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Is Spinal Surgery Really Necessary - and Does It Work?

By Steven Hefferon, CMT, PTA, CPRS

 

There are only two groups of people who need to read this article: those who just got back from the surgeon's office and were told that surgery is the only option, and those who have had surgery that failed. In either case, you probably don't know what to do next.

Let me try to calm your nerves and offer an action plan. You see, I don't care what type of surgery you're considering or have already had. The question is not what condition you have but what caused it.

Barring trauma, our bodies are damn near perfect - and it's not by mistake. If you believe in God, you know He surely did not intend to create junk. If you believe in evolution, science has convinced you that most creatures adapt perfectly to their environment.

In nature, it's a simple fact that if you don't adapt, you die. But if you look at humans, what you see is that we just keep on doing what we are told to do or what we think we should be doing and, in time, we find a way to screw things up.

I'm not going to sit here and tell you that you should not have surgery or that the surgery you had was a mistake. I can assure you, however, that once you have surgery, everything changes. You will never be the same, even if the surgery is a success.

I consider it my duty to give you information you may not get from anyone else. What I'm about to tell you comes from years of hands-on work and conversations with thousands of people who have gone through the same thing you're going through. Funny thing is, everyone thinks his or her case is unique. But the questions, emotions, and physical conditions are more or less the same.

There are maybe a dozen or so types of surgical procedures for back pain, and all of them attempt to do one of two things: remove the pressure on the nerve or stabilize the spine. In my opinion, surgery is an extreme approach - again, if you don't include trauma.

Let's take a herniated disc, for example. You have pain because the disc is pressing on the nerve. You've been told by your doctor that the only thing he can do is remove the part of the disc that's touching the nerve. Your first thought probably is that this is good news. After all, here's someone who is going to take the pressure of the nerve - and then it's good-bye pain. Not so fast!

Here are some important things you should know - things that are not always made 100 percent clear ahead of time - as you ponder the surgery option:

1. Once the operation is completed, your body will go through a recovery process that includes a lot of pain and awkward movement just to get you through each day. This is going to be your first potential source of trouble. Because your body is having to contort itself, you'll be putting unnatural wear and tear on other areas of your body. As a result, you may begin to have problems above or below the surgery or in other joints such as the hips or sacroiliac (SI). This is similar to what happens to your tires when your wheels get out of proper alignment.

2. All surgeries produce scar tissue. But because back pain surgery occurs so close to nerves, the scar tissue often builds up and makes contact with a nerve, causing as much pain as if the disc itself were still putting pressure on the nerve.

3. Your most important consideration is going to be rehab. You see, the rehab you're likely to get soon after the operation is only going to address your postoperative pain. They will use soothing modalities and work with you to improve your functional skills and what are called "actives of daily living," which include bathing, dressing, going to the bathroom, and the like. This is fine and necessary so you can go home and be safe. But this type of rehab squanders a great opportunity to really help you.

Earlier, I told you that surgery is an extreme approach to back pain. While you're weighing your options, allow me to give you a short course on back pain.

It starts with understanding that all conditions have a cause and that failure to address the cause of the problem will lead to further complications. Going back to the wheel alignment analogy, ask yourself this: Is changing the tires going to solve the problem of uneven tread wear? The answer, of course, is no. The new tires will also experience abnormal wear and tear that, if left uncorrected, could lead to a catastrophic failure. This is why you have to deal with causes, not symptoms.

Most back pain conditions that are symptomatic have to do with something called "postural dysfunctions." Postural dysfunctions are similar to a car's tire being out of proper alignment. In the body, improper alignment is seen as abnormal curvature of the spine and abnormal positioning of the pelvis. The great news is that we know what cause these postural dysfunctions, and they are correctable.

To get our bodies back into balance - or proper alignment - so they can function normally again, we need to get our muscles back into balance. This little known principle is rarely acted upon by the traditional medical community - one, because it isn't taught in med school and, two, because the heath care system doesn't allow it.

One reason is that the insurance companies will only pay for getting rid of the symptoms ASAP. They don't care about your life struggles; they only care that you move through the health care system at minimal cost to them.

Here's what I would advise if you do opt for surgery: Demand that postoperative rehab addresses both short-term and long-term goals, meaning that it will not only include working on decreasing your pain so you can safely go home, but also that the physical therapist will identify any postural dysfunctions, including abnormal curvature of the spine and abnormal positioning of the pelvis. Insist that they explain how your muscles are out of balance, which muscle are strong or weak, flexible or tight in relation to each other.

Have them write everything down as part of your long-term goal and ask for a copy. Knowing that everyone has imbalances, tell them you need the following five points addressed.

This first consideration alone would prohibit 50% of the population from doing this stretch.

1. Which postural dysfunction did you identify?

2. How would you describe the curvature of my spine from top to bottom?

3. How would you describe the position of my pelvis (level or tipping)?

4. Can you please note for me, specifically, my muscle imbalances?

5. Please write down for me which muscles I need to stretch and which ones I need to strengthen; also, please explain what each muscle group does so I know I'm doing the correct set of exercises.

For those of you who are still considering surgery, I'd recommend finding a qualified therapist first and asking him or her the same five questions. Give yourself 60 days to work on stretching and strengthening before you decide whether or not to go under the knife.

I know it's hard to tell a physical therapist or a doctor what to do, but if you're reading this, they most likely did not do some or all of the things I've mentioned. If you eventually do decide to have surgery, understand that the number one reason why back pain sufferers fail to get long-term relief - and by that I mean more than five years - is that this very simple principle of muscle imbalances was not taken into consideration.

If what I just described about addressing the cause of your condition isn't enough to calm your fears and give you hope, I don't know what else I can say. Other than to suggest that you seek out the best of the best surgeons and ask for a reference list of people who had back pain surgery a minimum of five years ago.

One last word about outcomes. Back pain surgery is the only category of surgery that actually has a clinical term for failure - Failed Back Surgery Syndrome. All I know is that if I were considering this kind of surgery, I'd sure want to get a straight answer from my specialist as to why this is so. Good luck with that one.

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