New Study Reveals That Back Surgery Fails 74% of the Time

Editorial Commentary:

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 had actually 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 [1] 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. [2]

Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”

Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.

Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.

This new study in the journal Spine [1] shows that in many cases surgery can even backfire, leaving patients in more pain.

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. [3]


27 Million Adults With Back Problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, twenty-seven million adults reported back problems, with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned. [4]

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You may also want to review the recently published European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain, which specifically states: 

"Surgery for non-specific CLBP cannot be recommended unless 2 years of all other recommended conservative treatments — including multidisciplinary approaches with combined programs of cognitive intervention and exercises — have failed".

This study re-confirms the findings of the UK BEAM Trial, published in the British Medical Journal in 2004. [5] Those authors stated:

"Manipulation, with or without exercise, improved symptoms more than best care (medical care) alone after three and 12 months.   However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise" (page 1381). 

You may also want to read these 3 recent Editorials:

Why Do Spinal Surgery Rates Continue To Rise? 
Chiro.Org Blog ~ April 10th, 2010

New Study Finds Chiropractic Care Superior to Family Physician-directed Usual Care
Chiro.Org Blog ~ October 7th, 2010

If Not Chiropractic Care, Then What’s Your Alternative?
Chiro.Org Blog ~ September 25th, 2010

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REFERENCES:

1.   Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects: An Historical Cohort Study
SPINE (Phila Pa 1976) 2011 (Feb 15);   36 (4):   320–331

2.   Study Says Back Surgery Often Makes Things Worse
The Daily Hit ~ Oct 14, 2010

3.   Back Surgery May Backfire On Patients In Pain
MSNBC.com ~ Oct 14, 2010

4.   Why Do Spinal Surgery Rates Continue To Rise?
Chiro.Org Blog Editorial ~ April 10th, 2010

5.   Findings from the: “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial”
British Medical Journal 2004 (Dec 11); 329 (7479) 

Send all comments or additions to:    Frankp@chiro.org