First, a few interesting quotes:

The July, 2004 issue of "The BackLetter" published by LIPPINCOTT contained this interesting phrase: "The world of spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate." (Vol. 12, No. 7, pp.79)

Allan and Waddell( A Historical perspective on Low Back Pain and Disability, Acta Orthopaedica Scandinavica Supp. No. 234, Vol. 60, 1989) reviewed the history of medical management of LBP. Their conclusions were rather embarassing to the medical profession. They concluded that, "medicine's whole strategy of management has been negative, based on bed rest . . .," meaning that bed rest really does NOT work. They also spoke of the numerous approaches to low back pain that medicine has taken, few of which work. "Bone-setters, like their decendants osteopaths and chiropractors today, continued to treat the common everyday aches and strains for which orthodox medicine has no good answer and only equivocal interest." All of which is to say, that manipulation is an effective treatment for low back pain. They continued with the following indictment: ". . .the rapid and enthusiastic expansion of disc surgery soon exposed its limitations and failures. It was accused of leaving more tragic human wreckage in its wake than any other operation in history."  In a related article, Waddell went on to say, "the concept of disc lesions was soon extended, particularly by orthopedic surgeons who were keen to re-establish their role in low back disorders."

Waddell concluded in the orginal article: "Sadly, we must conclude that much of low back disability is iatrogenic . . ." That means, "caused by the doctor." His own landmark book on the subject, "The Back Pain Revolution," 2nd Ed., 2004, Elsevier Ltd. concluded that "Back pain was a 20th Century medical disaster and the legacy reverberates into the new millennium."

So where does that leave us now? I always urge my patients who are thinking about back surgery, to please exhuast the conservative avenues of treatment first. There is no documented case that I am aware of, that shows a patient suffering needlessly due to conservative care BEFORE back surgery. Chiropractors are the leaders in innovative, safe, effective techniques for reducing low back pain (LBP) through non-surgical means. While we don't claim to have every answer to every back pain issue, but we do recommend a consultation with a chiropractor before getting surgery. It may turn out that surgery is the only option; then again, there may be conservative therapies that can help, depending on the medical issue. Consider the following:

>   In the landmark 1981 study by Burton and Kirkaldy-Willis (Causes of Failure of Surgery on the Lumbar Spine, Clinical Orthopedics, Vol. 157, 1981), the phrase "Failed Back Surgery Syndrome (FBSS)" first gained expression. The authors concluded that the most common surgical reason for poor post-operative spine surgery was failure to either adequately diagnose or treat a condition called "lateral spinal stenosis." Many herniated discs have this same condition as an ancillary issue. Bizarrly, 20 years later, this situation had not changed. Additionally, as of 2004, no other clinical studies had been published regarding the structural (anatomical) reasons for the very existence of this entity. Now, why in the world does this situation continue to exist, given that there are about 500,000 spine surgeries performed each year in the U.S? According to "The Burton Report," it is beyond comprehension why this is so. It has been posited that perhaps hidden agendas and personal gain are the reasons for the lack of study and investigation into this monumental failure of back surgery. Inadequate training may also be a factor.

Think I'm making this stuff up? Consider what the NY Times said on the Business/Financial Desk section, December 31, 2003; in an article written by Reed Abelson and Melody Peteresen called "An Operation to Ease Back Pain Bolsters the Botton Line Too." Abstract: Complex operation called spinal fusion has emerged as treatment of choice for many kinds of unrelenting back pain, with quarter of a million procedures perfomred this year in US; several researchers say there is little scientific evidence that spinal fusion, in which metal rods are screwed into spine, works any better for most patients than simpler laminectomy, in which same part of bone, lamina is removed but without hardware; photos, diagram; critics say difference is money, with surgeons and hospitals getting up to four times as much reimbursement; Medicare spent some $750M last year on spinal fusions; Medtronic, which makes spinal hardware, has been subject to charges of paying kickbacks to surgeons."

>  Fairbank F, et.al., "Randomized controlled trial to compare surgical stabilization of the lumbar spine with an intensive rehabilitation program for patients with chronic low back pain," Brit. Med. J., May, 2005. In this interesting study, it was determined that surgery may not be necessary for patients with LBP and degenerative disease. This study showed that patients with chronic back pain and disc degeneration can do just as well with an aggressive rehabilitation program as they can with fusion surgery. Alf Nachemson, MD, of Gothenburg University in Sweden, a famous and pioneering back researcher himself, said that the new study shows that all patients should underdo aggressive nonoperative care before even contemplating fusion surgery. Nachemson himself has been an outspoken critic of spinal surgery for decades. He has consistently stated in numerous articles and interviews that 99% of back surgery is unnecessary. This recent article by Fairbank is consonant with Nachemson's thinking.

> See also, Deyo, RA, et.al., "Spinal Fusion Surgery: the case for restraint," New England Journal of Medicine, 2004, 350: 722-6.

All in all, we recommend you consult with us or a chiropractor near you if surgery has been recommended. There may be conservative alternatives such as chiropractic care, rehabilitation, exercise, stretching, even diet available to individuals in lieu of surgery. The interesting fact is, if the conservative route, whatever you decide, doesn't help, you can always get the surgery later.

Think about it.