Think Twice About Surgery for Back Pain
Robert Filice, M.D. Former staff physician

A recent issue of the medical journal “Spine” reported the findings of a study of long term patient satisfaction with their back surgeries compared with physician expectations for the results. What was found was that 40% of patients reported virtually no difference in the severity of their back pain when rated one year after surgery. Overall, the surgeons performing these procedures predicted that 99% of the patients would have some improvement from the surgery.

What does this study teach us? First, surgeon’s are overly and inappropriately optimistic about the results they can obtain with Back Surgery. Since the scalpel is the surgeon’s only tool, and since surgery is a serious matter, it is not surprising that such a high percentage of surgeon’s predicted such a high expectation of benefits. How else could you justify a surgical procedure to a prospective patient? The problem is that back surgery fails to improve the original symptoms in almost one half of the cases rated one year post operatively. One reason for the discrepancy is that patients in private practices may not be asked to return for follow-up evaluations, or if they do return, results are not tabulated in a scientific manner. Therefore, if a surgeon quotes you a 99% chance of improvement from a proposed surgical procedure, you would want to ask him how he arrived at those results and whether in fact all of his patients are actually followed over time with results tabulated in a scientific manner. Or is he quoting results from published studies rather than his own personal data?

That brings up the second problem. Why do so many patients fail to benefit from technically correctly performed surgery? By far the most common reason is misdiagnosis of the cause of the pain. As we have reported many times before, just because a disk bulge is visible on an MRI, that doesn’t necessarily mean it is the cause of the patients sciatic or back pain. The problem may arise from the sacroiliac ligaments, in which case there can be no hope of improvement from a microdiscectomy.

Thus another question you might want to ask your surgeon is "How can you be sure that my pain arises from the area you are wanting to operate on?” Also ask, “What other areas or conditions might produce a similar pain pattern and render the operation you propose useless?” If he says there are no other conditions that could cause your problem, there is a 50/50 or better chance that he is wrong. Most surgeons know nothing about ligament dysfunction.

My advice here is that patients not agree to surgical procedures without an evaluation by a competent Prolotherapist. Most low back conditions, including disk bulges, can be successfully treated with Prolotherapy. Except under the most urgent and dire circumstances, unless you’ve had a Prolotherapy evaluation, and possibly a trial of Prolotherapy treatments, you should not entertain the idea of back surgery.