A Surgeon’s Perspective on Surgery for back pain
17 Jul 2015George Ampat, Consultant Orthopaedic Spinal Surgeon and owner of Ease The Spine–Ease The Feet in Cheadle Hulme precinct gives us a surgeon’s perspective on surgery for back pain.
Though back pain is one of the most common health problems, its cause is not usually clearly identified. More than 80 percent of adults will experience an episode of back pain at some point in their life. Half us will have back pain in a given year. Men and women of all ages can be affected by back pain.
Most of back pain is simple and will settle with no active intervention. The general advice is to keep mobile and to rest as less as possible. However back pain can be worrying and needs to be looked at if patients have “Red Flags”. Red flags include the history of cancer, infection, fever, inability to pass water or numbness in the saddle area. If these symptoms are not present, then back pain can be managed with mobilisation, simple stability exercises and over the counter medication.
Research shows that only 2 to 3 patients out of 100 who attend a health professional for back pain finally require surgery. The remaining 97 to 98 % get better without surgical intervention.
Unfortunately there is a false-belief that surgery or new technology can fix back pain. This is far from the truth. Surgery is very rarely required for back pain. Surgery is generally only needed when the nerves in the back are compressed and that causes leg pain. This leg pain in association with back pain is commonly called sciatica. Though numerous inventions and devices have come into the market claiming that they would resolve back pain, it has all made a quick exit when subsequent research has not substantiated their claim.
The usual cause of sciatica (back and leg pain) is a disc prolapse and in most cases it usually resolves without surgical intervention. The vertebral column is composed of blocks of bones with cartilaginous cushions in between these bones. The cartilaginous cushions are composed of a firm covering with a softer inside just like a jam doughnut. In a disc prolapse the softer inside comes through the firm outer covering and pushes on the nerves that go down into the legs. This is like how jam may come out of jam doughnut. Even with sciatica there is no need to consider any surgical intervention for six weeks if there are no red flags. The majority of the sciatica and leg pain usually resolve within this period.
However some patients who continue to experience significant leg pain beyond 6 weeks may benefit from surgery. Unfortunately there is also worrying evidence of unnecessary and wrongful surgical interventions in the spine.
When the first operation does not work, sometimes a repeat operation is required on the spine. This type of surgery is called failed back surgery.
The media hype and false promises that new devices or operations may provide magical cures may be because of the commercialisation of medicine and spinal devices industry in particular. These unfounded claims of miraculous cures for back pain are by no means specific to this device. This is true for many devices or new cure that appears for back pain. It is possible that the lack of a reliable cure for back pain is driving industry to invest in new research. However patients should be very cautious before agreeing to undertake any procedure with a new device. The large surgical device industry may be pushing the need for surgery. However both patients and professionals need to be cautious before embarking on surgery for back pain.
It is possible that a new surgical fix for back pain may be an empty promise. Any patient considering surgery must take into account that surgery can backfire, leaving patients in more pain. Patients with bad backs should understand that there is no easy solution. There is no magic bullet. It is vital that patients need to scale back their expectations. Legally it is also possible that a consent between a vulnerable patient in severe pain and an enthusiastic surgeon may not withstand the legal test of a fair consent in the future. With appropriate treatment, pain can be eased, but a complete cure is very difficult.
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