Surgery

Alternatives to Lumbar Disc Surgery



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Lower back pain is a common complaint in today's world. It is one of the most common reasons for a person to visit their doctor and is the most common reason for disability under the age of 45. The lower back is the lumbar region of the spine, from just below the ribs to the pelvis. Most commonly, pain in this region is caused through lifting heavy objects in an inappropriate manner.

The first and best alternative to lumbar disc surgery is prevention. While expecting people to avoid an initial lower back injury, or more often back strain, may be unrealistic, compounding that initial hurt to the extent where surgery might be considered necessary should hopefully be possible through understanding.

Lifting should be done by squatting in front of the object, taking hold, and raising it by straightening our legs. Bending over an object with our legs straight and trying to lift it, effectively using our lower back to do so, places too much strain on our lower back muscles and the lumbar discs of our spine. Particularly so if the object being lifted is at an angle to ourselves. Our lower back does not have anywhere near as much strength as our legs no matter how much exercise we do targeting that region; after all, our leg muscles are well exercised by both holding us up much of the time and transporting us around, whether we walk, run or even skip.   

While taking pain medication can alleviate the effect, it is VERY important to avoid lifting for three to five days to avoid compounding the problem. Unfortunately, many people who minimize the pain through pain medication seem to believe that that cures the cause of the pain. It does not! We will only increase the damage to our lower back by continuing to lift objects, even those we would normally consider to be relatively light. Placing additional strain on our lower back because we are not getting the pain signals that we would without pain medication, will just increase the damage that already resulted in our feeling pain in the first place.  

More serious injuries to this region are usually due to compaction events. This may be from dropping a significant distance onto our feet, perhaps due to an elevator failure where there is a sharp drop followed by an abrupt halt that crushes the spine together. While inappropriate lifting results in a chronic lower back pain problem, a compaction accident results in an acute back pain issue.

Both can result in serious health issues for the victim. And lower back pain accounts for more sick leave than any other cause in Western societies. The best treatment is avoidance. Learn to lift properly and avoid situations that may cause spinal compaction. Prevention is always better than cure for every medical condition.

However, if we have lumbar injuries that lead our doctors to recommend lumbar disc surgery, then we have some serious decisions to make. Any surgery is potentially problematical. An adverse reaction to the anesthetic can still kill patients, even today, although it is less common now. Surgery on any part of our spine has the potential to fail, hopefully that would just mean no improvement. But the worst case scenario is paralysis of our lower extremities, possibly confining us to a wheel chair for the rest of our lives.

Therefore, it certainly pays us to consider alternatives to surgery to determine if they are viable in our specific case. A study comparing conservative care to early surgery for sciatica, a syndrome of symptoms related to the sciatic nerve that frequently includes lower back pain, showed that while successful early surgery showed better results in the first six months, after two years there was no significant difference between the patient groups.

Another cause for lower back pain is osteoarthritis, a degenerative joint disease. Surgical procedures, such as disc excision and vertebral fusion, usually lead to a relief of intrinsic pain in the short term, but they may also alter the functionality of the patient's spine, leading to further degeneration of surrounding tissues and of neighboring discs. The failure rates for lumbar fusions are typically 20% to 40% after five years. Recent studies using a developed nitrogen-rich plasma-polymerized bio-material show positive indications for supplanting surgery by enhancing the hydrostatic shock absorption properties within spinal columns where it is reducing due to tissue deterioration.

However, this is not to say that ALL alternatives are better than surgery for an individual. Intradiscal steroids showed excellent promise initially in experiments that predominantly failed to utilize an effective control group. More recent studies indicate a minimal effectiveness except for patients that show modic changes on MRI scans and signs of end-plate inflammatory issues.

Whether lumbar disc surgery will ultimately be beneficial to an individual sufferer of lower back pain or not, is dependent on a significantly large range of factors. While it is best to avoid the issue in the first place, through the thoughtful use of our bodies, we may well be enticed by the promise of a quick fix. Before we take that quick surgical fix, however, it is most definitely in our best interests to consider our options and get at least a second opinion, if not a third!

Sources:

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

The Potential of N-Rich Plasma-Polymerized Ethylene (PPE:N) Films for Regulating the Phenotype of the Nucleus Pulposus.

The role of intradiscal steroids in the treatment of discogenic low back pain.


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