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Category: Herniated Disk

Think Twice about Back Surgery

Think Twice about Back Surgery

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Back pain is incredibly common—in fact, just about every adult in the United States has experienced back pain in some form or another, and it is one of the top complaints heard in doctors’ offices and hospitals around the country. Yet the cause of any one type of back pain is one of the most difficult things to diagnose. There are many treatments for back pain, such as chiropractic, physical therapy, acupuncture, surgery, saline injections, and steroid injections, all with varying degrees of risk. According to experts, you should treat back pain conservatively—that is, you should opt for the least risky, minimally invasive treatment option first before considering treatments such as spinal surgery.

Of course, there is risk with any surgery, but failed back surgeries can be calamitous—so much so that there is a condition called “failed back surgery syndrome,” also commonly referred to as failed back syndrome. According to the University Hospital of Columbia and Cornell, New York-Presbyterian Hospital, “Failed back syndrome is a general term that refers to chronic severe pain experienced after unsuccessful surgery for back pain. Surgery for back pain is conducted when there is an identifiable source of pain—usually to decompress a pinched nerve root or to stabilize a painful joint. However, back pain can have a number of causes and accurate identification of a source of pain is complicated; often symptoms do not correlate well with x-rays or magnetic resonance imaging scans. As a result, diagnosis and patient selection for surgery are essential.”

Failed back syndrome has a large array of causes. For example, the original source of the pain can return or complications may arise during surgery. The nerve root triggering the pain may be ineffectively decompressed, joints or nerves may become irritated during the surgical procedure, or scar tissue may compress or bind nerve roots. Additionally, nerve damage sustained during the surgery can add to already existing pain. In some cases, nerves may rejuvenate to a degree, but even this can result in pain if the regeneration is abnormal.

Numerous factors can add to the onset or advancement of failed back syndrome. Contributing causes include residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness, and spinal muscular deconditioning. Insufficient or unfinished rehabilitation and physical therapy, particularly in patients whose back muscles are out of shape, can cause chronic pain as well. A patient can also be susceptible to the advancement of failed back syndrome due to systemic conditions such as diabetes, autoimmune disease, and peripheral blood vessels (vascular) disease.

There are other risks of surgery as well—contamination can occur when a surgeon’s gloves have bacteria present on them, passing them to the patient and causing infections that range from mild to very severe.

As an alternative to surgery, there are steroid injections for back pain—but they aren’t always successful. Lumbar epidural steroid injections, as they are called, can help relieve pain, but they carry with them their own hazards. As Spine-Health.com puts it, “In addition to risks from the injection, there are also potential side effects from the steroid medication itself. These tend to be rare and much less prevalent than the side effects from oral steroids. Nonetheless, reported side effects from epidural steroid injections include: Localized increase in pain, non-positional headaches resolving within 24 hours, facial flushing, anxiety, sleeplessness, fever the night of injection, high blood sugar, a transient decrease in immunity because of the suppressive effect of the steroid, stomach ulcers, severe arthritis of the hips, and cataracts.”

To reduce the risk of these side effects of invasive back pain treatments, it is wise to pursue conservative therapies first. When looking at back pain treatment options, always be sure to get a second—and maybe even a third—opinion on how your back pain should be handled. If you’re looking for a drug-free, non-invasive alternative, consider chiropractic care. In addition to treating your back pain directly, your chiropractor can also act as your back-pain quarterback to coordinate care across multiple treatment methods.

 

What is a Slipped Disk?

What is a Slipped Disk?

lower-back-pain-200-300A slipped disc is the common term for a prolapsed or herniated spinal disc. These discs are set in position between the vertebrae and do not “slip”. Instead, the disc’s outer, fibrous ring tears, thereby allowing the soft, inner portion to extrude through the tear and press against the spinal nerves. Inflammatory chemicals may also be released as a result of the tear and may cause significant, long-term pain.

Depending on the location of the slipped disc, the individual may experience numbness and tingling sensations in the extremities, sciatica and even erectile dysfunction, in addition to the localized pain.

Diagnosis can be performed using a number of methods (X-rays, computed tomography, discography), but a magnetic resonance imaging scan (MRI) is usually the most effective, as it can provide highly detailed three-dimensional images of the affected area. These methods, however, are generally reserved for those cases where natural recovery has failed to improve the symptoms.

A physical examination is commonly performed prior to imaging tests and can include the testing of reflexes, sensations and muscle strength in the extremities and the patient’s ability to walk. These tests may include the straight-leg raising test where the patient slowly raises each of his or her legs individually while lying down. A slipped disc usually induces pain and/or numbness in patients as they raise their legs beyond two-thirds of their normal range.

Treatment for the majority of slipped discs generally consists of the patient practicing gentle exercises and taking prescribed painkillers (if there is significant pain) while the disc shrinks of its own accord. Your chiropractor may also perform spinal adjustments to correct the subluxations that are causing the herniated disc.

Lifting, reaching and sitting for long periods of time during recovery are to be avoided as they often aggravate the condition. However, exercise is important since movement encourages blood flow to the affected area.  Swimming is one of the best methods for exercising during recovery because it releases the compression forces on the spine while promoting blood flow, thereby encouraging the torn disc to repair itself.

Natural recovery can usually be achieved within 4 to 6 weeks, but if the symptoms persist past this point then the imaging tests (i.e., MRI) mentioned above can be applied. Depending on the severity of the tear, the physician may recommend physiotherapy or surgery. Approximately 1 in 10 cases of herniated discs will require surgery due to severe nerve compression, difficulty in walking and standing, symptom severity and/or lack of improvement.

Surgery may consist of open discectomy (where all or a portion of the disc is removed), prosthetic disc replacement (where an artificial disc is inserted to replace the damaged disc), or endoscopic laser discectomy (where the compressed nerve causing the pain is released and part of the disc is removed using a laser and endoscope). Recovery from this type of surgery usually takes 2 to 6 weeks although in some cases, further surgery may be necessary.
As with most conditions, an ounce of prevention is worth a pound of cure. Regular visits to your chiropractor can help nip any subluxation in the bud so that it does not lead to a slipped disc. Engage in regular exercise, avoid sitting for prolonged periods of time, maintain good posture, lift using the proper technique and drink plenty of water (so your discs stay well-hydrated). If you look after your general health and fitness, you will significantly reduce the likelihood of a slipped disc.