Are Too Many People Having Spine Surgery?
This spine surgeon thinks so and offers important cautions
As a veteran spine surgeon who focuses on calming the nervous system as a way to help alleviate chronic pain, I’ve witnessed a disturbing trend of major spine surgery being performed on spines that are normal. Surgery performed for questionable indications often causes problems far worse than the original problem.
“Normal” doesn’t mean that a 60-year-old spine looks the same as a 20-year-old spine. Aging discs between the vertebrae narrow down, lose water content and form bone spurs around the edges.
Degenerative Changes and Back Pain
It has been well documented that all of these changes are expected and cause loss of flexibility. By age 60, there is a 100 percent likelihood of having these degenerative changes — but that doesn’t mean suffering from chronic back pain. Research has shown that there is essentially no correlation between “disc degeneration” and “pain.” In fact, I believe the term “degenerative disc disease” is erroneous. It is not a disease. A better term would be a “normally aging disc.”
Research shows that meaningful pain relief two years after a spinal fusion for lower back pain is less than 30 percent. Even more worrisome is that the re-operation rate is around 20 percent within 11 years. Additionally, you may have worse pain after surgery. The medical term for this condition is “failed back surgery syndrome.” This is not a club you want to join — being part of this group means that you may well suffer crippling pain for the rest your life.
When Surgery Is the Answer
Unfortunately, many patients and medical professionals feel that surgery is the “definitive” answer or the “last resort.” But what people seem not to realize is that surgery is the definitive answer only if the anatomical abnormality causing the corresponding matching symptoms can be identified. Otherwise, surgery is not a choice at all.
How has the medical profession come to believe that a 25 percent success rate (which is what research shows for spine surgery for lower back pain) is not only acceptable, but considered the definitive solution? Why is this happening when the data also shows that we are operating on spines that are aging in an entirely normally, non-pathological way?
(MORE: 7 Back Pain Myths Busted)
There’s more. Numerous peer-reviewed research studies show the presence of anxiety, depression or personality disorders are strong predictors of poor outcomes of any treatment, including surgery. However, surgeons assess the mental state of their patients less than 10 percent of the time.
Surgeons cannot sort these issues on their own in the middle of a busy clinic. One study showed that surgeons are able to accurately assess the level of a patient’s distress only about 28 percent of the time, regardless of how long they’ve been in practice.
The Case of the Dental Hygienist
Recently, I evaluated a young dental hygienist who came to my office complaining of neck pain on her right side. It is well known that muscular neck pain is an occupational hazard for people working in the dental profession; the prolonged bent-over and leaning postures are a problem. Her neck MRI showed mild degeneration of her lower discs that were well within normal for her age.
She was also experiencing increasing anxiety consistent with working full-time and being the mother of a couple of young children. I asked her why she had come to see me for a problem that was obviously non-surgical; she told me that she was seeking a second surgical opinion, since another spine surgeon had recommended a two-level fusion of her neck.
This is not an uncommon occurrence. I see variations of this story every day I am in clinic. Major procedures are frequently being recommended and performed after just one clinic visit on normally aging spines.
What to Consider Before Choosing Surgery
I believe it is critical to make a thoughtful decision, since the risks and potential downside of any spine surgery are significant. Consider the following when considering elective spine surgery:
- Do not make a surgical decision your first visit.
- Understand the nature of pain and take charge of your own care.
- You should be getting seven to eight hours a sleep a night for at least three months. Medications are often needed. Lack of sleep adversely affects your perception of pain, as well as altering your judgment.
- Your anxiety should be actively assessed and treated. Beware if you think you do not have anxiety or anger. Chronic pain almost always induces frustration, and you may not be connected to it.
- Pain medications must be stabilized. High dose narcotics alter the nervous system.
- Understand that neck or back pain often does not resolve with surgery. Be aware of exactly which symptoms are being surgically addressed.
In my opinion, surgery is always just part of the solution and never the definitive answer. Addressing your physical conditioning and central nervous system are equally important. Surgery permanently alters the structure of your spine. Make this decision very carefully, with a clear mindset and taking full responsibility for your care.
Dr. Hanscom is an orthopedic spine surgeon at Seattle Neuroscience Specialists with Swedish Medical Center in Seattle, Wash. He specializes in complex spine problems in all areas of the spine. He is the author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain.