The Luklinski Back Pain Clinic
2, Milford House, (off Harley St.) 7, Queen Anne St, London W1M 9FD
Tel: 0207-631-3067 Emergencies:  0410-901140
www.back-pain.co.uk

SURGICAL PROCEDURES FOR TREATING SPINAL CONDITIONS


Position of patient for spinal surgery.

One of the main purposes of our website is to inform the public of the dangers and fallacies related  to spinal surgery. When I started my studies of the spine more than 30 years ago, I came to the conclusion that spinal surgery was definitely the wrong approach to the treatment of  chronic  and acute back pain, because no matter how serious a spinal condition, it can always be cured, or at the very least made asymptomatic, using Orthopaedic Medicine.

General Facts and Information:

Over 20,000 spinal operations are carried out in the UK each year, and more patients allege negligence after spinal surgery than for any other type of operation. The same probably applies for operations in the USA.

A common surgical procedure is spinal fusion which in theory is intended to stabilise a section of the spine that may need supporting due to slippage or some other deformity and thereby to remove pain. In practice, the operation is invariably a failure leading to serious and debilitating consequences for the patient. One reason for the operation's failure is the fact that the cause of the patient's slipped disc is never taken into account. If for example the patient has a slightly shorter leg ("short leg syndrome") which has led over time to the patient adopting a protective walking gait or posture, then by fixing vertebrae in a rigid position the spine is no longer able to adjust itself to correct any imbalance. By  focusing on the 'slippage' which needs additional support, the factor creating the imbalance is invariably overlooked, and pain becomes more intense than before the operation, appearing in other parts of the body which were not previously affected. The correct approach is to mobilise the affected joints and to prescribe appropriate exercises and movements to strengthen muscles to prevent slippage from occurring.

The surgeon is not trained in Orthopaedic Medicine and is therefore unaware of other procedures such as mobilisation for correcting a slippage or herniated disc. Discectomies are also performed (where discs are removed or cut away) in the belief that this will reduce pressure on adjacent nerve roots. However, no account is taken of the fact that a chain is only as strong as its weakest link. If one of the links in the chain is fixed rigid or removed, the whole structure soon becomes unstable due to the intervertebral pressures which are created. A discectomy weakens the segmental area and scar tissue and adhesions soon develop, leaving the patient in pain and much worse off than before the operation. There is permanent weakness and crippling debilitation. The spine is a bio-mechanical wonder, but it cannot function properly if discs are cut away or  vertebrae are fused together; and many patients are persuaded to undergo more than one spinal operation when preceding operations fail.

Then there is the question of 'money', for even if a surgeon is aware of non-surgical treatment options, he would have to be prepared to lose a patient/customer  in order to recommend non-surgical treatment options; and most hospitals cannot afford to keep their beds empty for any length of time.

Specific Facts and Information

1. 60% of spinal fusion patients will continue to suffer from back pain. A full recovery is uncommon and cannot be predicted.
2. 30% of patients will be neither better nor worse because the pain does not emanate from the segment that has been fused!
3. 10% are distinctly worse for having a failed fusion.
4. In 10-20% of cases the bone graft fails to unite completely leaving a permanent pseudoarthrosis.
5. In cases of prolapsed discs and sciatica, 65% of patients will continue to experience post-operative back pain, and it is quite easy to operate at the wrong level or on the wrong side (minimally invasive surgery increases this risk).
6. A dural tear occurs in 3-5% of lumbar spine operations.
7. Pedicle screws are inserted in fusion using a 3.5mm bit and a depth gauge; in 12-21% of screw placements, the pedicle is transgressed and the peripheral cortex is broken.

Surgical Complications

Nerve root damage; post operative neuroma; dural tear; leaking cerebro-spinal fluid; post-operative infection; discitis; cauda equina syndrome; deep venous thrombosis (a common side-effect); post-operative hypotension; peripheral nerve injury. Nerve roots can be damaged during open discectomy, decompression for stenosis, spinal fusion, or by subcutaneous procedures such as epidural or cortisone injections. A single nerve root injury can be transient or permanent. The latter is very troublesome, while multiple root injury is disastrous. An S1 root injury may cause complete foot drop, while damage to the S2-4 nerve roots may  affect the bladder, bowel, or sexual organs. In all cases of nerve root damage there will be sensory or motor symptoms.

In discectomy, a nerve root usually lies directly over a protruding disc and it has to be retracted to one side in order to remove the protrusion. While the surgeon extracts the disc fragment, the assistant holds the nerve root out of the way with a retractor, and it is during this period that nerve root damage often occurs, because the root may already be functioning on a very limited blood supply and any slight manipulation during surgery can cause a critical problem which from time to time will occur even in expert hands. The consequences of nerve root damage are only evident when the patient wakes up from the anaesthetic to find that the pain is worse than before with weakness in a limb. Quite often a jerk of the leg during surgery warns the surgeon too late that nerve injury has occurred.

A contused root is initially very painful and many patients continue with severe disabling pain for many years. They complain that the pain is stabbing, shooting, burning and very unpleasant.  The chances of recovery from nerve root injury is poor. Some patients have to learn the technique of self-catheterisation and daily manual evacuation of the bowels. Their life expectancy is reduced because repeated urinary tract infections will damage the kidney.

There are considerable neurological risks in spinal surgery, so please treat these facts seriously and visit this link to study other people's experiences of spinal surgery. [April 2002 Please note that this link has now been taken down by the hospital no doubt because of the number of  patients who were complaining about their post-surgical condition. The hospital has now removed the patients' forums and have replaced it with a public relations page.] Here is a link from another spine forum: spineonline.com]

If you still wish to undergo surgical treatment then at least you  are now aware of  the risks involved, which we believe are totally unacceptable bearing in mind the fact that virtually all spinal operations result in failure of one kind or another.

Mr B M Luklinski

MSc Medical Rehabilitation
MSc Physical Education
Dip (Hom Med)

http://www.back-pain.co.uk