Surgery

Surgery

Contemplating surgery? It's a big decision. Chiropractic care is a non-invasive and safe alternative for some forms of surgery. Explore all your options before you commit to surgery.

According to a story from the April, 8, 2002 issue of the New Yorker online magazine "Fact", the results of back surgeries performed over the years have been much less than expected. The article starts by asking the question, "Is surgery the best approach to chronic back pain?" It then goes on to state, "Last year, approximately a hundred and fifty thousand lower-lumbar spinal fusions were performed in the United States."

When asked about the chances for success with spinal surgery, Dr. Eugene Carragee, at Stanford, who says he performs the operation only on a select group of patients who have been carefully screened, estimates that less than a quarter of the operations will be completely successful. For the majority of patients, the surgery does not have a dramatic impact on either their pain or their mobility.  He concludes, that the patient's prospects for a future that is free from back pain is fairly poor.

The New Yorker article also states that many patients who have had surgery end up going back to their surgeons. In a study in the state of Washington of workers injured on the job who received fusions for degenerative-disk disease, the results showed that twenty-two per cent had further surgery.  The article also reported that Dr. Seth Waldman, at New York's Hospital for Special Surgery, claims to regularly see spinal-fusion patients who experience persistent pain after multiple operations. Sadly, few patients facing spinal surgery seem to have any idea that the statistics are so unfavorable.

In the December 2001 issue, the journal "Spine" published the results of an award-winning study from Scandinavia in which patients who underwent fusion surgery for chronic lower-back pain were compared with those who had had no surgery. In this randomized controlled trial, only one out of every six of the patients in the surgical group was rated by an independent observer as having an "excellent" result after two years. Additionally, Dr. Richard Deyo, an internist and an expert on back pain at the University of Washington, recently published a statistical analysis of existing research which suggested that spinal fusion generally lacked scientific rationale, and also that it had a significantly higher rate of complication than did discectomy.

In conclusion, the article quotes Dr. Seth Waldman, who sees the consequences of failed fusions at the Hospital for Special Surgery every week. Dr. Waldman wishes that the medical profession could be persuaded to show a little restraint. He concludes the article by saying. "If you have a screwdriver, everything looks like a screw. There will be a lot of people doing the wrong thing for back pain for a long time, until we finally figure it out. I just hope that we don't hurt too many people in the process."

From the Journal of Manipulative and Physiological Therapeutics (JMPT) comes a case study of a 35-year-old woman with cauda equina syndrome helped by chiropractic care. The case study was published in the November-December 2004 Issue of the peer-reviewed research periodical.

In this evidence-based case report, the woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, for a period of 6 months. She had undergone emergency surgery for acute cauda equina syndrome due to lumbar disc herniation, six months earlier. The cauda equina (CE) is formed by nerve roots at the end of the spinal cord inside the spinal column. Cauda equina syndrome (CES) is when there is low back pain, unilateral or usually bilateral sciatica, sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss.

The patient eventually began chiropractic care and received a series of adjustments. After only 4 adjustments, the patient reported full resolution of midback, low back, and buttock pain. After an additional 4 visits the patient had not yet seen improvement in her neurologic symptoms. However, even though this patient had received surgery, there were no adverse effects noted. This case study did not look at possible results beyond the initial 8 visits. The study noted that a review of previous studies showed that 2.3% to 12% of chiropractic patients have a history of at least one prior spinal surgery.

The conclusion of the published case study noted that this case appeared to be the first published case of chiropractic adjustments being used for a patient suffering from chronic cauda equina syndrome. It seems that this type of spinal adjustment was safe and effective for reducing back pain and had no effect on neurologic deficits in this case. They noted that rapid pain relief seen in this case is extremely unusual for patients with cauda equina syndrome. They therefore concluded that it was very likely that the adjustments contributed to the resolution of spinal pain in this patient.

The above is the headline from an April 7, 2013 article on Fosters.com of the Fosters Daily Democrat from Oregon. The article notes that hospitals are now starting to post mistakes online in an effort to improve patient safety.

The article notes that  for the first time, the U.S. Centers for Medicare and Medicaid (CMS) has released inspection reports for hospitals nationwide from the past two years. The release of these reports was in response to a request by the Association of Health Care Journalists, who has placed these reports onto a publicly searchable database.

According to the article, in Oregon alone, the database shows that, since January 2011, inspectors have found at least 82 violations. "We take every one of these seriously," said Cheryl Nester Wolfe, Salem hospital's chief operating officer. "It's a good opportunity to examine our system and figure out where we can make improvements."

An article in The Boston Globe dated April 09, 2013, about hospital safety specifically at Brigham and Women’s Hospital notes that the hospital publishes a newsletter that openly talks about errors made at the hospital. The newsletter, "Safety Matters" is not available to the general public, but copies are delivered to the newspapers such as the Boston Globe.

"Open-faced transparency is really valuable to staff at an institution because it causes them to know themselves better," said Paul O’Neill, a member of the Lucian Leape Institute at the National Patient Safety Foundation, a nonprofit research organization based in Boston. But few, if any, other hospitals are doing anything like what the Brigham does, he said: "Unfortunately, I would say it’s highly unusual."


On the Portland TV news station website KGW.com, on April 3, 2013 Jason McNichol, president of Health Advocacy Solutions commented on some of the additional benefits of  having hospitals publish errors online by stating, "It also gives hospitals an incentive to do the right thing because the more accountability and transparency there is, the more incentive there is for hospitals to clean up mistakes and problems when they see them.