Back Surgery: Too Many, Too Costly and Too Ineffective

By J.C. Smith, MA, DC

There’s an 80 percent chance you’ll suffer back pain during your lifetime, for which your medical doctor will likely recommend over-the-counter pain medication or prescription medication to relieve the pain temporarily.

Depending on your doctor’s assessment and how you respond, they may even consider you a candidate for spine surgery at some point, an increasingly likely (and dangerous) option.

Then there’s chiropractic, which research and experience show is the safest, most effective option for most cases of back pain. Unfortunately, too many people end up in a medical doctor’s office instead of a chiropractor’s office, which accounts for the rampant use of medications and surgery for back pain, particularly here in the U.S. Here’s why back surgery – and medical management of back pain in general – is too frequent, too costly and too ineffective, and why chiropractic care should be your first option when dealing with back pain.

Too Many, Too Costly

Research suggests that of the 500,000-plus disk surgeries that are performed annually (a significant increase of late), as many as 90 percent are unnecessary and ineffective. Richard Deyo, MD, a professor at Oregon Health and Science University, notes, “It seems implausible that the number of patients with the most complex spinal pathology [has] increased 15-fold in just six years” and mentions one strong motivation includes “financial incentives involving both surgeons and hospitals.”

broken backA study conducted by Deyo and Cherkin in 1994compared international rates of back surgeries and discovered that the rate of American surgery is unusually excessive and directly attributed to the supply of spine surgeons: “The rate of back surgery in the United States was at least 40 percent higher than any other country and was more than five times those in England and Scotland. Back surgery rates increased almost linearly with the per-capita supply of orthopedic and neurosurgeons.”

On the Top 10 list of diseases in America, “back pain” stands at number eight, which according to Forbes.com costs over $40 billion annually for treatment costs alone. Other estimates that include disability, work loss and total indirect costs range between $100 and $200 billion per year. Back pain sent over 3 million people to emergency rooms in 2008 at a cost of $9.5 billion, making it the ninth most expensive condition treated in U.S. hospitals.

What accounts for these staggering costs? We know one thing: Doctors and hospitals are making huge profits off the backs (no pun intended) of unsuspecting patients who are not told there may be better and cheaper ways to solve their back pain with chiropractic care or other non-invasive methods. Back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications. Just take a look at these per-surgery costs for various types of back surgeries:

  • Anterior cervical fusion: $44,000
  • Cervical fusion: $19,850
  • Decompression surgery: $24,000
  • Lumbar laminectomy: $18,000
  • Lumbar spinal fusion: $34,500

Dr. Deyo found the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter. When combined with surgical costs, medications, magnetic resonance imaging (MRI), rehabilitation and disability, the average spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion and $112,000 for a cervical fusion.

Fortune 500 companies spend over $500 million a year on avoidable back surgeries for their workers and lose as much as $1.5 billion in indirect costs associated with these procedures in the form of missed work and lost productivity, according to a two-year study by Consumer’s Medical Resource (CMR). The study, “Back Surgery: A Costly Fortune 500 Burden,” found that one out of three workers recommended for back surgery said they avoided an unnecessary procedure after being given independent, high-quality medical research on their diagnosed condition and treatment options. In addition, patients who refused surgery and opted for alternative and less invasive procedures to treat their back pain reported experiencing healthier and more personally satisfying outcomes.

Too Ineffective

Back surgery “has been accused of leaving more tragic human wreckage in its wake than any other operation in history,” according to Gordon Waddell, MD, director of an orthopedic surgical clinic for over 20 years in Glasgow, Scotland.

“Low back pain has been a 20th century health care disaster,” said Waddell. “Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem.”

 

In 2010, 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 the hopes of resolving their low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, only 26 percent of those who had surgery had returned to work, compared to 67 percent of patients who did not have surgery. Of the lumbar fusion subjects, 36 percent had complications and 27 percent required another operation. Permanent disability rates were 11 percent for patients undergoing surgery, compared to only 2 percent for patients who did not undergo surgery. In what might be the most troubling finding, researchers determined there was a 41 percent increase in the use of painkillers, with 76 percent of surgery patients continuing opioid use after surgery. Seventeen surgical patients died by the end of the study.

Surgical Hand with ScalpelThe study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs do not work, according to the study’s lead author, Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine. His study concluded: “Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a workers’ compensation setting is associated with a significant increase in disability, opiate use, prolonged work loss, and poor return-to-work status.”

Commenting on the procedure in general, Dr. Nguyen said, “The outcomes of this procedure for degenerative disc disease and disc herniation make it an unfortunate treatment choice.”

In 1994, the conducted the most thorough investigation into acute low back pain in adults and came to the following conclusion in its Patient Guide: “Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back pain problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”

In his 2009 article, “Overtreating Chronic Back Pain: Time to Back Off?” Dr. Deyo speaks of the shortcomings of medical spine treatments in the U.S.: “Jumps in imaging, opioid prescriptions, injections, and fusion surgery might be justified if there were substantial improvements in patient outcomes. Even in successful trials of these treatments, though, most patients continue to experience some pain and dysfunction. Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels.”

Dr. Deyo is not alone in his call for reform in spine care. The editors of The Back Letter, a newsletter from the Department of Orthopedic Surgery at Georgetown Medical Center in Washington, D.C., agreed with his frustration:

“The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate … There is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedical screws to fusion cages to artificial discs – there is little evidence that patient outcomes have improved … Many would like to see an entirely new research effort in this area, to see whether degenerative disc disease and/or discogenic pain are actually diagnosable and treatable conditions.”

Chiropractic: The First Option for Back Pain

According to Pran Manga, PhD, a health economist, “There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management.” He is not alone in his assessment. Numerous international and American studies have shown that for nonspecific back pain, manipulation is heads above all other treatments. In fact, Anthony Rosner, PhD, testifying before the Institute of Medicine, stated: “Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”

Chiropractic care not only has catapulted to the top of the list for back pain care; chiropractic patients are also extremely positive about their treatments. TRICARE, the health program for military personnel and retirees, evaluated patients’ response to chiropractic care.

The enormously high patient satisfaction rates astounded the TRICARE administrators, with scores that ranged from 94.3 percent in the Army. The Air Force tally was also high, with 12 of 19 bases scoring 100 percent; and the Navy also reported ratings in the 90 percent or higher. Even the TRICARE outpatient satisfaction surveys (TROSS) rated chiropractors at 88.54, which was 10 percent “higher than the overall satisfaction with all [health care] providers.”

T.W. Meade, MD, of the Wolfson Institute of Preventive Medicine in London, surveyed patients three years after treatment and found that “significantly more of those patients who were treated by chiropractic expressed satisfaction with their outcome at three years than those treated in hospitals – 84.7 percent vs. 65.5 percent.”

The Treatment of Choice

The truth is now emerging. There is broad agreement internationally that surgery should not generally be considered until there has been a trial of conservative nonsurgical care. Here are a few of the many examples supporting chiropractic’s use as the first-line treatment for back pain:

Dr. Manga conducted two studies in the 1990s and noted, “There should be a shift in policy now to encourage the utilization of chiropractic services for the management of low back pain, given the impressive body of evidence on the effectiveness and comparative cost-effectiveness of these services, and on the high levels of patient satisfaction.”

An editorial in the Annals of Internal Medicine published jointly by the American College of Physicians and the American Society of Internal Medicine in 1998 noted that “spinal manipulation is the treatment of choice”: “The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain … Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.”

William Lauerman, MD, chief of spine surgery and professor of orthopedic surgery at Georgetown University Hospital, stated: “I’m an orthopedic spine surgeon, so I treat all sorts of back problems, and I’m a big believer in chiropractic.”

Dr. Deyo has mentioned chiropractic as a solution: “Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems.”

Dr. Waddell also suggests chiropractic care as a solution: “There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute low back pain.”

And Jo Jordan, PhD, has written that spinal manipulation may be the “lone ray of light” for back pain treatment.

Be Safe, Not Sorry

In 2006, doctors performed at least 60 million surgical procedures of all types; one for every five Americans. No other country does nearly as many operations. Not only are surgeries rampant, but many are being shown to be ineffective and dangerous.

According to Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, medical care is now the third-leading cause of death in the U.S., causing 225,000 preventable deaths every year as tools to make them safer go unused.

So, what’s the take-home message? Most people experience back pain, and much more often than not, it’s caused by something that doesn’t require extreme intervention, like a tumor, fracture, infection, etc. When back pain strikes, chiropractic is a great first choice, but too many people end up taking medication – or even worse, they end up in a vicious cycle of medical care that eventually can lead to the operating room – for back pain that could have been managed conservatively in the overwhelming majority of cases. That’s something to think about the next time your back hurts.

Article from: http://www.toyourhealth.com/mpacms/tyh/article.php?id=1447


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Ice and Heat Therapy

In many cases, temporary pain and even additional injury can be minimized and even avoided by a simple application of ice. Ice, applied in a timely manner and in an appropriate way, can reduce inflammation. Inflammation left unchecked can allow the source of the pain to continue doing damage to muscles, ligaments, tendons, and other structures.

Ice causes the veins in the affected tissue area to constrict. This reduces the flow of blood while acting as kind of anesthetic to numb the pain. But when the ice is removed (and this is key), the veins compensate by expanding, which then allows a large volume of blood to rush to the affected area. The blood brings with it important chemicals that aid in the healing process.ice application

Back and neck injuries frequently involve muscle sprains and strained ligaments, which can spasm and become inflamed.

Ice massage, or cryotherapy, is effectively used to treat many kinds of injuries, including those associated with back or neck pain.

Ice massage can provide a number of benefits, including:

  • Assisting the body in minimizing tissue damage
  • Mitigating muscle spasms
  • Reducing or eliminating pain by numbing sore soft tissues

Ice therapy is not recommended as a form of treatment for any kinds of rheumatoid arthritis, Raynaud’s Syndrome (a circulatory disorder of blood vessels of the extremities), colds or allergic conditions, paralysis, or areas of impaired sensation.

 

While ice therapy is used to reduce swelling, heat therapy is used to relax the muscles and increase circulation. Both kinds of therapy help reduce pain.

Heat therapy is often used in patients who have chronic or long-lasting pain. Heat therapy can involve many kinds of methods, from simple heating pads, wraps, and warm gel packs, to sophisticated techniques, such as therapeutic ultrasound.

Back injuries can create tension and stiffness in the muscles and soft tissues of the lumbar region, or lower back. In many cases, your circulation may be impeded.

The tension in the muscles can sometimes escalate to spasms.

Heat therapy:

  • Dilates the blood vessels of the affected muscles, allowing them to relax and begin healing.
  • Helps lower discomfort by reducing the amount of pain signals going to the brain.
  • Increases the ability of your muscles to easily flex and stretch, thereby decreasing stiffness.

Heat therapy, as well as ice therapy, are normally parts of an overall chiropractic treatment plan and rarely accomplish maximum results without it.

Heat therapy is not used on swollen or bruised tissues, or in patients who have dermatitis, deep vein thrombosis, diabetes, peripheral vascular disease, open wounds, and cardiovascular conditions such as hypertension.

 

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What Your Spine Says About Your Health

By Perry Nickelston, DC, FMS, SFMA

January, 2012 (Vol. 06, Issue 01)

You may have heard the saying, “the eyes are the window to the soul.” There is another saying in the world of chiropractic, “your spine is the window to your health.” How can the condition of your spine divulge so much information about overall health? Your spine is the central support column of your body and its primary role is to protect your spinal cord.

Think of it like the foundational frame of a house holding everything together. If the frame becomes dysfunctional many problems will begin to manifest themselves. The house begins to develop cracks, shifts, and structural problems. When your spinal foundation becomes dysfunctional you develop aches, pains, injuries, and other health related issues. The good news is you can do a simple spinal health checklist to determine if you may benefit from the expert intervention of a chiropractor or other healthcare professional. Becoming familiar with simple spinal anatomy, structure and function will help empower you to take control of your health. spine_stnd_37700_1_1_3740

Your spine is composed of 24 bones (vertebrae); 7 in the neck (cervical spine), 12 in the middle back (thoracic spine), 5 in the lower back (lumbar spine) and the base tailbone (sacrum). Your soft spinal cord is encased inside these 24 moveable hard vertebrae to protect it from injury. Your spinal column has three natural curvatures making it much stronger and more resilient than a straight design. There are cervical, thoracic, and lumbar curves designed with precise angles for optimum function. However, these curves are different than the abnormal curves associated with scoliosis and postural distortions. You may remember getting screened in school or your doctor for scoliosis when they had you bend over and touch your toes. This was an early checklist for spinal abnormalities. Through life’s stresses, genetics, trauma, injuries, and neglect the spine can develop dysfunctions in these curvatures and the body must compensate by changing posture as a protective mechanism.

What are some of the compensations your body develops and what can they tell you about spinal health?

Rounded Shoulders: This is a very common postural distortion resulting from more sedentary lifestyles. Hunching over in front of a computer screen hours on end simply feeds this dysfunction. This poor posture pattern adds increased stress to the upper back and neck because the head is improperly positioned relative to the shoulders. Common effects are headaches, shoulder, pain, neck pain and even tingling and numbness in the arms because of nerve compression by tight muscles.

Uneven shoulders: One shoulder higher than the other is indicative of a muscular imbalance or spinal curvature. You probably see this one on most people where one shoulder is migrating up towards the ear. Stand in front of a mirror and you can easily see if this asymmetry is present. You may also notice that one sleeve is longer than the other when you wear a shirt. This asymmetry is a common precursor for shoulder injuries, headaches, neck pain, elbow injuries and even carpal tunnel syndrome (tingling in the hands).

Uneven hips: Hips that are not level are like the foundation of a house that is not level. You begin to develop compensations further up the body so you remain balanced when walking. You develop altered spinal curvatures, shoulder positions, and head tilts. Your body has one primary purpose of maintaining symmetry and balance and it will do it whatever way is necessary. Signs of unbalanced hips may manifest in abnormal shoe wear typically on the outside edges and pants will fit unevenly in the leg length.

When you visit a chiropractor for a spinal evaluation some of the things they will search for during your evaluation are underlying signs of spinal damage that you can’t see. Spinal x-rays are a safe and effective way to get look at your spine for damage or potential problems. Just like a dentist takes an x-ray of your teeth to see if you have cavities or problems with the bones below gum line. If problems are detected, corrective or preventive measures can be implemented to help your body function at optimum.

Degenerative Disc Disease (DDD): This is not a real disease in the terms of how we think of them. DDD is term used to describe degeneration and excessive wear on the soft tissue disc structures between the spinal bones. It may come with age or from biomechanical asymmetries in movement causing excessive wear from overuse. Sort of like uneven treads on a car with imbalanced tires, one may be worse than the other. Although the degeneration cannot be reversed, once discovered there are strategies your chiropractor can implement re-balancing exercises and therapies to help prevent further damage.

Osteoarthritis: The breakdown of the tissue (cartilage) that protects and cushions joints. Arthritis often leads to painful swelling and inflammation from joints rubbing together. The increase in friction causes a protective pain response and excessive swelling where the body attempt to add artificial cushioning via swelling.

Herniated disc: A herniated disc is an abnormal bulge or breaking open of a protective spinal disc or cushioning between spinal bones. Patient’s may or may not experience symptoms with a herniated disc. Disc diagnosis is conformed via a special imaging study called an MRI (\Magnetic Resonance Imaging) which observes soft and hard tissue structures. You cannot see or confirm a suspected disc herniation via normal spinal x-rays.

Spinal stenosis: The narrowing of the spinal canal the open space in the spine that holds the spinal cord. Stenosis is a more severe form of arthritis that typically causes radiating (referred pain down the arms or legs) from an irritated or compressed spinal nerve.

If you experience spinal pain, tingling, numbness, weakness, muscles spasms or swelling near your spine or arms and legs consult a healthcare professional. These are all warning signal signs from your body that something is wrong and needs your attention. Pain is how your body communicates its function with you. A car has dashboard warning lights that tell you when the car has a problem. If you chose to ignore the signals bad things are going to happen. Your body has its own warning light system. Start checking for the warning lights. Ignore them at your own risk.

Article pulled from: http://www.toyourhealth.com/mpacms/tyh/article.php?id=1522

 

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Side Effects of Inversion Tables

NewTracton    Inversion therapy involves a patient positioning himself upside down with gravity boots or an inversion table. The table method generally is considered safer and easier. The therapy is used to treat back pain, although preliminary research has provided conflicting results.

At the Back Pain Relief Center we use the Pettibon Spinal Rejuvenation table.

Designed for full spine traction and rejuvenation. Vibration is used to relax the muscles or red tissues and the adjustable traction angle can be set to up to 30º to help unlock the facet joints so that rehydration of the discs and ligaments or white tissues can begin. The dual traction of pulling both the neck and lower back decompress the entire spine. Patients control their level of tolerance for vibration, traction force and inversion angle.

Because mechanical traction is applied by an actuator along with gravity from the angle of inversion this makes this type of inversion traction safer as the patient is not required to be inverted nearly as much to get traction at the spinal joints. This is very helpful for those suffering from spinal degenerative joint disease and bulging spinal discs.

#64FullSpineDecompression

For those patients who are unable to tolerate inversion we also have a flat decompression table.

Potential side effects from other forms of inversion.

Eye Injuries

One of the first studies to look into the effects of inversion tables on the eyes was published in 1985 in the Journal of the American Medical Association. Researchers evaluated healthy volunteers using inversion therapy and discovered that the intraocular pressure in the eye more than doubled, increasing to levels well within the range associated with glaucoma. There were also increases in pressure in the central retinal artery, as well as redness in the conjunctiva tissue that lines the inner surface of the eyelids and small red hemorrhages on the outside of the eyelids. The report concluded that–although long-term effects on the eyes of healthy volunteers were unknown–if you already have retinal vein abnormalities, macular degeneration, ocular hypertension, glaucoma or any other eye disorder, you should avoid inversion altogether.

Gastrointestinal

If you have either a hiatal hernia, which occurs when a weakened diaphragm allows a portion of the stomach to move up into the chest cavity, or a ventral hernia, which develops at the site of previous surgeries, you should avoid inversion table therapy. It’s possible that the pressures from the upside-down orientation can make those conditions worse, one reason they are listed as contraindications by almost all manufacturers of inversion tables. There have also been anecdotal reports of nausea during inversion therapy.

Heart Effects

A study published in 1983 in the Journal of the American Osteopathic Association treated healthy volunteers from the Chicago College of Osteopathic Medicine with three-minute periods of passive inversion. The volunteers experienced an increase in systemic blood pressure from 119/74 mm of mercury before inversion to 157/93 mm of mercury during inversion. For this reason, if you suffer from congestive heart failure, carotid artery stenosis, high blood pressure or other heart or circulatory disorders, or are on anticoagulants or aspirin therapy, inversion therapy is not recommended.

Musculoskeletal Complaints

The Archives of Physical Medicine and Rehabilitation published a study in 1985 that documented several musculoskeletal side effects in human subjects undergoing inversion therapy. The most common were headaches, ankle discomfort, calf and thigh pain and chest discomfort. These symptoms were temporary, although a few, such as headaches, persisted for longer than five minutes.

Stroke

One of the most potentially serious side effects from inversion therapy is a stroke, which occurs when a blood vessel in the neck or brain becomes blocked or bursts. Due to the increased blood pressures involved in inversion therapy, as well as the pooling of blood into the neck and head areas, if you are already at risk for a stroke or transient ischemic attack, the inversion could trigger an attack. Symptoms typically include paralysis, difficulty speaking, memory loss and impaired thinking.

Read more: http://www.livestrong.com/article/157599-side-effects-of-inversion-tables/#ixzz2KwdIDbzn