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Failed Back Surgery Syndrome

By Dr. Gray

I have been in practice for 39 years; I have had tremendous success in fixing the cause of back, neck, arm, and leg pain.  As you might imagine I have seen some incredible, horrific back problems during the course of my career. Along with other pathologies that are not of my specialty, which affords me the opportunity to work closely with other disciplines. What I have seen more and more of late in my office are patients who have back, neck or shoulder pain that began pre-surgery and is still with them post-surgery and post physical therapy.

Let me say this up front; I am not a Chiropractor who believes every ailment and situation can be healed by an adjustment. I have always worked closely with ethical Neurologists, podiatrists, pain clinics, dentists, etc. I believe in a multi-disciplinary approach when clinical evidence dictates.

The definition of failed back surgery syndrome per Wikipedia is:

Failed back syndrome or post-laminectomy syndrome is a condition characterized

by persistent pain following back surgeries.

Failed back syndrome (FBS), also called "failed back surgery syndrome" (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery, usually after laminectomy. It is characterized as a chronic pain syndrome. Multiple factors can contribute to the onset or development of FBS. Contributing factors include but are not limited to residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.

Common symptoms associated with FBS include diffuse, dull, and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The term "post-laminectomy syndrome" is used by some doctors to indicate the same condition as failed back syndrome.

The treatments of post-laminectomy syndrome include physical therapy, minor nerve blocks, transcutaneous electrical nerve stimulation (TENS), behavioral medicine, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intrathecal morphine pump. Use of epidural steroid injections may be minimally helpful in some cases. The targeted anatomic use of a potent anti-inflammatory anti-TNF therapeutics is being investigated.

So why does the surgery actually fail? I submit the surgery probably did not “fail”, but that it was unnecessary because it did not fix the cause.

Did the 6-8 weeks of physical therapy fail? Again, I believe the wrong protocol is to blame.

A special report on June 20, 2013, featured by USA Today, titled “Under the knife for nothing” is filled with information that will help you determine whether a surgical procedure is a good idea.

“Tens of thousands of times each year, patients are wheeled into the nation’s operating rooms for surgery that isn’t necessary, a USA Today review of government records and medical databases finds.     “Even more turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided, either because the medical facts don’t warrant it or because there are non- surgical treatments that would better serve the patient. “

The article specifically names “spinal surgeries” As one of the six procedures that are often unnecessary.

The problem with “failed surgery” is not that the surgeon didn’t do what he or she said they would do, it’s because they “failed” during diagnosis, the Triage phase of the assessment of the patient’s pain. It’s the protocol that’s followed when a patient presents with back, leg, neck, or arm pain. The protocol is the same for every patient, NSAIDS, PT, stronger meds, more PT, MRI, Epidurals, ablation, surgery then back to PT. What is missing in this circle of treatments? The Chiropractor! The profession that specializes in the correction of spinal misalignments. 

 After the roundabout with the surgery cycle, some are finding the pain is still there and sometimes worse. So now you have wasted up to 6 months and are still in pain, at which time you are sent back to the MD who schedules you for more surgery.

Another source investigating back surgery results is: From the Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Milford, OH; Meharry Medical College, Nashville, TN; and Department of Physical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, KY.

They advised; “Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses. After two years, only 26 percent of those who had surgery had actually returned to work.   Another way of saying that is that this form of back surgery FAILS 74% of the time.   However, 67 percent of patients who had the same exact diagnosis, but DIDN'T have surgery, DID return to work. Statistically, this means you are TWICE as likely to return to work if you DO NOT get surgery.

In another troubling finding, the researchers determined that there was a 41 percent increase in the use of painkillers, particularly opiates, in those who had the surgery. Last year we reported that deaths from addictive pain killers have doubled in the last 10 years. “The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work”, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

The authors of the USA Today article interviewed Nancy Epstein MD, neurosurgeon and chief of Neurosurgical Spine and Education at Winthrop University Hospital in Mineola, N.Y. She was an investigator in the Surgical Neurology International study. In the USA Today website, the article is accompanied by a video which Dr. Epstein is featured saying, “Over the course of the year I looked at patients with neck and back complaints coming in who were told they needed surgery and out of those, at least a third…were scheduled for operations I didn’t think they needed.”

 It is our opinion the Chiropractic profession should be one of the first referrals, or protocols in a triage or diagnostic situation regarding spinal surgery and many shoulder surgeries to. A Chiropractor who has experience with these highly complicated cases is best suited to fix the issues without invasive, life threating costly procedures. A few MD’s have begun to refer to the Chiropractic physician as they have started to recognize the benefit to their patients. Chiropractic has a very high rate of successful treatment for spinal pain conditions. Much more needs to be done to bridge the gap between the MD's and the DC's. The MD's we work with seem to have originated from the common patient and their impressive improvement after treating with us and advising their MD's they no longer need the surgery. 

 Dr. Gray has successfully helped thousands headed for surgery avoid it, he even has a high success rate helping those still in pain after a “failed” spinal or shoulder surgery. The high success rate at our practice is due to the individual whole-body approach. Dr. Gray’s patients undergo a lengthy history, including the three main causes of trauma, physical, emotional, and environmental.  Diagnostic x-rays are used to confirm involved areas. Patients are then specifically treated to fix the cause of the pain. NO two patients are the same and each are treated specifically to correct the cause of their pain. The treatments are painless. Follow up treatments are necessary to stabilize the involved regions.

If you or someone you know has been advised to have shoulder or spinal surgery or if you’re in pain and you would like to have a Chiropractic consult, please call our office at 321-622-6778.





Donald Petersen Jr., BS, HCD(hc), FICC(h) Dynamic Chiropractic Aug 15, 2013


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