Research: Surgeons too enthusiastic about offering spinal …

In our practice we often see patients who are in severe back pain. They have an MRI, X-ray and/or scan that shows an inaccurate picture of what is causing their pain. The MRI cannot show muscle spasms from a simple back strain which can cause excruciating pain. Conversely, the MRI can show a large herniated disc which may be completely painless. Yet that large herniated disc will send the patient to surgery. As you will read in the research below, this was considered unsupported enthusiasm for the surgical management of discogenic back pain. Now surgeons are publishing new data with a tempered enthusiasm.

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about degenerative disc disease using the contact form below.

The decision to perform surgery in patients with predominantly axial pain (low back pain caused degenerative disc disease) should be made with the understanding that many patients may not respond to the treatment.

April 2018,European journal of orthopaedic surgery & traumatology

In a study out of Greece, surgeons reassessed a few of the most commonly performed spinal fusion alternative surgical procedures.(1) Their reassessment surroundedadjacent level disease. This is advanced degeneration above and below the fusion site. The researchers of this study examinedmotion preservation surgical methods that were recently developed in order to overcome this complication.

(Motion preservation surgical methods) include total disc replacement, laminoplasty (cutting away of bone and other pressure causing material on the nerves), interspinous implants (spacers to hold nerve pathways open) and dynamic posterior stabilization systems (not a fusion but similar. This procedure allows controlled movement of the spine).

What is being said in the above research and the below research is, these surgeries may not be as helpful as doctors thought.

In an editorial from theDepartment of Neurosurgery, University of Virginia, doctors found: Without prospective trials with non-conflicted surgeons and standardized selection criteria, the true role for sacroiliac jointfusion procedures in the treatmentof chronic lower back pain will remain murky. The consequences of the unsupported enthusiasm for the surgical management of discogenic back pain still negatively impacts the public perception of spinal surgeons. 2

Enthusiasm they say from surgeons is not realistic. When the surgical outcome is poor, the patients are surprised. Researchers say patients should have been told upfront of the likelihood of complication

Journal of back and musculoskeletal rehabilitation, May 2017

Four to fifty percent of patients will developFailedBack Surgery Syndrome followinglumbarspine surgery. Repeated surgeries lead to escalating costs and subsequent decreases in success rate.

2016:University of Minnesotas Department of Orthopedic Surgery inClinicoEconomics and outcomes research:

The 60% may be considered an improvement over results found in other studies. In a heavily cited 2006 landmark study from the Schulthess Clinic in Zurich Switzerland, doctors reported on 17 patientswith chronic low back pain, with a positive response to specific diagnostic tests for sacroiliac joint dysfunction who a bilateral sacroiliacfusion procedure.

At the time of follow-up (on average 39 months after surgery),

In the August 3, 2016 edition of the New York Times, author Gina Kolata wrote:

Back to MRI assessment

Is MRI to blame? Doctors at the Leiden University Medical Center in the Netherlandsquestioned whether or not MRI has any value in determining sciatica treatment or diagnosisand why surgeons rely so heavily on the readings.(5)We often see patients who visited the doctor who had unsupported enthusiasm for sacroiliac joint dysfunction surgery because they had an MRI showing a herniation between the L5 and S1 vertebrae and a prognosis of impending surgery.

Spinal Fusion Alternative: Regenerative medicine for problems of the spine

In a new paper Japanese doctors came up with a scoring system to help clinicians determine if sacroiliac joint pain was originating from the posterior longitudinal ligament of the spine.

The ligaments are important as attested to by researchers atUniversity of Mississippi Medical Center. As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature.(7)

Why not get a consultation to see if the ligaments are the cause of your back pain before your embark on surgery?

The video below shows treatment of the low back with bone marrow derived stem cells. Compare this to surgery.

STEM CELL INSTITUTEA leading provider of bone marrow derived stem cell therapy, Platelet Rich Plasma and Prolotherapy in Los Angeles and the world!11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025PHONE: (800) 300-9300

1: Gelalis ID, Papadopoulos DV, Giannoulis DK, Tsantes AG, Korompilias AV. Spinalmotion preservation surgery: indications and applications. Eur J Orthop Surg Traumatol. 2018 Apr;28(3):335-342. doi: 10.1007/s00590-017-2052-3. Epub 2017 Oct 6. Review. PubMed PMID: 28986691.

2. Shaffrey CI, Smith JS. Editorial: Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.

3 Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. ClinicoEconomics and Outcomes Research: CEOR. 2016;8:23-31. doi:10.2147/CEOR.S97345.

4 Schtz U1, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg. 2006 Jun;72(3):296-308.

5.el Barzouhi A, Vleggeert-Lankamp CL, Lycklama Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group. Predictive value of MRI in decision making for disc surgery for sciatica. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.

6. Kurosawa D, Murakami E, Ozawa H, Koga H, Isu T, Chiba Y, Abe E, Unoki E, Musha Y, Ito K, Katoh S, Yamaguchi T. A Diagnostic Scoring System for Sacroiliac Joint Pain Originating from the Posterior Ligament.Pain Med. 2016 Jun 10. pii: pnw117. [Epub ahead of print]

7. Butt AM, Gill C, Demerdash A, Watanabe K, Loukas M, Rozzelle CJ, Tubbs RS. A comprehensive review of the sub-axial ligaments of the vertebral column: part I anatomy and function. Childs Nerv Syst. 2015 May 1.

Read the original:
Research: Surgeons too enthusiastic about offering spinal ...