Rule Out the Simple Back Pain Surgery First

spinal stenosis

Just about each week, I learn about a patient who had a surgical treatment to reduce extreme chronic back pain and found themselves far worse off than before. Among the list of greatest concerns is that money motivates surgeons to persuade people into much greater and more complicated operations than they really have to have -- and then those surgical procedures end in expected complications.

The greed claim sounds a bit tough, but it comes from a reliable source: The Journal of the American Medical Association.

The Oregon analysis observed that the amount of elaborate surgeries for back discomfort in Medicare individuals went up by 15-fold over a recent five-year period, but there was absolutely nothing in the patient population -- such as increasingly challenging back deformities -- to explain the increase.

Surgical rates for ordinary decompressions are around $600 to $1,000. The difficult surgical procedures earn surgeons up to 10 times more. Yet another possible variable is the temptation for both medical professionals and people to go for a new, more costly method simply because it sounds better.

The issue is that the more sophisticated surgical procedures carry at least double the threat of a poor outcome, according to the analysis.

The majority of back ache that isn't resolved effectively with medicines or other non-surgical therapies is attributable to disk herniation or spinal stenosis. Spinal stenosis is development of bone near a nerve coming out of the spinal cord which pushes against the nerve root and causes ache to move down a leg. The vast majority of individuals who need back surgery because of spinal stenosis can be benefited from a relatively simple lumbar decompression. This will involve removing bone, ligament and facet joint material which is compressing the nerve root. This procedure has a high rate of success as it's been evolved over the last 20 years.

Based on one editorial, if the patient also has some deformity of the spine -- front to back or side to side -- the simple lumbar decompression can lead to spine instability with elevated deformity, so those patients might need a fusion where adjacent vertebrae are fixed together with bone grafts. Even in these circumstances, simpler strategies get just as good results than more complicated procedures that add metal or other instrumentation into the back.