I am tired of the carnage. Every week I see one to six patients who have undergone botched spinal surgeries that never had a good chance of success. Not only is the goal of surgery unattained, but the surgical trauma to the spine is often very severe. I would estimate that 50-60% of the post-spine fusions never should have been performed.

There is almost a complete disconnect in the spine care world between what we are doing and what we know we should be doing. The fallout is tragic both in societal costs and human suffering.

I am specifically referring to fusions as opposed to decompressions. A fusion is an operation that “welds” two or more vertebrae together. A decompression operation is one that simply removes pressure off a pinched nerve or set of nerves. In spite of the controversy surrounding all spine surgery, most of the time a specific nerve or set of nerves are relieved of pressure, patients feel much better. Although there might be some surgeons more aggressive than others in deciding to perform this type of surgery, most of the time the decision-making is reasonably clear-cut. If you happen to be in the minority of those patients who still have persistent nerve pain after a bone spur or ruptured disc has been removed, the downside is a fraction of that of a failed fusion, and the complication rate is lower.

As this web site matures, I will clearly delineate what I term a “structural” problem versus a “non-structural” problem of the spine. I will also list specific examples. For the moment, I am defining a structural problem as one that is clearly identifiable as abnormal anatomy on a diagnostic test and also has MATCHING clinical symptoms. Examples are: tumor, infection, fractures, active slippage between two vertebrae, and a pinched nerve with matching sciatica down the leg. Spine surgery is a wonderful structural solution to a structural problem. It does not predictably work well for vague symptoms with ill-defined anatomy. If I can see it I can fix it.

I am not against spine surgery. I am a very busy surgeon and truly enjoy being able to solve both simple and complicated spinal problems with surgery. When this happens, you are happy; I am your hero and get paid very well. There’s certainly nothing bad about that.

Conversely, I cannot tolerate the suffering of the patients I see that have had their spines destroyed by aggressive fusions. Part of the problem is that surgeons do what they are trained to do, even when the best course of action is non-surgical. The result is usually patient in worse pain. Not only is the original problem often solvable with an appropriate care program, but the patient often ends up with a spine with a structural problem—one CAUSED by surgery. These problems can be very severe, particularly when contrasted with a normal aging spine before surgery.

I can often salvage a part of your life back. I cannot give you the years back you have lost, and I cannot give you back the spine you had before you had that first operation, which had a low chance of success. You will quickly get the picture as I tell you what I see. All of the stories I will be sharing will be based on true events. Some facets of the stories will be changed to protect the identity of my patients.

One of those stories is about Marsha’s three unnecessary back surgeries.

BF

Marsha was a 36 year-old businesswoman with two young children. She was referred to me by another patient and came to see me from the east coast. She had the spontaneous onset of back pain about eight years ago. Everything possible had been tried, but she continued to spiral downward with increasing pain.

In 2005, she had an MRI scan done that showed some mild degeneration of the discs in her lower back. These were normal for her age. A surgeon recommended she undergo two artificial discs at L3-4 and L4-5. They did not help her pain, and in fact, she got worse. The discs buckled, and a year later, they were removed at another hospital on the west coast. During this operation, they went back in through her abdomen to remove these artificial discs. In this situation, the major blood vessels are scarred down and attached to the discs. It is a very difficult procedure, and during the operation, her major vein, the vena cava, was torn. Her ureter (tube from the kidneys to the bladder) was also torn. Both were repaired, but she was left with residual swelling of her feet due to the partial disruption of the vena cava. A year later she had L5-S1 fused for ongoing low back pain.

When she saw me, she still had ongoing low back pain, thoracic pain, and neck pain. Two other spine surgeons had recommended to her that she should undergo a two-level fusion in her neck. Her MRI of her neck was normal for her age showing just some mild degeneration.

She desperately wanted to go back to work. Her husband was threatening to leave her. She was on drugs to wean her off narcotics but was having a difficult time. She was extremely motivated to get better but completely trapped by her pain and lack of a plan to solve her pain problem.

None of her surgeries were helpful or necessary. Yet the spine world was offering her only more surgery. I do not know the end of this story. I spent a couple of extra hours with her explaining the DOCC protocol to her in detail. She is fully engaged and I do think over 12-24 months she can become pain-free and functional. It is upsetting to me that she does have the three-level fusion in her lower back and residual swelling in her feet. If she had been able to engage in the structured rehab before any surgery, she might have completely come back to normal. Now she will have some permanent structural limitations.

BF