Unnecessary Disc Surgery and How to Avoid It

October 25, 2013

I am traveling to Dubai this weekend to give a presentation at the World Congress on Low Back and Pelvic Pain. I’m speaking about how rapidly sciatica and cervical radiculopathy can often be corrected, enabling patients to recover both quickly and long-term.

I will present two cases, one cervical and one lumbar, each with a 4-6 week history of pain radiating all the way to the hand or foot and with some numbness in the hand or foot as well. Both patients were out-of-work due to their pain and referred for MRIs in consideration of surgery because they were not improving. One was actually scheduled for disc surgery.

On examination, they both had significantly positive “tension signs” in that extremity and considerable loss of range-of-motion (ROM) due to their pain, all captured nicely with photographs. They both had some loss of sensation as well and very large disc herniations on their MRI compatible with their clinical presentations.

Patients like this are very common and seek care from a wide variety of clinicians. Both patients had been referred to physical therapists but were unable to provide any help.

Surgery for disc herniations is commonly performed in cases like these and quite successful much of the time. But surgery is still a big deal since it always carries risk, simply by being in a hospital or operating suite. Though unlikely, risks are not small: infection (now-days includes antibiotic-resistant microbes), blood loss, drug or blood reaction, deep vein thrombosis, anesthesia complication or surgical error. Other medical errors are not uncommon inside hospitals. These things happen someplace, every day, when surgery is performed.

Then there’s also the possibility that the surgery won’t work, or won’t provide enough improvement to enable the patient to get “back to normal”. All these risks and complications, coupled with the pain and recovery time even if the procedure goes well, makes surgery the last resort, an opinion held by most every surgeon and patient.

But what happened to these two patients is noteworthy, but not because they are particularly unusual. Indeed, their good fortune could occur for at least half of the thousands, perhaps 10s of thousands, around the world who every day are in their predicament. They were shown a way to recover rapidly and fully, without surgery. How this was done has been described in textbooks, scientific studies, and taught to clinicians literally around the world. If you’ve never heard of this, and especially if you’ve also had sciatica or a neck radiculopathy, it’s simply because most physicians either ignore, are unaware of, this exceptionally attractive type of care.

Their good fortune occurred because the radiologist to whom they were referred for their MRI arranged to also undergo a special form of clinical evaluation that identified that their disc problem could be rapidly and easily corrected. For these two patients, that exam revealed that there was a simple way that each patient could move their own cervical or lumbar spine that promptly began to correct their herniation so they began to feel pain relief. First their hand or foot and then arm or leg pain went away, because of these movements, all in just a few minutes. Those same movements then eliminated the pain from their neck or low back. In just 20 minutes, they were both pain-free and able to bend and move about with no pain.

Their pain remained eliminated. They no longer had positive tension signs (straight-leg-raising was now negative) and their spinal movement was fully restored with no discomfort………..again, all in 20 minutes.

A repeat MRI right then showed a noticeable reduction in the size of their respective herniations.  I’ll be showing those MRIs in Dubai.

They were instructed to continue performing these pain-relieving movements several times each day and temporarily avoid any forward bending or slouched sitting. They remained pain-free and were gradually able to return to all forward bending activities over the next week. They were both fully recovered and back-to-work within two weeks and they had remained pain-free and fully active when last checked two years later.

Both rapid recoveries required only 3 visits with this specially-trained physical therapist because, after that initial evaluation and rapid change, the therapist merely served as a coach teaching them how to treat themselves throughout each day. The frequency of this very specific self-care is what prolonged their rapid improvement so they could so quickly return to all their daily activities.

The first major point: these rapid recoveries could have happened weeks earlier if their doctors had simply had them see a therapist with this type of training. So much of these patients’ suffering and work-loss was unnecessary, not to mention the wasted money spent on useless treatments.

The second major point: if these patients had not undergone this form of care, at least one, and likely both, would have undergone an unnecessary operation, with all its risks and expense. There are now four studies that show that this form of evaluation and care, when provided to patients considered to be disc surgery candidates, can bring about these rapid recoveries in 50%, thus avoiding what would have been unnecessary disc surgery.

Dr. John Wennberg, PhD, of Dartmouth Medical School, has said: “If operating on the wrong leg is considered a “medical error”, what do we call operating on someone who doesn’t need surgery?”

This form of mechanical care is called “Mechanical Diagnosis & Therapy”, also commonly referred to as “McKenzie Therapy”. Both the evaluation and treatment processes have been studied extensively and the success of these methods in rapidly correcting cervical and low back pain and their syndromes is very well-documented.

Yet every day in the U.S., thousands of patients are undergoing disc surgery without ever being evaluated in this manner to see if their pain can be mechanically corrected without surgery.

Patients deserve to know about this. Payers likewise deserve to know about this. Clinicians should be obliged to be sure patients are given this opportunity to recover easily and quickly, not just before surgery is considered, but early in their pain episode so surgery never has to be even contemplated.

Not every patient will respond this way. But the published studies report that 80-90% of acute low back and neck pain will resolve this quickly and easily. By the time patients’ pain becomes more chronic, or to the point of considering surgery, their chances of a rapid recovery like I’ve described here is reduced to about 50%.

How would you like to be treated? When the evidence of the effectiveness of this type of care is so strong, for spine care doctors, therapists, and chiropractors to not provide this type of care is simply unacceptable.

I’ll address this more in my next posting. I always welcome feedback and questions. Please be sure to click on “Like” if this was useful and enlightening, or “Leave a Comment” by clicking on “Comment” below. Have a wonderful week everyone.


One Response to “Unnecessary Disc Surgery and How to Avoid It”

  1. […] there is strong evidence that eliciting the two clinical findings of directional preference and pain centralization […]

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