The Secret Behind Low Back Surgery
Chiropractor in Amarillo discusses the research
Chiropractors see patients almost daily that are considering spinal surgery as a solution to their pain. Far too often, they perceive surgery as an early option rather than the last option. We are careful to advise our patients that there are only a few reasons to consider low back surgery initially.
There are certainly urgencies that require immediate surgical treatment. Things like myelopathy and atrophy require immediate attention.There is a condition called cauda equina syndrome that is an emergency. CES is when there is a change in bowel or bladder function or what is called 'saddle anesthesia'. That is when anything that typically would touch a saddle is numb and/or tingling.
In general, however, outside of conditions requiring immediate attention, surgery should always be the ultimate and final option.
This is not only because it is invasive and has serious risks of adverse events and a significant recovery period, but also because many surgeries must be repeated. Even in successful outcomes, the patient is likely to develop spinal conditions above and below the site of surgery as the years pass by.
In addition, when a patient is in the midst of chronic pain syndrome, Due to a hypersensitized central nervous system, they run a 60% chance of developing chronic pain at the new site of injury. Even when the surgery goes perfectly.
Of course, there are lost causes and cases that are beyond helping conservatively, but we strongly believe there are better ways to go about treating spinal pain than surgery in general.
Why They Did It
Since low back pain is so predominant with medical appointments, and related surgeries remain controversial, as well as the fact that new techniques for surgery and treatment continue to emerge, the authors felt it important that low back pain treatment be evidence-based through solid research. They wanted to gather up all of the research they could find on low back surgery in order to analyze the outcomes, the quality of the research, and the conclusions of the research papers.
How They Did It·
- The authors used available medical databases to search for any research having to do with low back pain and surgical treatment.·
- There were two different independent investigators.·
- The quality of each research paper was assessed through professional, standardized questionnaires (AMSTAR and PRISMA).·
- It was determined that none of the authors of this paper had any conflict of interest.·
- The diagnoses in the paper were categorized separately as disc herniation, spondylolisthesis, stenosis, facet joint syndrome, and degenerative disc disease.
What They Found·
- The authors included 40 reviews in this study.·
- According to the quality questionnaires, only 5%7.5% of the papers were rated as excellent.·
- Most of the research papers were rated as being of fair.·
- In addition, 22.5% of the reviews (AMSTAR) we’re determined to be of very poor quality while the other questionnaire (PRISMA) determined that 7.5% of the papers were of very poor quality.·
- Ultimately, only 44% of the papers had a conclusion that was evidence-based and 37.5% didn’t even reach a conclusion to the primary objective.
Wrap It Up
Most systematic review papers on lower back pain and surgery don’t reach very good or excellent quality. In fact, a mere 27.5% of them even contain evidence-based conclusions.
That simply does not bode well for those considering lower back surgery at this time.
Martins DE, e.a., Quality assessment of systematic reviews for surgical treatment of low back pain: an overview. Spine J, 2016. 16(5): p. 667-75
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (http://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109
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