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Back Off From Back Surgery

by Dr. Julian Whitaker

Published 04/30/09

At least four out of five Americans will experience low back pain at some point in their lives. Those who are fortunate will recover in a few days or weeks. However, some 40 million Americans-over 15 percent of our population-suffer from chronic back pain.

The financial costs associated with back pain are enormous. We spend over $24 billion a year on medications, visits to physicians, physical therapy, and surgery to treat our aching backs. Yet, for many people, the money, time, and effort invested in these remedies brings no relief.

Standard treatment for a slipped disc-a common cause of back pain-is surgical disc removal, an operation performed over 200,000 times a year. While this conventional approach may alleviate back pain, in the long run it can lead to more problems.

You see, once a disc is removed or a joint fused, the likelihood of other discs deteriorating is increased because of the added stress on the remaining discs. Most people rely on painkillers to cope, even after they've had surgery, which is a sure sign that conventional treatments don't address the real problem.

Why Surgeries Fail

Disappointing outcomes from surgery to relieve back pain are so common that there is even a name for this problem: failed back surgery syndrome. Failed back surgery syndrome can occur for many reasons:

• According to orthopedic surgeon Peter F. Ullrich, Jr., M.D., the most likely explanation is that the lesion that was operated on was not the cause of the patient's pain. This occurs more often than you might think. Other causes include nerve irritation, muscle strains, or injuries to bones or ligaments.

If the source of your pain is not in your spine, having surgery on a disc is unlikely to make any difference. Scar tissue forms in the nerve roots during the healing process. Unfortunately, there's no proven way to prevent this scar tissue, called epidural fibrosis, from forming. In most cases, epidural fibrosis causes no pain. For an unfortunate few, however, pain relief is short-lived, and pain gradually recurs during the weeks or months following surgery, as the scar tissue grows. If the disc was repaired rather than removed, the injury can recur.

• The surgeon may have failed to remove a fragment of disc or bone.

• The implant or fusion may have failed.

• And, of course, there is always the possibility of permanent nerve damage or injury during an operation.

The bottom line: Back surgery is a serious, invasive procedure. If you're considering surgery for a bulging or degenerated disc, make sure that all other possible causes of your pain have been ruled out. If you do decide to have surgery, choose a board-certified orthopedic surgeon who specializes in spine surgery rather than a general orthopedic surgeon.