Back Surgery Success Rates, Risks, and Costs

 
Back Surgery “Success” Rates, Risks, and More
Are you one the many people suffering from back pain?  Has your pain ever gotten so bad that you have considered surgery?  Read on to learn about the success rate of surgery and treatment options.       

 

 

back-surgery

 

 
TYPES OF BACK SURGERY
The most common types of back surgery are fusion—where two or more bones in your spine are permanently joined together and diskectomy and laminectomy—where portions of bone and disk are removed. 

 

IS SURGERY SUCCESSFUL?   WILL IT HELP MY PAIN?
Answers for this question vary widely because surgeons report success as whether or not the spine fuses (for fusion surgeries) or whether the correct portion of disk was removed (for discectomy surgeries).   By definition, surgeons report very high success rates.  Patients report success as whether their pain was relieved.  The success of pain reduction is shockingly low.  For instance, spine surgeons often quote a 98% success rate for fusion surgery.  This percentage refers to the fusion process, not the reduction of pain.  For single level fusions, the percentage of patients obtaining significant relief is approximately 40%.  With three levels this drops to 15%. 

Neurosurgeons give microdiscectomy a 95-98% success rate; however when success is defined as returning to their previous occupations without pain medications, the overall success rate plummets to 29%.  Among spinal surgery patients, one out of every four patients is dissatisfied with their surgery two years post-op.  (Surg Neuol 1998 Mar; 49(3): 263-7)

Dr. Belanger, a skilled surgeon, recognizes that even “successful” surgeries might require follow-up surgery in the future.  “Revision surgery,” as it is called, is according to him also “highly likely to be ‘successful.’” 

 

 

SO I COULD HAVE PAIN AFTER THE SURGERY? 
YES!  Back surgery is an invasive procedure that could in fact CAUSE you MORE pain than you had to begin with.  In fact, the risk of back surgery causing more pain is so high that it has been labeled “failed back surgery syndrome” and is defined as “chronic pain in the back or extremities following open spine surgery.”  (PMRehab 09).  Dr. Scott Fishman admits to having cases where people feel worse after the surgery.  Interviews with patients months and years after their surgery have revealed that upwards of 90% still feel pain and that more than 70% cannot do normal activities. 

 

Since scarring is a natural part of the healing process after surgery, scar tissue may be the cause of a lot of post-surgery back pain. 

 

 

 

ARE THERE OTHER OPTIONS? 
YES!   Low power laser therapy has been proven effective in the treatment of patients with acute lumbar disc herniations.  If you have a pinched nerve causing pain, chiropractic can help.  To prevent recurrent back problems, use good body mechanics (lift with your knees, don’t slouch, etc), keep your back muscles conditioned with regular exercise and stretching, control your weight , and don’t smoke.   

 

MY RELIEF FROM BACK PAIN by Gifford Jones 
I was in excruciating pain!    An MRI revealed two ruptured disks and spinal stenosis. Finally someone knew I had genuine pain and wasn’t a drug addict looking for a morphine fix. One of Toronto’s top neurosurgeons gave me the bad news. Surgery offered only a 70 percent chance of relieving the pain, but a 30 percent chance of making it worse. Being on the cutting end of a scalpel always makes a surgeon cringe. He knows all the things that can go right, but also those that can go wrong.   A long sleepless night gave me time to weigh my options. I finally decided that since the odds were worse than gambling in Las Vegas, I’d go home hoping time would heal me.

At this low point I remembered a column I’d written about Low Intensity Laser Therapy (LILT). This treatment had eased the pain of patients who were suffering from a number of acute and chronic painful conditions.

So I called Dr. Kahn, founder of Meditech, in Toronto. Since I could not walk Dr. Denis Potosky, a Russian orthopedic surgeon, now working as a therapist with Dr. Kahn treated me with LILT at my home for several days. The first few treatments provided no significant relief. But within a week I was able to drive to the clinic and four weeks later I was once again pain free in my office.

Researching and writing an article about LILT is one thing. Being a grateful patient who’d been spared a major surgical operation prompted further inquiry. At this point I’d also become a very curious patient, wondering how light therapy could result in such a dramatic relief of pain.

Studies at the University of London, England and other research centers show that it’s important to decrease the duration of acute inflammation. This results in less scar tissue and chronic pain. LILT accomplishes this by giving a jump-start to the body’s natural healing process. It delivers energy to the muscles and joints that’s transformed into biochemical energy. The result is increased blood supply to the injured area, decreased swelling and accelerated healing time.

 

WHAT IS MORE COST EFFECTIVE? 
The financial justification for the use of laser therapy as the first line of defense in disc herniations is overwhelming. Data collected from the SPORT trial found that the average surgical procedure cost $15,139, which rises to $27,341 when other costs such as diagnostic tests and missed work are factored in. The cost of conservative treatment in that same study averaged $13,108. In our experience, even the most extreme example of a herniated disc patient (receiving 40 treatments), resulted in a total treatment cost of just $3,200. When diagnostic tests and health care visits are factored into this equation, the total cost of laser therapy is closer to $5,700. This is a savings of more than $20,000 versus surgery and $7,500 over standard conservative treatment. Moreover, laser therapy is noninvasive and no adverse events have been reported in more than 3,000 publications.  With the risks and poor success rate of surgery, can you afford NOT to try laser therapy? 

Tosteson AN, Skinner JS, Tosteson TD, Lurie JD, Andersson GB, Berven S, Grove MR, Hanscom B, Blood EA, Weinstein JN. The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine, 2008;33(19):2108-15.