SURGERY

SURGERY

INTRODUCTION

At the most basic level, all back pain is caused by damage to the nervous system. The nerves simply produce pain in response to a harmful event (thereby alerting the brain to the problem). The pain is detected by special receptors in the body, and then transmitted, usually via the spinal cord, to the brain.

At a structural level, back pain is caused by a number of different conditions. Some of the more common problems are listed below:

  • Bulging disc;
  • Herniated disc;
  • Direct, nerve-root impingement;
  • Spinal stenosis;
  • Spondylolisthesis;

All of these conditions lead to nerve-root impingement either directly or indirectly. For example, if the pressure on one of the intervertebral discs becomes too great it will, in all likelihood, start to bulge (by a fraction of a millimetre). This leads to pressure on the surrounding nerve fibres, resulting in pain.

The surgical approach to ‘solving’ these conditions is, quite frankly, brutal. For example, in cases where the intervertebral disc is either bulging, or herniated, the surgeon will remove some, or all, of the disc to lower the pressure on the nerve fibres, a procedure known as a Discectomy (disc-ectomy, pronounced disektomy).

But, in the absence of a disc, the spine will not function properly; it becomes unstable. To combat this, the surgeon performs a spinal Fusion, literally welding the two vertebrae (which previously surrounded the disc) together.

Other, common, forms of spinal surgery include IDET (Intradiscal Electrothermal Therapy) and Laminectomy.

IDET is used to treat small herniations by inserting a wire into the wall of the disc and then heating it to 90°C. This causes the wall (the annulus fibrosis) to thicken and contract, promoting closure. The heat also burns the small nerve endings within the disc wall, making them less sensitive.

A laminectomy is similar to a discectomy but instead of removing the intervertebral disc, part of the vertebra itself is removed (again, in an attempt to decrease the pressure on the surrounding nerve fibres). The part that is removed is called the lamina, hence the term laminectomy.

EFFICACY

Today, surgery is a widely accepted part of medical science. The techniques that are used are often very successful. It therefore seems logical that surgery on the spine should be no different. In terms of its clinical outcome, however, spinal surgery usually fails. The patient is frequently (if not invariably) worse off after the operation.

Even the surgeons admit that a high chance of failure exists so much so that Failed Back Surgery Syndrome is a recognised, and serious, condition amongst their patients (characterized by intractable pain and varying degrees of functional incapacitation).

Please take this advice seriously.Once you have had surgery, there’s literally no going back; the effects are 100%, completely irreversible.
Amongst other things, the high rate of failure can be attributed to the fact that surgeons focus their attention on the spine, when the cause of the problem is often not local. For example, if a patient has short-leg syndrome (where one of their legs is shorter than the other, typically by more than 5mm), it is quite common for them to experience back pain. Obesity is also an extremely common cause of back pain, but neither of these two conditions is solved by operating on the spine.

Indeed, most operations on the spine either aggravate the condition, or generate new ones. A fusion, for example, increases the stress on the spine because the normal range of vertebral motion is destroyed (the stress at the point of fusion is sometimes removed, but the overall load is increased, simply transferred to surrounding areas).

Surgery is also incredibly invasive. It is quite common for the surrounding muscles, ligaments and nerves to be damaged during an operation. By its very nature, surgery tends to limit the blood supply to these structures (ischaemia), and this heightens the risk of injury.

If the spinal nerves are damaged the effects are potentially very serious. For example, damage to the S1 nerve root can result in paralysis of the foot, a condition known as ‘foot drop’. On the other hand, damage to the nerve roots from S2-S4 may affect the bladder, bowel, or sexual organs. In all cases of nerve root damage there will be sensory or motor symptoms.

In addition to this, it is very common for the spine to become damaged in the months following on from surgery. The anatomical structures of the back are invariably traumatised by surgery to the spine; in addition to this, ischaemia can often be a permanent outcome of surgery, and bleeding and infection are also possible. All of these factors contribute to the formation of abnormal scar tissue, or adhesions, that literally stick two parts of the body together. This might not sound too bad, but adhesions are a major cause of post-operative pain, stiffness and crippling disability and they are often permanent.

CONCLUSIONS

In our opinion, the only spinal conditions that require surgery are:

  • Fractured, or broken, vertebrae;
  • Certain infections;
  • Cancer.

Otherwise, we strongly advise all of our patients not to undergo spinal surgery.

Instead, we believe the correct approach is to decompress, or mobilise, the spine using non invasive techniques that are based on Orthopaedic Medicine.

To receive non-invasive treatment, you can visit our Spine Clinic. You can also receive a Diagnosis filling the on-line Consultation Form. For those people who can neither afford personal treatment, nor make the trip to London, we recommend that you purchase a Backrack™.For those who wish to understand the risks involved in spinal surgery from people who have already undergone the procedure we recommend that you visit our Spine Guestbook page and/or directly our Patients’ Forum page.

PRICE

Approximately: £15,000 – £25,000 (depending on the procedure).

Usually paid by the NHS or private insurance; complications during/after surgery will result in additional cost.

X