeper conversation.

My surgeries can result in complications like every other surgeon.  I just want you to be sure that the potential benefit of a given operation truly outweighs the potential risks. Many surgeons out there just want you to say “yes” so they can practice cutting. You need to seriously consider the possible outcomes of allowing them to.

JYR, BF