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Chiropractic Vs. Back Surgery

If you’re having low back pain and have questions about whether you should call a spine surgeon or a chiropractor in Greenville, NC there are some things you need to know first.

  1. The spine was designed to be mobile.

    Back Surgery

    1. This is hugely important when considering low back surgery. Surgery is certainly not a simple procedure however the overall concept is not complicated.
    2. When there is a disc bulge, low back surgery attempts to remove the disc and replace it with bone. When there is no disc, it completely immobilizes the joint but also can remove the current source of low back pain or more commonly radiating leg pain (sciatica) because the disc, which was removed is no longer putting pressure on the nerve. This assumes that nerve pressure from the disc is the ONLY cause of the low back pain and symptoms or sciatica. That, of course, is not always the case and one reason why low back surgery is often ineffective.
    3. After low back surgery, your spine will NEVER be normal. That does not mean that the low back pain or sciatica symptoms can never get better. It means that your spine is designed to move and when you cut out the disc allowing that movement and fuse it, you are going to likely cause other problems later on down the road. Most surgeons will tell you that once you have low back surgery, the question is not “if” but “when” you will have low back surgery again.

  2. Typically low back pain arises from a few basic problems.

    1. A DISC BULGE is when the disc, which is the main joint between two vertebrae, is damaged. There are a few different ways that the disc can bulge or be damaged and cause low back pain or sciatic pain.
      1. A disc bulge can put pressure on one of the two spinal nerves that are coming out of the vertebrae at any level.
      2. A disc bulge can put pressure on the spinal cord itself.
      3. A disc bulge or disc degeneration can cause pain due to the nerve fibers that are found in the end plate of the vertebra where the disc and the vertebra meet on the top or bottom of the disc.
        1. This is a common source of low back pain that is often unable to change during low back surgery. Because low back surgery often fuses the damaged disc and joint in place, it prevents the joint, which needs movement to heal, from moving and healing. Low back surgery is much more ineffective with low back pain symptoms caused by end plate damage than disc bulging and causing radiating leg pain from hitting a spinal nerve.
      4. SPINAL STENOSIS literally means “narrowing” of the spine in Latin. The question is “WHY?” Most commonly there are bone spurs (osteophytes) that grow on the vertebrae due to degeneration of the spine which is caused by abnormal stress on the vertebra. This abnormal stress is typical because the spine has shifted out of place, i.e. scoliosis, anterior head syndrome (a.k.a. gooseneck or forward head posture). When your spine is not balanced and is in an abnormal position instead of its normal position, there will be more stress on the bones. Your muscles have to work hard to hold an object when it is farther away from your body than when it is close. Similarly, when your spine is shifted to an abnormal posture, your body’s center of gravity is moved away from a centered and balanced position. This will put an uneven stress on smaller areas of your spine instead of the same amount of weight being evenly distributed throughout ALL of the discs and vertebrae in your spine. This abnormal stress will cause the bone to grow more bone…hence the bone spurs. These bones spurs can be located on the back of vertebra, inside the spinal canal. More bone in the spinal canal, which is where your spinal cord is, equals a narrower spinal canal which is called spinal stenosis.
        1. Surgery for spinal stenosis typically consists of a laminectomy which is when they cut the laminae (the back of the vertebrae) of the vertebra off. This allows for less pressure on the spinal cord. The idea is that if there are bone spurs in the front of the spinal canal then removing the back of the spinal canal (the laminae) will give the spinal cord more room so there is less pressure. The other option to remove pressure from the spinal cord is to remove the bone spur causing it but that is not done because you have to move the spinal cord out of the way when coming from the back, which is extremely dangerous. Keep in mind that this bony armor that is protecting your spinal cord from the back and is there for muscles to attach to, is no longer there.
      5. Surgery may still be an option but should VERY rarely ever be the first option.
        1. Western medicine is great at saving lives in emergency situations. If I’m shot and have a bullet in my spine or was involved in a SEVERE car accident and my spine is crushed, then surgery is almost certainly my first option. Emergency situations like this, however, are only a very small fraction of situations in which spinal surgery is done. The first option for most chronic or musculoskeletal symptoms like low back pain, neck pain, mid back pain, headaches, sciatica, etc. should always be chiropractic treatment. It’s important to understand that the way to solve a problem is to first know the cause of that problem andlow back surgery Greenville NCabnormal spinal alignment is certainly the most common cause of low back pain, which is why chiropractic care is so effective in treating it.
        2. Low back pain is NEVER caused by a lack of screws in your spine or bone chips where your disc was. You don’t have a deficiency of NSAIDS, muscle relaxers or opiates. These treatments are not only invasive but come with serious potential side effects and at best, are only capable of removing symptoms to allow you to ignore the problem for longer without actually addressing the reason your low back pain is there.

To better understand low back surgery and chiropractic care take a look at the table below for an exhaustive comparison of the two treatment options.

 

Low Back Surgery

Imaging
Treatment Goals
Worst Case
Best Case
Treatment
Down Time
Cost
Insurance
Research

Imaging

Non-weight bearing imaging (MRI, x-ray). Many M.D.s and traditional chiropractors do not yet understand the benefit of weight-bearing imaging. Medically, the use of weight-bearing MRI has increased recently whereas standing x-rays are rarely if ever taken. Follow up x-rays are taken supine (lying down) and as a result, do not show the spine post-surgery under a load. Follow x-rays are almost always take only immediately after surgery before the patient has healed.

Treatment Goals

Decrease or eliminate symptoms (low back pain, numbness, tingling, and radiating (sciatica) pain.

Worst Case

Pain gets worse, use of painkillers increases, allergic reaction to anesthesia, paralysis or death.

Poor outcomes are so common that there is a specific ICD-10 diagnosis code for “failed backed surgery M96.1”.

Best Case

Decrease or eliminate symptoms (low back pain, numbness, tingling, and radiating (sciatica) pain. BUT you will likely need additional back surgery as a result of abnormal spinal motion above and below the vertebra where surgery was performed. Normal spinal movement will NEVER be achieved.

Treatment

Many different back surgery options are available depending on the type of spinal decay or injury. The most common include an intervertebral disc replacement, removal or fusion. Typically these surgeries are recommended as a result of a damaged disc that has herniated.

Down Time

Back braces are often p

rescribed to immobilize the low back for six weeks to three months, while it heals from the surgery.

Assuming the surgery is “successful” and the symptoms have not increased or stayed the same, most of the pain from the surgery will be better after four weeks. Pain will hopefully continue to decrease slowly after this time. Even with successful surgeries, some patients continue to have pain up to three to six months after surgery. After six weeks patients are often recommended physical therapy to help strengthen the muscles supporting the low back.

Cost

Including surgical costs, medication, x-ray and/or MRI, rehab and physical therapy, the average low back surgery is easy $100,000 – $169,000!

Insurance

North Carolina, and some other states, require a minimal amount of conservative care before they will pay for low back surgeries i.e. physical therapy or chiropractic.

Research

  1. Patients who saw a surgeon first, 42.7% had low back surgery.
  2. Low back surgery is often no more effective than receiving NO treatment of any kind.
  3. One study showed that after 2 years, 26% of patients who had surgery returned to work compared to 67% who did not have surgery.
  4. 27% of low back fusion surgery patients required  low back surgery after two years.
  5. 11% of low back fusion surgery patients were permanently disabled compared to 2% who did not have low back surgery.
  6. Researchers determined there was a 41% increase in painkiller use, particularly opiates, for patients who had back surgery.
  7. As much as 90% of low back disc surgeries are unnecessary and ineffective.
  8. Low back surgery rate is 40% higher in the U.S.
  9. Low back surgery has been found to be helpful in only 1 out of 100 low back pain patients.

Structural Chiropractic

Imaging
Treatment Goals
Worst Case
Best Case
Treatment
Down Time
Cost
Insurance
Research

Imaging

Weight bearing structural x-rays to determine structural abnormalities. This is a more functional examination. If necessary standing MRI is ordered. Correction potential x-rays are often taken of patients performing mirror image exercises and/or during spinal remodeling with specific spinal traction orthotics to determine the orthotic and placement of orthotic that the patient will receive the most correction from. The Follow-up x-rays are taken after two-three months of corrective chiropractic care to determine the need for continued corrective care or protective care to maintain spinal improvements.

Treatment Goals

Correct abnormal spinal shifts to approximate a more normal spine. Maintain and improve normal spinal movement, stability, and function. Decrease or eliminate symptoms (low back pain, numbness, tingling, and radiating (sciatica) pain. Prevent reoccurring exacerbations and injuries.

Worst Case

Chiropractic care isn’t effective or the patient’s case is too severe to benefit from chiropractic care. However, these cases typically benefit from improved outcomes with surgery. Surgeons often report surgery is easier and more effective with shorter recovery times with patients who received chiropractic care prior to surgery because of improved mobility.

Best Case

Decrease or eliminate symptoms (low back pain, numbness, tingling, and radiating (sciatica) pain). Patient’s abnormal spinal structure is greatly improved to the point of restoring normal activities of daily living. Patient’s spine has normal function and mobility and is stable because of an improved spinal structure. Continued chiropractic care is not required but recommended.

Treatment

Structurally focused chiropractic care is focused on restoring the normal spinal structure to reduce abnormal stress on the spine and discs. This is done with specific segmental (one vertebra at a time) chiropractic adjustments and regional mirror image chiropractic adjustments.

Spinal remodeling traction with specific spinal orthotics in addition to physical therapy spinal exercises to stabilize spinal correction are performed each visit and at home.

Down Time

The patient is restricted from any lifting, bending, twisting or any activities that increase pain. Often prolonged sitting or standing are restricted until low back pain and symptoms have improved. The patient is encouraged to stay mobile with light activities like walking, to tolerance. Physical therapy will be performed under chiropractor supervision to help stabilize chiropractic adjustments and spinal remodeling Immobilizing the spine often makes the condition worse and slows healing.

In special cases, supportive devices may be prescribed. Unlike surgery, chiropractic care typically has a very minimal increase in symptoms or discomfort. Significant improvement in low back pain or radiation pain is not unusual during the first few visits but more commonly symptoms get slightly worse before they get better with structural chiropractic care. Improvement in symptoms is seen most commonly in the first 2-6 weeks often taking 6-12 weeks for resolution of most or all symptoms. Severe disc damage may necessitate chiropractic treatment for up to 12-18 months but is usually only necessary when disc damage is a direct result of spinal trauma and not primarily degenerative changes, which are far more common.

Cost

One phase of structural chiropractic care for 36 visits can range from $3,000-$5,000. Additional phases of structural chiropractic care may be necessary depending on the severity of the case.

Insurance

Insurance reimburses chiropractic care to eliminate low back pain only. Structural chiropractic is the most advanced form of chiropractic care that treats to correct abnormal spinal shifts and curves. Improvements in spinal structure with chiropractic care often reduce or eliminate low back pain, numbness, tingling, and other symptoms before the treatment necessary for structural correction is complete.

Similar to how antibiotic treatment is recommended beyond the elimination of symptoms. If insurance paid for only 2-3 days of antibiotic treatment instead of the typical 10-day regime, it would be similar to how they reimburse chiropractic care in network. Out of network insurance is much more likely to reimburse patients for more even if they refuse to pay for all of the structurally necessary physical therapy, and spinal remodeling.

Research

  1. Patients who saw a chiropractor first, only 1.5% had low back surgery.
  2. 98% of patients treated by a chiropractor experienced a significant reduction or elimination of their back pain and had no need for low back surgery.
  3. Rubenstein et al. report, in all the Randomized Control Trials of Spinal Manipulative Therapy (chiropractic adjustments) they reviewed there was not a single serious adverse event!
  4. Chiropractic adjustments provide statistically significant better pain relief than any other intervention at one and six months.
  5. Patients with low back pain had 32% less CT/MRI imaging, 40% less inpatient care and 32% less surgery per episode of low back pain.
  6. Comparing 1.5 million Medicare patients who used chiropractic care and 5.8 million who didn’t, Medicare paid 45% less for the chiropractic patients’ care than for those who used non-chiropractic healthcare.
  7. In 1994 The Agency for Health Care Policy and Research (AHCPR) concluded that chiropractic adjustments are the most effective and cost-effective treatment for acute low back pain.
  8. 80% of 300 totally disabled patients with low back pain for seven years or longer had good to excellent results. 70% improved to the point of being able to have no work restrictions with long-lasting results after one year follow-up.
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