Back Surgery Can Back Fire
According to a new study, patients who had spinal fusion were less likely to return to work and needed more opiates. Experts estimate that nearly 600,000 Americans opt for back operations
each year. But for many, surgery is just an empty promise,
say pain management experts and some surgeons. A new study in the journal Spine shows that in many cases surgery can even backfire, leaving patients in more pain.
Researchers reviewed records from 1,450 patients in the Ohio Bureau of
Workers’ Compensation database who had diagnoses of disc degeneration,
disc herniation or radiculopathy, a nerve condition that causes tingling
and weakness of the limbs. Half of the patients had surgery to fuse two
or more vertebrae in hopes of curing low back pain. The other half had
no surgery, even though they had comparable diagnoses.
After two years, just 26 percent of those who had surgery returned to
work. That’s compared to 67 percent of patients who didn’t have
surgery. In what might be the most troubling study finding, researchers
determined that there was a 41 percent increase in the use of
painkillers, specifically opiates, in those who had surgery.
The study provides clear evidence that for many patients, fusion
surgeries designed to alleviate pain from degenerating discs don’t work,
says the study’s lead author Dr. Trang Nguyen, a researcher at the
University of Cincinnati College of Medicine.
For some patients, there is a legitimate need for spine surgery and
fusion, says Dr. Charles Burton, medical director for The Center for
Restorative Spine Surgery in St. Paul, Minn. “But the concern is that
it’s gotten way beyond what is reasonable or necessary. There are some
areas of the country where the rate of spine surgery is three or four
times the national average.”
Burton and others recommend that patients get a second opinion when
back surgery is recommended for the treatment of back pain without
neurological symptoms, such as sciatica, especially if other treatments
haven’t been suggested first.
“We are very successful at improving leg symptoms," says Dr. William
Welch, vice chairman of the department of neurosurgery at the University
of Pennsylvania Medical Center and chief of neurosurgery at
Pennsylvania Hospital. “We are less successful at treating back pain.”
The reason, Welch says, is that it’s often hard to pinpoint the exact
cause of someone’s back pain. Even MRIs can be misleading because
abnormalities, such as degenerating discs, can be seen on scans for
virtually everyone over the age of 30 regardless of whether they have
pain. Even when the surgery is a success, it rarely dispels 100 percent
of back pain, Welch says.
Article written by Linda Carroll, msnbc.com
Low Back Pain Blog
