Is Lower Back Surgery For YOU?

An abnormality showing on a scan or Xray may not be the cause of your pain. And yes! In many instances, it is possible to have abnormal findings such as spondylosis or arthritic changes, degenerative discs or bulging discs on scans and Xrays and NOT be the source of your pain. Studies show that many people have bulging/herniated/degenerative discs in their backs and do not have pain and vice versa. For example, an MRI scan may show a severely arthritic segment of the spine with the intervertebral disc space being obliterated at a particular level, and yet this may not be causing pain as that joint might be quite stable. However, the spinal joint above or below this level, can be the problematic one, causing pain, by being hypermobile but still have a normal appearance on the MRI scan. So surgically removing a disc or correcting the wrong level may not yield the pain relief or the results you are looking for, because that structure, although appearing abnormal may not be the causing your pain. It’s like catching someone that appears suspicious while the real culprit gets away!

Even if the correct pain causing structure is identified, it is not quite as simple as surgically removing it and then expecting your pain to end. This is because the invasive nature of surgery means cutting through healthy tissues which then need the additional time to heal and recover, NOT from the original injury or problem, but to recover from the ‘surgical procedure’ that supposedly fixed it!
 
 



 

 

 

 

 

 

 

Beware of success rates of spinal surgeries, wherein success sometimes means that the patient did not die on the operating table or that they were pain-free for a short time post surgery!

 

Once you have undergone a surgical procedure, there is no undoing it. There will be a permanent irreversible change in the architecture of the spine due to loss of bone or disc structure resulting from procedures such as laminectomy, discectomy or decompression. The loss of bone structure is irreversible; it does not grow back , thereby compromising the architectural stability of the spine potentially needing further surgeries to address this problem.

 

As for a spinal fusion procedure, if the operated level fuses and stabilises successfully, the levels above and below the fused level also start to get involved and start showing the same damage because the original flawed movement mechanics (the real cause) that lead to the damage is still at work. Within a few years you may be recommended another fusion surgery to fuse yet another level! If you have been advised multi level fusion (more than 2 levels) for lumbar degenerative disc, think twice. The spine is meant to move. Fusion at multi levels will make you lose a considerable amount of motion in your lower back and cause motion stresses, wearing down and destabilizing levels above and below the fused spine, creating even more problems and potential future surgeries down the line.

As we grow older the bone structure gets weaker and can cause loosening of the surgical hardware (screws and bolts!). At this point imagine having to undergo another surgery to “fix” the loosened hardware on your structurally weak osteoporotic bones. In addition, a declining cardiovascular status that comes with advancing age means that you would be risking your life, were you to undergo a another major Back operation. The leaves you with a hard choice between having to cope with the pain or risking your life hoping to fix it on the operating table.
 
Bottomline is that...
Back surgery (laminectomy, decompression, discectomy, fusion etc.) does not change the poor movement mechanics that were at play in causing the original back issues prior to surgery and starts to wear down other spinal levels as well within a matter of time.
The biggest drawback with something as invasive as a back surgery is the potential serious complications it carries - bleeding, infection, blood clots, dural tears, potential continuance of chronic back pain due to scarring that can grab nerves, nerve damage, to name a few. Apart from that it may fail to address your pain- the reason why you wanted the surgery in the first place!
 


Is Surgery really the Answer?

Following a major surgery on your back, you tend to take your rest and rehab with the Physio far more seriously than when you haven’t undergone surgery So, because the surgery entails a period of enforced rest and intensive rehab - you are very likely to get better. Now, let that sink in.... If you were to try rest and rehab as if you had undergone back surgery and skipped the surgery altogether, then you may as well have the same results as if you had undergone surgery; just minus the risks that come with its invasive nature! The question now is…If the surgery you plan to undergo, were to have the same or no better outcome than guided exercise and rehab, would you still choose this risky option?

 

 

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• In majority of Back Pain cases, Surgery is not the best option let alone your only option. However, Surgery can be extremely beneficial in cases of severe trauma to the spine from falls /accidents or it may be considered in those with substantial neurological problems such as loss of bowel and bladder control, sudden/recent onset saddle anaesthesia (loss of sensation in inner thighs and private parts) , rapid loss of power in your limbs etc. In other words the potential benefits should outweigh the serious risks associated with surgery.

• If you do not belong to the above category and your Back Pain and leg symptoms have been a build up over time and you happen to have good days and bad days (of pain) then you are very likely not a candidate for surgery, even if you think you have tried everything conservative so far. However, the cause of this changing pain needs to be identified. There can be different causes to a Back Pain- bulging disc/ degenerative disc, facet joint arthritis , spondylolisthesis, spinal canal stenosis. But in all these conditions, the movements, postures or loads that influence YOUR pain and keep you in pain, need to be identified and addressed. At Empower Physiotherapy this is the first order of business, when it comes to addressing a Mechanical type of Lower Back Pain. We use our 5 Step System to End Chronic Back Pain naturally and without resorting to invasive procedures such as injections or surgery.

 

"I have tried the conservative route and it didn't work for me… "
Its important to understand why your previous treatments didn't work; it will bring you closer to finding the thing that does. If you have tried Yoga, Pilates, back strengthening, pain killers, passive treatments (injections, massage, Electrical treatments, manipulations) or even Physiotherapy, and you have had little success and are now considering surgery as your last option to pin your hopes on, then think again.
Yoga & pilates are often advised in a very generic sense for low back pain patients. However if you are having a mechanical back pain, there is various movements and postures in yoga and pilates- some of which have as much a chance of making your Back Pain better as it does of making it worse. So it should not be a surprise if it didn't resolve your back pain.
Passive treatments (injections, massage, Electrical treatments, spinal manipulations etc)-, which are treatments that are done to you without your active participation only trick the nervous system to mask the pain, doing little to address the cause. If you continue with passive treatments and don’t resolve the cause, the problem, in fact, silently gets bigger over time.
Active treatments such as strengthening or stretching exercises can be misleading and even aggravating over time if they incorporate the same faulty patterns of movements and if they are timed incorrectly. Lastly, resorting to Surgery does not fix the way you move or the poor mechanics that cause the problem in the first place and "you can't simply cut out pain".
If you have already tried Physiotherapy before without success it is likely that the treatment was mainly passive or if you did have an active treatment, it did not address the root cause.
I hope that this gives you some clarity as to why certain treatments may not have helped you in the past and instills a little hope in you, that you have a shot at getting better.

 
"What can I do now?"

So, you have done your bit of research and you want a natural solution instead of Surgery, then you have come to the right place. At Empower Physiotherapy, we often see people who have tried many things before and even been prescribed surgery. We find that 80 percent of the time their Back Pain responds to our very individualised and holistic 5 Step approach to treatment and does not need aggressive interventions like injections or surgery. You see, when given the opportunity and the right environment your body will do its best to heal itself. Why not try careful guided exercise and advice to create the best healing environment, before you submit to risky incisions and long medicated recoveries? Consider working with a Specialist Physiotherapist to address your specific Back issue- someone who doesn’t just prescribe a set of general exercises and passive treatments, but genuinely wants to help you recover in a natural and low-risk manner.
A Specialist Physiotherapist will carefully listen to your history to understand what you have tried so far didn't work, analyse your symptoms, come up with a customised plan of action, and problem-solve WITH you versus trying to solve the problem FOR you. One of the primary goals of our practice is to use guided, natural movement to help your body recover to its full strength and health based on your own individual needs.You may think that your regular exercise and stretching is enough, but working specific muscle groups can reinforce faulty movement patterns making your body unbalanced as a whole and thereby perpetuating the pain cycle. At Empower Physiotherapy, you will be designed your own personalised programme that balances you both mentally and physically! And working with a professional will allow you to customise your treatment plan to your own individual goals.
At Empower Physiotherapy we use our 5 Step System to End Chronic Back Pain even if its been Years of Suffering Already.
 
IF you want to find out if the non-surgical route is an option for your particular type of Back Pain then schedule a Free Phone consultation. The phone call is complimentary and there is no obligation to book any appointments with us thereafter! Our goal is to help you make the right decision about what to do next for the best.
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You can also check out our BACK PAIN PAGE which is loaded with information and tips.