Five Considerations Before Undergoing Back Surgery
Learn About Lower Back Surgery Considerations
Hello. This is Dr. David Green education director for premier pain specialists in Chicago. Today’s topic is five things to ask yourself before undergoing elective back surgery. Over 600,000 low back surgeries are performed every year in the U S unfortunately half will not obtain the desired outcome and actually 10% will end up worse than they were before the surgery. The first consideration before elective back surgery is whether or not to seek a second opinion.
A second set of eyes may be indicated because it is a big decision. Um, the second set of eyes may recommend the same surgery. That person may recommend a different surgery altogether, or the person may recommend no surgery. So for a lot of low back conditions, if you take that person’s situation and show it to 10 board-certified spine surgeons, you may get five different answers. So it’s not always a clear cut, uh, consideration. Okay.
For this picture, you have a very large disc herniation right here, pinching on a nerve root. All right, so if conservative treatment fails, you know, surgery can be considered, but it may be that the person wants to do just a simple diskectomy and other surgeon might recommend a diskectomy and fusion. You know there could be different answers. The second consideration is have you really tried all conservative options?
This may include physical therapy, chiropractic treatment, spinal decompression therapy, acupuncture, medication management, and interventional treatments. For example, one of the treatments that premier pain includes radio frequency ablation where a catheter provides thermal energy and dead ends. These tiny little nerve endings that provide sensation to the arthritic and painful joints. Okay. That can provide pain relief for up to 18 months.
More Considerations to Learn
Third consideration is looking at a risk benefit assessment prior to surgery. No back surgery is going to be risk-free and you know there are levels of surgery. You know you have a little diskectomy versus a scoliosis surgery which has complication rates greater than 50% risks of surgery could be infection, bleeding, nerve injury, anesthesia risks, failure to few is potential scar tissue formation later on. These are the things you need to look at and then look at the benefits of the proposed procedure.
And then you need to look into yourself in the mirror and say, I’ve have, I really tried everything non-operatively so I can look at myself back in the mirror afterwards if it doesn’t go as planned and say I’m okay with this because there was nothing else available to me. The fourth consideration is a reality check on the potential outcomes. We know that half of back surgeries don’t end up with the expected outcome and 10% end up worse.
Help with Pain Management For a Failed Back Surgery
Let’s say half of your pain goes away with the surgery. You got to have fusion laminectomy. Is that good enough? Okay. Or are you going to look at yourself a year later and say, this is not good enough? Now I have have essentially a failed back surgery. Um, and I’m miserable. So you have to really look cause it’s very hard to hit a home run with all the pain going away. Okay? So you have to think about what’s going to be acceptable. Let me give you an example.
The FDA study on the lumbar artificial disc. Here’s what that looked like. They looked at that versus spinal fusion, and what they found is that even at the one year point, over half the patients in both groups were still taking narcotic medication. So it was not, it was very typical to not hit a home run and there you have it.
So you have to be very careful about your reality. Fifth consideration is the timing of surgery. For elective surgeries. You could pick the best time, you can do it in the summer. You can do it on a sabbatical from break. Um, you know, you don’t have to do it right in the middle of a heavy workload or during the school semester or whatnot. Here’s some rehab considerations. For a simple laminectomy, you’re looking at six to eight weeks.
For a spinal fusion. Typically it’s around three months in. For an adult scoliosis procedure, it’s a very long, a six to nine to even 12 month rehab period. The bottom line is that you want to feel comfortable with the decision for elective low back surgery, even if the surgery does not produce the desired outcome. Okay. It is reasonable to work through these five considerations to make sure that it is the right thing for you.
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