Should I consider back surgery?
Q: Dr. Scott, I’ve had back pain for years. Should I consider back surgery?
A: The late Robert Mendelsohn, MD, author of “Confessions of a Medical Heretic,” joked, “Anyone who has a back surgery without seeing a chiropractor first should also have his head examined.”
Dr. Mendelsohn’s concern is as true today as it was in the 1980s before the avalanche of research began to swell that criticized the massive amounts of unnecessary spine surgery. It has been a bitter medicine to swallow for the medical profession to realize why back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history. (Epstein, 2016; Waddell & Allan, 1989)
Primary care providers refuse to refer their patients with back pain (the number one cause of disability in the world) because of the huge profits made from drugs, shots and surgery.
Despite these revelations, the call for restraint and reform in spinal care has fallen on deaf ears in America as the statistics show these spine surgeries are escalating despite the warnings, the poor outcomes and the huge costs of these ineffective treatments. In fact these authors were right when they concluded this problem has “more to do with economics than with evidence-based treatment approaches.” The rate of back surgery in the United States is at least 40 percent higher than any other country and was more than five-times those in England and Scotland. Despite these warnings, spine surgeries are doing much harm, and experts estimate that nearly 600,000 Americans opt for back operations each year.
When hospitals can charge $50,000 to $100,000 or more for radical back surgeries, the incentive to utilize lower cost services is compromised. Realistically, why would a hospital want a chiropractor on staff who will earn a mere $800 per case on average? (Mushinski, 1995) Interestingly, the most highly trained physicians on earth to help patient’s recover from back pain are not medical doctors…they’re chiropractors.
In his book “The Back Pain Revolution” (1998), Gordon Waddell, DSc, MD, the director of an orthopedic surgical clinic for over 30 years in Glasgow, Scotland, determined that back surgery is mostly ineffective and unnecessary, and there are very disturbing reasons why this disaster has happened:
“Low back pain has been a 20th century health care disaster. Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. Back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history.”
Finally, the dagger in the spine surgeon’s back should have occurred way back in 1994 when the US Public Health Service’s Agency for Health Care Policy & Research (AHCPR) stated the following in its Patient Guide:
“Even having a lot of back pain does not by itself mean you need surgery. Surgery has been found to be helpful in only one in 100 cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptom is back pain.”
Better Options
Compare all of this bad news with what the Annals of Internal Medicine recently published jointly with the American College of Physicians and the American Society of Internal Medicine. They noted that “chiropractic therapy is the most effective and cost-effective treatment for acute low back pain.” “Perhaps most significantly chiropractic spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equine syndrome, chiropractic spinal manipulation is the treatment of choice.”
Pran Manga, an economist at the University of Ottowa was commissioned by the government of Ontario to assess the effectiveness and cost-effectiveness of chiropractic management of back pain. (Manga, 1998)
“There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us I forming our conclusions and recommendations.”
The cost advantages for chiropractic for matched conditions appear to be so dramatic that Manga, in his second report, concluded that doubling the utilization of chiropractic services from 10% to 20% may realize savings as much as $770 million in direct costs and $3.8 billion in indirect costs. Four out of five patients of chiropractors have endured their problems for more than 6 months, typically undergoing medical care and/or physiotherapy before even reaching their chiropractor.
Dr. Scott Cuthbert is the chief clinician at the Chiropractic Health Center in Pueblo, Colorado, as well as the author of two new textbooks and over 50 peer-reviewed research articles. PuebloChiropracticCenter.com.
