Posts in Chiropractic News

Injecting fat into discs

Written By davecasey6719@gmail.com, On April 30, 2014

Surgeons are injecting the spine with fat from patient’s stomachs in ‘promising’ new treatment for chronic back pain

Damaged discs are one of the most common causes of chronic back pain

Surgeons are injecting fat cells into the discs in the spine, damaged discs are one of the most common causes of chronic back pain.

The fat stored around the abdomen is rich in stem cells, which have the ability to develop into different types of tissue, and the theory is that injecting them into the spine will help “repair” the discs. One of the biggest problems seen by chiropractors is degenerative disc disease.

Around one in four people will suffer disc problems at some time in their lives.We are always told the discs work as shock absorbers to cushion the spine during movement, but this is not true in fact they only allow flexibility and prevent the bones of the spine from rubbing together. They are very poor at absorbing “shock”.

The discs continue to degenerate throughout our lives, which means they provide less cushioning .

Chiropractors can control discomfort seen with damaged discs but often the damage is too extensive and then  surgical procedures are the last resort, all too often this ends up just fusing the discs together or trying to replace problem discs.

Over recent decades there has been the hunt for the surgical “holy grail” that surgery can replace or repair the discs. To date surgery has not succeeded in this quest.

This latest attempt hopes to stop the body’s immune system rejecting chemicals, that were once used in previous attempts at restoring the cushioning properties of the discs.

The new treatment is different, as it’s designed to repair any damage and protect against future degeneration.It involves first taking fat from the patient’s abdomen using liposuction. This can be done under local anaesthetic. Around 100 millilitres (a fifth of a pint) of fat is removed.

Until recently fat like this was discarded as surgical waste, but it is now known to contain many types of cells, including stem cells.The theory behind this new treatment is that the stem cells will be attracted to areas of damage and start repairing them.

Stem cells can be obtained from bone marrow, too, but extracting them involves an uncomfortable procedure which yields only 5,000 to 60,000 cells.

A 20-minute liposuction session from the abdomen can harvest 40 million cells.The stem cells are extracted from the fat in a laboratory and can then be injected into the damaged discs.

When researchers at the Mayo Clinic in the U.S. tested it on animals, they found that the height of the discs improved by 26 per cent compared with those injected with a placebo.

In addition, the water content of the inner section of the disc improved.A higher water content helps keep the gel-like middle moist and better at cushioning the spine from damage.

The treatment is being tested on 100 patients at three centres in the U.S., including Flower Hospital in Texas.

The patients will be monitored over the next few months. Jane Tadman, from Arthritis Research UK, says stem cells offer ‘a promising source of cells with which to treat degenerative disc disease.

However  we should focus on treatment that  attempts to maintain a healthy spine in the first place and avoid surgery completely. Even with new surgical techniques surgery will never be the main treatment for the vast amount of low back pain patients to date surgery is only used in a small number of back pain patients and does carry significant risks.

 

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BACK PAIN CLINIC MARKET HARBOROUGH

Written By davecasey6719@gmail.com, On March 29, 2014

HARBOROUGH BACK PAIN CLINIC

It is important that you follow up with regular sessions to ensure the back pain is kept under control.

Living a life without back pain is possible with the help of your  chiropractor.

About Back Pain Treatment in Market Harborough

Back pain is a common ailment. Most people suffer from simple or non-specific back pain, which is often put down to being caused due to minor injury or strain and this is simply not always true. Often back pain is due to accumulated damage and can never be completely cured.

Types Of Back Treatment in Market Harborough

There are various methods for relieving back pain such as mild activity, taking bed rest, heat therapy and ice therapy. Chiropractic has become the treatment of choice for back treatment that identifies the cause of back pain and then increases or restores the potential for movement to help overcome it. Many people find this is an effective way of easing joint and muscle pains.

 

 

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Lumbago

Written By davecasey6719@gmail.com, On March 21, 2014

Lumbago

Lumbago is just an old term used to describe pain in the lower back

Lumbago is another term for low back pain a condition experienced by up to 80% of people in the industrialised Western world at some point in their lives. The term first appeared in the 1600s, then used mainly by doctors. It became more popular amongst the medical profession and was widely used even in the 1960s and 70s. Lumbago is a meaningless term often used by GPs to give an instant diagnosis, just as the term slipped disc is meaningless, both terms have no place in the modern world and only serve to confuse patients even more.

The term lumbago is derived from Latin – with lumbus meaning loin. Hence, lumbago means ‘weakness in the loins’ (which does conjure up a number of visions), or alternatively, ‘weakness in the lower back’ which is a more accurate description.

We commonly consider lower back pain to be a modern-day phenomenon and indeed, it appears that the sedentary lifestyle enjoyed in our civilised world may contribute to the problem. However, the fact that lumbago was described in the 1600s suggests that our ancestors also suffered back problems.

It is likely however, that in those days, it was not a lack of exercise or bad posture that contributed to the problem, but rather, degenerative conditions such as arthritis.

 

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Should I take paracetamol for back pain or see a chiropractor

Written By davecasey6719@gmail.com, On March 12, 2014

Painkiller paracetamol’s ‘link to liver failure’

BRITAIN’S most popular painkiller is at the centre of a major health scare over fears it can cause liver failure and death.

Health regulators are to limit the amount of paracetamol in prescription medicines because of soaring cases of liver damage.

Paracetamol – also known as acetaminophen – is highly toxic to the liver if taken in excessive amounts and even more dangerous at the larger doses found in prescription combination drugs. But if taken with a second over-the-counter drug that already has high levels of paracetamol, it can kill. Paracetamol is often found in cold and flu medicines without realizing people are overdosing on a regular basis.

Now the US regulator, the Food and Drug Administration, has announced it will cap the amount of paracetamol in drugs at 325mg per capsule instead of the current 500mg. Some prescription medicines in America contain as much as 750mg of paracetamol.

In Britain, prescription-only and over-the-counter paracetamol tablets are limited to 500mg. People are warned not to take more than two 500mg pills in four hours and no more than eight in 24 hours. Taking more could lead to acute liver failure.

You only need to take one or two extra tablets to cause liver damage. In some cases just 10g of the drug – or 20 tablets – has been linked to overdose and liver damage. Sudden liver failure, which can be caused by the drug, can lead to the brain rapidly swelling often giving doctors little chance to save people. Just days ago it emerged that ibuprofen painkillers cause an increased risk of strokes in heart disease sufferers.

In 2009 1,198 deaths were put down to adverse drug reactions –up by almost 100 on the previous five years. Paracetamol was linked to 33 deaths in 2009.

One in 20 adults regularly take at least six painkillers when ill. ­Britons each consume an average of 373 painkillers every year.

Sandra Kweder, from FDA’s Center for Drug Evaluation and Research, warned: “Patients taking these prescription products often do not know they are taking paracetamol  at all. They don’t realise that they’re overdosing.”

The change in dose will be phased in over three years.

A spokeswoman for UK regulator, the Medicines and Healthcare Products Regulatory Agency, said:  “In response to concerns about the risks associated with overdose, we have put in place a number of risk minimisation measures in the UK aimed at reducing the risk of liver damage following deliberate or accidental overdose from paracetamol.”

WOMAN ‘KILLED BY HEADACHE PILLS’ 

Healthy Sharon Loughran, 45, died after accidentally overdosing on paracetamol. At her inquest in 2009, South and East Cumbria coroner Ian Smith warned of the dangers of overusing the drug. Mrs Loughran suffered liver failure after regularly taking two or three pills. The sudden liver failure led to her brain swelling and gave doctors no chance to save her. Her husband Craig told the inquest how she was generally fit and healthy, but suffered frequent headaches..

A forensic expert reported that going beyond regular doses would cause liver failure.

  • More than half of prescriptions given to children were wrong, study found

Parents often give their children Calpol or similar medicines containing paracetamol at home before going to a GP who prescribes another painkiller.  One in four babies is being given too much paracetamol by ‘over-confident’ GPs and parents, a major study claims.

Experts warn that in these cases, too much of the painkiller can cause liver damage.

The study found that parents often give their children Calpol or similar medicines containing paracetamol at home before going to the GP who then prescribes yet another painkiller.

It said 22 per cent of babies aged between one and three months had been given an overdose of paracetamol over a 12-month period, with another 5 per cent who were likely to have been given an overdose.

Official guidelines state that babies aged between three and 12 months should be given no more than 240mg of paracetamol a day – the equivalent of just two teaspoons of Calpol.

But the researchers warn that  many parents will give babies half a  teaspoon every few hours on top of another painkilling medicine prescribed by their GP, which is far too much.

Astonishingly, the research also found that 15 per cent of medicines handed out had  not come with any instructions saying how much should  be given.

Dr James McLay, one of the study’s authors, said parents and GPs were ‘over-confident’ in prescribing paracetamol.

Dr McLay, from the department of medicine at the University of Aberdeen, said the study was the first to describe the patterns of paracetamol prescribing by primary care physicians in the community. He added that it was worrying to discover that just over half of the prescriptions failed to comply with basic recommendations on dosage amounts from the British National Formulary for Children..

There have been some reports of children prescribed too much paracetamol suffering liver damage.

In a study, a team led by Dr Kenneth Simpson analysed data from 663 patients who had been admitted to the Edinburgh Royal Infirmary between 1992 and 2008 with liver damage caused by paracetamol.

They found 161 people with an average age of 40 had taken a staggered overdose, usually to relieve stomach and back pain, headache or toothache.  Back pain is the most common pain full condition experts are concerned how often back pain patients self-prescribe painkillers without knowing the dangers. Treatment such as chiropractic should be used more often than just self-prescribing painkillers.

Two out of five seen in the study died from liver failure – a higher fatality rate than recorded for deliberate overdosing, says a report in the British Journal of Clinical Pharmacology.

Dr Simpson, of Edinburgh University and the Scottish Liver Transplantation Unit, said staggered overdoses can occur when people have pain and repeatedly take a little more paracetamol than they should.

He said: ‘They haven’t taken the sort of one-off massive overdoses taken by people who try to commit suicide, but over time the damage builds up and the effect can be fatal.

‘They are often taking paracetamol for pain and they don’t keep track of how much they’ve consumed over a few days.‘But on admission, these staggered overdose patients were more likely to have liver and brain problems, require kidney dialysis or help with breathing and were at greater risk of dying than people who had taken single overdoses.’

Hospital doctors may find low levels of paracetamol in the blood of people suffering from staggered overdoses even though they are at high risk of liver failure and death. Dr Simpson said some people reacted worse to a lower dose than others, with high alcohol consumption exacerbating the problem – and it was not possible to identify them in advance.

He said 10g was the lowest amount in the study leading to death while 24g over 24 hours was a recognised fatal dose.

‘The safest thing to do is monitor how much you’re  taking and do not exceed  eight 500mg tablets in a day,’ he said.

Normal quantities of the drug are broken down harmlessly by the body but excessive amounts can accumulate in the liver, leading to irreversible damage.
Paracetamol is one of the most common painkillers we use — every day thousands of packs are sold in supermarkets and chemists, and it’s our favourite remedy for dealing with a headache.

Desiree Phillips a 20-year-old single mum died last August of acute liver failure caused by paracetamol poisoning.

In pain after an operation to remove non-cancerous lumps in her breasts nine days earlier, Desiree was recovering at home, taking ‘a few more’ tablets than the recommended maximum daily dose of eight 500mg tablets, when she was found unconscious and rushed back to hospital.

She underwent a liver transplant but it was not successful.

Paracetamol had built up in her body without anyone noticing — the drug produces a by-product known as NAPQI, which attacks the liver. As it gradually accumulates, it can result in a ‘staggered’ overdose.

Last November, a medical journal published research showing that just a few extra paracetamol daily can be fatal and that a staggered overdose is much more likely to be fatal than a deliberate one

The Government is rightly concerned about the effect of binge drinking on our livers — hence David Cameron’s campaign to introduce minimum pricing of alcohol —

 but overdosing on paracetamol, not booze, is the most common cause of acute liver failure in the UK.

Yet still the National Health Service say there’s no cause for concern. Millions of us use the drug with no side-effects. But when you are in chronic pain — the elderly with aching joints or a workaholic suffering from repetitive headaches — more and more of us think: ‘To hell with the stated daily dose, I’ll just take a couple more.’

I’ve written before about the dangers of addiction to over-the-counter drugs such as Nurofen Plus, but paracetamol .There are no checks when you buy a packet of paracetamol, unlike codeine. That needs to end.

All painkillers should be carefully controlled — because we have become a nation of massive pill-poppers. An ageing population is being handed huge amounts of prescription drugs to deal with arthritis and spinal degeneration. These drugs are often supplemented with over-the-counter preparations which no one is monitoring.

The number of people addicted to non-prescription painkillers is soaring and still the Government doesn’t intervene. Now, there’s a new danger — 39,000 packs of co-codamol, containing paracetamol and codeine, which are  three times stronger than the dose stated on the packet, have gone on sale by mistake.

A spokesman for the UK medicines regulator said: ‘If you feel you have taken the wrong strength tablet, and in the unlikely event you feel unwell, speak to your GP.’ That sounds pretty complacent to me.

 

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Back pain test ‘aids diagnosis’

Written By davecasey6719@gmail.com, On March 10, 2014

Back pain test ‘aids diagnosis’

A simple technique could help differentiate patients with different causes of back pain.  Test commonly used by chiropractors in their offices are seen to be valuable aids to diagnosis. Researchers have devised bedside tests that distinguish between neuropathic pain (nerve damage) and other causes of pain. It said the tests are better than existing tests for neuropathic pain. The different causes of pain have different treatments and the researchers say, “if a diagnosis is wrong, patients may receive treatment, including surgery, that does not improve their pain”.

This study indicates that a simple, quick diagnostic procedure can distinguish between the most common cause of back pain (axial) and pain caused by nerve damage (neuropathic). As the treatment for these can be very different, this is potentially a very useful tool. As a chiropractor we see misdiagnosis all the time, most patients are just managed with pain relief without any attempt made to locate the actual cause ofr pain.

Where did the story come from?

The research was carried out by Dr Joachim Scholz from the Massachusetts General Hospital in Boston and colleagues from other institutions in the US, UK and Switzerland. The work was supported by a grant awarded by Pharmacia through The Academic Medicine and Managed Care Forum, with supplementary support from Pfizer. The study was published in the (peer-reviewed) medical journal PLoS medicine, a free journal from the Public Library of Science.

What kind of scientific study was this?

This was a diagnostic test validation study. It had two parts, the first of which involved the researchers devising a set of questions and bedside tests for distinguishing between two different types of back pain: neuropathic and axial. These diagnostic ‘tools’ were then tested on a separate group of participants to measure their accuracy.

Neuropathic pain is caused by damage to the nerves and is often difficult to formally diagnose. Sufferers commonly describe it as a ‘burning’ or ‘stabbing’ pain. A common form of neuropathic pain is ‘radicular’ low back pain, also called sciatica, which comes from a ruptured or bulging  disc and radiates from the back into the legs. The researchers compared this to the most common type of low back pain, ‘axial pain’, which is confined to the lower back and is non-neuropathic (not caused by nerve damage but is due to damage to joints, muscles or other tissue.

What does the NHS Knowledge Service make of this study?

Diagnostic studies such as these are rarely reported in the news, though they form an important part of developing any potential test.  There are a few points to consider about this study:

  • The researchers also looked at the accuracy of the individual examination signs that make up the tool and showed
  • that the best tests were tests for radicular pain known as a straight-leg-raising sign,
  •  a test for detecting cold, and a reduced response to pinprick test.

    These findings indicate that a simple, quick diagnostic procedure can distinguish between radicular (neuropathic) and axial (non-neuropathic) low back pain in the selected group tested. Because the two types of back pain are treated in different ways, this is important when deciding who to refer for further tests such as an MRI scan.

    The use of these tests routinely in chiropractic surgeries has been valuable and prevents over use of MRIs and surgery in the treatment of back pain.

     

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Spinal operations

Written By davecasey6719@gmail.com, On March 2, 2014

Back pain has become something of a modern epidemic in our desk-bound, sedentary society, with 80 per cent of adults experiencing it at some time or another, and a third of the population suffering from it regularly.

Many GPs can offer sufferers little more than pain relief, which has led to great demand for chiropractors. Easing yourself into normal activities with the help of painkillers and anti-inflammatories is what most GPs recommend and, for most people, this will curb the pain however without identifying the cause. If the pain doesn’t go you need expert help, increasingly patients are turning to chiropractors who have become the experts of choice in such cases as patients realise that they cannot just take painkiller repeatedly without suffering the consequences in the future.

” Chiropractors offer treatment as part of a whole spectrum of treatments that are effective for musculoskeletal conditions.  Chiropractors in this country undergo an extensive five university degree based on medical training in musculoskeletal conditions and are a closely regulated profession with very high standards.  After university they  must also complete a programme of further education every year in order to be allowed to stay on the register of the General Chiropractic Council. Any chiropractor who is not on the register is practising illegally.

Chiropractic treatment combining manipulation with the latest rehabilitation techniques has a proven track record, so why doesn’t everyone with back pain just go to their local chiropractor. Back pain is incorrectly perceived as a transient injury that will heal itself after taking a course of painkillers, wrong. With back pain at epidemic levels this can simply not be true. Many people do not understand what chiropractors actually do, most people still believing that they manipulate bones into place.  Whatever the real or perceived risks, for many people with back problems,  chiropractic is  a proven way of alleviating and managing debilitating pain. So why don’t studies reflect this?

Because osteopaths and chiropractors tailor their treatment to individual patients, it is difficult to conduct accurate clinical trials, as no two individuals are the same, says Robert Lever, professor at the European School of Osteopathy in Kent.

People often come to chiropractors on personal recommendation and word of mouth, not because of reviews in medical journals. The bottom line is that they are interested in results.

People often don’t appreciate their medical training and that they are qualified to use X-rays and other special imaging, just as spinal surgeons can. In some cases, as you see with spinal surgeons, chiropractors will use similar X-ray and MRI images to diagnose why patients are in pain.

Unfortunately MRI and CT scans – usually the first step in trying to identify the source of back pain – are notoriously unreliable in providing useful answers. For many decades now the use of MRI scans and X-rays have been shown to present an inaccurate picture for back pain. Because the majority of back pain is due to functional dysfunction and not related directly to structural abnormalities of the kind shown with spinal images.

It should only be once  these conservative measures fail that a spinal surgeon should be considered as a last resort. Even then, it’s seldom the quick fix that patients pin their hopes on, and some surgeons warn that over-treatment, particularly in private practice, is all too common. Research studies have often suggested surgery is over used and has more outcome too often.

‘A lot of people without back pain have a bulging disc on an MRI scan — so you can’t automatically link this to the patient’s pain,’ says Paul Thorpe, spinal surgeon at Musgrove Park Hospital in Taunton.  ‘Also, painful muscles and ligaments look perfectly normal on a scan  and yet this may be the root of the problem”.

It is very difficult to take a picture of a spine that simply is out of condition and weak, only a physical assessment can achieve this and this is where the skill of a good chiropractor can come into play.

Spinal surgeons are drawn from two specialty areas – neurosurgery and orthopaedics. ‘The margins between them have now blurred,’ says Mike Hutton, a spinal surgeon at Royal Devon & Exeter Hospital in Wonford. ‘But those from orthopaedics are the carpenters. They deal with deformity in the spine, such as scoliosis (curvature of the spine). ‘Those from a neurosurgical background are the electricians, they deal with more specialised surgery involving the nerves of the spine.’

Both operate on some of the most common back complaints, such as a  ruptured disc where  fragments of the disc are removed to stop it pressing on the nerves.

Another common back operation is spinal fusion where two segments of the vertebrae are effectively welded together (for instance to reduce the pain of arthritis), and decompression surgery where the overgrowth of bone in the spine is removed to stop it squeezing nerves.

Surgery is only used in 1-2% of all back pain cases, 99%  of back pain sufferers as a whole need other solutions to their back pain.

Back pain is a common affliction, frequently blamed on degenerative change even though this develops inexorably during life so that nobody by middle age has escaped it; yet for many, pain is an infrequent visiter. Any spinal expert will admit that they cannot predict why you are pain with 100% confidence, it simply is not possible even with all the advances made in modern medicine.

Interfering with a structure about whose function we are so profoundly ignorant, is surely not sensible but to date no specific treatment has proved to be the best.

Here are some patients reports.

I had a fusion about 21 years ago, because one of my vertebra crumbled – I was very lucky that at the time, they used some of my hip bone to do the fusion so no screws or metal work – my back is now stronger than ever and I Zumba 4 times a week and keep myself at my proper weight – I must admit, its not for the faint hearted, but if you are truly suffering with back pain, go and see someone. I lived on pain killers and anti-inflammatories for about 3 yrs before the surgery had to be done and I have stomach ulcers now because the pills were so strong.

Try and find out the cause of the pain seek out a good chiropractor and stick with them as they will try and identify the cause and try exercise, combined with manipulation to improve  muscles that  can support your back. Be realistic don’t expect miracles they don’t exist. Back pain has to be managed not cured if you can accept that you won’t be disappointed.

Having suffered with Degenerative Disc Disease of the neck and lumbar spine since the age of 22 (I worked on construction sites levelling and setting out) I finally underwent a C5/6 prestige disc replacement in August 2007 (Aged 36). Pain is still horrendous, movement of the neck to the left is severely limited, Peripheral nerve damage has since been identified. Am unable to drive, unable to walk, and have had to give up my precious job. Think VERY CAREFULLY before you undergo any surgery of this type. You may, like me, end up with a very poor quality of life, post surgery.

Spine Surgery Found No Better Than Placebo

In the past decade, a low-risk technique for repairing fractured bones in the spine has surged in popularity, to an estimated 100,000 operations last year in the U.S. But in the first two studies to rigorously examine the effect of the procedure, known as vertebroplasty, researchers found no detectable benefit when compared with a placebo group of patients who received a sham procedure that only mimicked the real thing.

It was the latest of several cases in which a popular medical procedure has been called into question by independent studies.

The results are likely to stir further debate about assertions—heard often in the Washington debate over health-care legislation—that unnecessary or relatively ineffective medical procedures are contributing to soaring costs. The American healthcare system different to UK but concerns exist.

“Vertebroplasty should not be done any longer, unless it’s in the setting of a study,” said Jeffrey Jarvik, of the University of Washington, who served as the senior author on one of the studies, which was funded by the National Institutes of Health.

The results, published in the New England Journal of Medicine, will also focus more attention on “comparative-effectiveness” research studies that aim to assess the benefits of different treatments already on the market.

“If we’re going to institute health-care reform, there’s rigorous evidence that [vertebroplasty] doesn’t work any better than a control intervention, and we should stop paying for it.”

The federally funded study signed up 131 patients in the U.S., Britain and Australia. Half of them received a vertebroplasty, in which the back is numbed, an injection is made into the vertebra, and bone cement is injected by a radiologist or spine surgeon to shore up a fracture. The other group of patients received a sham procedure, including the numbing, but no injection. The doctor opened the container of bone cement so its scent would fill the operating room to disguise whether these patients were receiving a real surgery or not.

After a month, both groups saw a substantial reduction in various measures of disability and pain, assessed by a questionnaire. But the reductions were a statistical tie—the actual procedure yielded no gain beyond the placebo effect of the sham surgery.

A separate study, including 78 patients and conducted similarly, was funded by the Australian government and Cook Medical Inc., a U.S. manufacturer of bone cement. It reached a similar conclusion: Vertebroplasty didn’t relieve pain any more than the sham surgery, measured three months later.

The results follow a 1999 loosening of regulations concerning the marketing of bone cement. In that year, orthopedic makers persuaded the Food and Drug Administration to downgrade the classification of bone cement to a low-risk regulatory category that doesn’t necessarily require clinical trials to show a product is effective at what it claims to do. At that time, the cement was sold to attach prosthetic joints to the bone, such as in the knee or hip.

Five years later, the FDA allowed makers of bone cement, including Stryker Corp., Johnson & Johnson and Cook, to market their products for use in a vertebroplasty—without a prosthetic, and without needing a controlled clinical trial that vertebroplasties are effective.

An FDA official said the agency’s decision was based on previous use of bone cements to fill in fractured bones. “We determine it’s not so extremely different that it’s outside the box,” said Heather Rosecrans, who directs the agency’s review of such devices.

Stryker and J&J declined to comment. Cook pointed to the small number of patients in each of the latest trials. “Bottom line is that more data, more research needs to be done here,” said Daniel Sirota, global business unit leader at Cook.

Other findings that have questioned established treatments included a large 2002 study that found no benefit to two popular knee surgeries, compared with a sham treatment.

Is back fusion surgery just a placebo?

It is possible that spine fusion surgery for back pain achieves its effectiveness through the placebo effect. The case that it is not only possible, but also probable has been discussed.

Background

Spine fusion can be done for many reasons, but the most common reason is degenerative conditions in the lumbar spine. Yet there is very little evidence that spine fusion surgery for back pain is effective. It is very expensive (the implants alone are often in the tens of thousands per case), often leads to complications, often requires further surgery, is associated with increased mortality and often does not even result in the spine being fused. That last one is not a big deal, because the results of the surgery are not well correlated with whether or not the spine fuses. Nor are the results related to how you fuse the spine, or whether or not you use implants (screws, rods and cages), except that “instrumented” fusions (using implants, which is now routine) are associated with more complications.

The rates

The rate of spine fusion surgery is increasing and has been increasing for many years. Data shows that in the USA, the rate has gone a long way past the rate of 1 spine fusion per 1,000 population per year. The rate has already overtaken hip replacement surgery and continues to rise. The rates of surgery vary widely across the USA, where back fusion is associated with the highest degree of practice variation. The US rates are far higher than most other countries, but the rates in many of those countries are increasing too.

The evidence

Three randomised clinical trials have been published comparing surgery to non-operative treatment for back pain. There have been no sham surgery trials, but the evidence from these three trials indicate that this surgery might achieve its results through the placebo effect.

Two of the studies put spine fusion surgery up against structured non-operative treatment alternatives: cognitive behavioural therapy and intensive rehabilitation in another. These studies found no significant differences in the outcomes between the operative and non-operative groups (except that the complication rate in the surgical group was higher).

The third study concluded that the surgical group did better. Interestingly, the surgical group didn’t do any better than in the other studies; the difference was that the non-operative group didn’t get better at all. This is because the non-operative treatment was not dressed up as something that might work (i.e., it wasn’t a good placebo). The authors state that the non-operative treatment “could vary within broad but commonly used limits reflecting the nonsurgical treatment policy in the society”. Patients were basically given more of the treatment that they had received before (the treatment that had previously failed and that led them into the study). Faced with more of the treatment that had already failed, this group was never going to get better – there is no placebo effect in doing nothing.

Spine surgery is not just a sugar pill; it is a much more elaborate placebo than that, and it is much more dangerous. The onus is on doctors to prove that spine fusion surgery for back pain is better than placebo before subjecting so many people to the risks of such major surgery.

 

 

 

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