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Spinal Stenosis and Fusion Surgery

by Jesse Cannone(more info)

listed in back pain, originally published in issue 175 - October 2010

If you're suffering from chronic lower back pain and past your college years, you may want your doctor to check for spinal stenosis. But if your doctor suggests spinal fusion surgery you may want to think twice.

Spinal Surgeon
Spinal Surgeon


So first of all, what is spinal stenosis? Basically it's a narrowing of the spinal canal which can put pressure on the spinal cord and other spinal nerves. This happens most commonly in the cervical (neck) and lumbar (lower back) areas of the spine. Muscle weakness, numbness and lower back pain from lumbar spinal stenosis typically result.

Not everyone with spinal stenosis experiences back pain. That's a very good thing, since 1 in 5 adults have it by their 40th birthday. And nearly half of those who reach age 60 will have a narrowed spinal column. Yet that doesn't stop doctors from making surgery an alarmingly common outcome of a spinal stenosis diagnosis.

For decades, the fastest growth in lumbar surgery has been among older patients with spinal stenosis. Now a new study published in the Journal of the American Medical Association [JAMA] has acknowledged that the number patients with spinal stenosis receiving the most complex spinal fusion surgeries has skyrocketed in recent years.

When it comes to spinal stenosis surgery, the study found there were three basic categories of back surgery used (in order from least to most invasive):

  • Decompression surgery - bone is cut away from where it is pressing on nerves in the spinal canal;
  • Simple fusion surgery - two vertebrae are permanently fused together using a bone graft and possibly plates and screws;
  • Complex fusion surgery - three or more vertebrae are fused together and/or the vertebrae are fused on both the front and back of the spine.

Guess which type of surgery was used 15 times more frequently in 2007 than it was in 2002? The same one with the highest average cost at over $80,000 per procedure - complex fusion surgery.
One might hope that the more complex surgery is used because it has better results. No dice. 13% of patients are back in the hospital within 30 days. One in five need lower back surgery again within 10 years. Worse yet, risk of major complications like stroke and risk of death within 30 days of surgery are both double that of decompression surgery.

And in spite of all the talk about improved surgical techniques and new surgical implant devices approved since the mid-90s, the number of successful outcomes has declined. A study at the University of Washington found fusion surgery patients between 1997-2000 were 40% more likely to undergo a re-operation within the first year than they were in the 1990-1993 period. Not exactly progress.

Here's the bottom line. Spinal surgery - any spinal surgery - is extremely risky business and should be considered only as an absolute last resort. Fortunately it's rarely your only option for ending pain caused by spinal stenosis.

Most cases of spinal stenosis are simply a result of growing older, with a number of conditions contributing to its development including a herniated disc, osteoporosis, calcification over growth, and scar tissue build up. That means natural treatments for these are often successful at relieving lower back pain and other spinal stenosis symptoms.

One of the first places to start with spinal stenosis is nutrition. Most people actually get enough calcium, but to be used properly, you also need to ensure you're getting enough Vitamin D and magnesium which helps your body keep a proper balance of absorbed minerals. This will help with calcification overgrowth.

Scar tissue build-up is typically the result of chronic inflammation and excess fibrin. Your body eliminates both with proteolytic systemic enzymes. But since your body dramatically slows down the production of those by your mid-20s, you should consider taking a supplement with them.

Herniated discs are usually caused by unequal stress. Correcting muscle imbalances will help your body return to a neutral state to relieve pressure on the disc. And how about painless decompression without surgery? You'll love how you feel after using either an inversion table or the Nubax which offer the real benefits of decompression without going under the knife.

Finally, you should recognize that just because you may have spinal stenosis doesn't mean the pain is actually originating from your spine. 75% of all pain is actually referred from miniature trigger points deep in your muscle tissue, sometimes far from the site of pain. If the above natural approaches don't end your pain, try using a trigger point self treatment system. Chances are, you'll find pain relief without needing any type of surgery.

Comments:

  1. Bill Yancey, MD said..

    There are some great reasons not to have surgery, and only a few reasons to consider it. Surgery has a very limited role in the treatment of back pain. Although it is probably offered to patients more often than is necessary (this is, after all, how surgeons make their living), there are a few good reasons to have surgery.


    A small number of surgeons think the only way to cure a medical condition is with cold, hard steel. There are also some surgeons whose only interest in the patient is in the fee they collect; they collect more for doing surgery than for talking patients out of surgery. Honest, ethical surgeons give the patient options and honest opinions. The problem may be in figuring out who is being honest and who isn't.


    Most insurance companies, especially workers compensation companies, would prefer not to pay for surgery, or long term rehabilitation instead of, or following, surgery. The less they pay out for procedures or physical therapy, the more profit they make. Stock holders like that; patients don't. And if insurance companies can find a way to no longer be the financially responsible party, all the better. Keeping the above two paragraphs in mind, some times surgery is a necessity. Statistically, necessary surgery probably falls in the range of 5% of cases. In another 5% of cases surgery may be appropriate because it saves the patient healing time and time off work, even if it does not affect the eventual overall outcome. This means that in 90+% of back pain cases, surgery is not needed! All surgery has the potential for complications, from pain to numbness to paralysis to death. Think hard about your choices. In general, a patient needs surgery when surgery can save his life, repair an injury the patient’s body cannot, or shorten significantly the recovery from an injury or disease. When it comes to the lower back, there are five absolute indications for surgery, but several elective reasons. The absolute indications for surgery are the following:


    1. Cauda equina or conus medullaris syndrome. These situations happen when there is a very large central herniated disc that compresses severely the nerves in the lower spinal cord. Without surgery, the compression would lead to eventual loss of function of those nerves, paralysis of muscles, and/or loss of sensation.


    2. Intractable pain, i.e. unremitting, severe pain.


    3. Progressive neurological deficit, loss of sensation, proprioception, muscle control, etc.


    4. New incontinence or retention, bowel or bladder.


    5. Hemorrhage into the spinal cord. The relative indications generally center on the relief of discomfort (less than intractable) and the shortening of recovery time from various problems: herniated disk, compression fractures, severe stenosis, severe spondylolysis, and severe spondylithesis, etc. There are also several types of surgery: open, micro, and minimally invasive (and endoscopic). Open takes less time, usually. The surgeon has a better view of the surgical field, but more structures are damaged and recovery is longer. Micro surgery takes longer; the field of view is smaller, but fewer structures are damaged and recovery is shorter. Minimally invasive surgery, in general, takes the longest; is the most difficult; has the narrowest field of view, but the shortest recovery time.


    There are trade-offs. Get the surgeon to explain them all to you. If he can't or won't, find another surgeon. If someone uses the words, laser surgery, he is trying to impress you. Nothing more. Lasers have their place in surgery -- usually cauterizing blood vessels. Very little surgery is done with a laser. A laser produces too much heat. Laser is a buzz word only. And the person using it is a salesman first -- surgeon second. He wants your money; he's not concerned with your best interests. Bill Yancey, MD Whatyourdoctor dot b l o g s p o t dot c o m


  2. THOMAS O'kEEFE SR. said..

    I have been diagnosed with lumbar spinal stenosis. My family dr. recommends seeing a spinal surgeon to recommend surgery. I had tremendous stiffness in my legs which would not allow me to stand straight or walk correctly. I did some research 2 days ago Vitamin d3. I started taking 8000iu.a day. The pain in my legs have disappeared. I don't want to keep this appointment with surgeon. Your thoughts.
    mosey60@yahoo.com


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About Jesse Cannone

Jesse Cannone CFT CPRS. Fitness and Rehabilitation expert, together with Massage therapist Steve Hefferon co-founded The Healthy Back Institute in 2001 and is the author of The 7 Day Back Pain Cure. Jesse has helped many people achieve their weight loss and fitness goals through his articles, books, audio programs, videos, and seminars. In addition to being a certified fitness trainer, Jesse holds many other certifications, including Post-Rehabilitation Specialist, Specialist in Performance Nutrition, and Master Fitness Trainer. He may be contacted via jesse@gethealthyandfit.com; www.losethebackpain.com

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