by Jeffrey R. Carlson, MD
As a spine surgeon, I see patients every day that have significant and life-altering pain related to spine problems. These patients are often sent to me specifically by a physician for a surgical evaluation. However, most patients have heard of someone or may have even been told by their referring doctor that spine surgery has a poor track record and should be considered a last resort. Alternatively, these same patients would be counseled by their physicians or friends that they should have surgery to repair the bad hip or knee on which they have been limping.
Surgery, in general, is a useful tool for improving life function, but it is not always the answer. There are some emergent conditions that can only be addressed by surgery. In spine disorders, there are generally three treatment options: 1) medications (pills or injections), 2) physical therapy or chiropractic treatments and finally, 3) surgery. These same three options can be used for treating hip and knee arthritis, but more commonly, the perception of surgery as a treatment for hip and knee pain is a more positive one.
Even when patients with severe spinal pain or nerve pain have failed all non-surgical treatments, the perception of the success of spinal surgery as being doubtful keeps many patients from making that final decision. The reality is, spine surgery performed in the 70’s and 80’s DID have poor outcomes, when the lack of proper imaging technology (MRI) and scientific knowledge led surgeons to perform exploratory operations in an effort to find and fix a potential problem. As research and imaging have improved, the evaluation of the spine patient has become much less of an educated guess and more of an evidence-based science. Current knowledge allows Spine physicians to better diagnose and treat patients with spinal disorders, including disc herniations, pinched nerves and spinal stenosis.
There is a recent study out of Canada that has helped to solidify the positive effects of spine surgery. Spine surgeons compared the outcomes of their spine surgery in 2 different ways, by evaluating quality of life scores pre- and post-operatively to determine the effective improvement with the surgical treatment, as well as comparing the outcomes of the spine surgery patient with the outcomes of their colleagues that perform hip and knee replacements. The spine surgical results were very positive in both studies. The researchers were able to determine that patients who underwent surgery for their pinched nerves and spinal stenosis, had better function after surgery, had fewer medical visits and a better quality of life after surgery. These patients also spent less money on medical care after surgery than they had before surgery.
The other part of the study also provided interesting results. The researchers compared patients before and after surgery for hip replacement, knee replacement and spine surgery. All three surgical groups showed equal improvements in quality of life after surgery. These results were found to be durable and sustainable throughout the eight year follow-up of the study. This places spine surgery in the same category for effectiveness as hip and knee replacement. Spine surgery may have had a rough patch 30-40 years ago, but now has been proven to have the same life-changing, positive effects that are seen in hip and knee replacement patients.
Dr. Jeffrey R. Carlson is a Fellowship-trained, Board-certified, Orthopaedic Spine Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Dr. Carlson has been voted a “Hampton Roads Top Doc” in 2012, 2013, & 2014. For more information about Dr. Carlson and his practice, go to www.osc-ortho.com or for an appointment, call 757-596-1900.
by Jeffrey R. Carlson, MD