What is the success rate of back surgery?
It depends on many factors - the problem itself, overall health of the patient, type of doctor performing the surgery, the type of procedure being performed, available technology for the procedure, experience of the surgeon, Murphy, etc.
Having had 3 major spinal fusions over the past 15 years, and having the first two turn out to be botched (something I didn't discover until the 3rd surgery) I think I'm somewhat qualified to comment on this.
Any back surgery, whether major or minor, is not to be considered lightly. I have been asked this question as well as whether or not someone should have an operation at all many times over the 20+ years I've been dealing with back pain. My answer is always the same.
ANY back surgery should not even be considered unless there is no other alternative therapy available. I don't care if your pain is at the point it's unbearable - if you can walk and you can take the meds necessary to relieve your pain, then avoid the operation. You should only consider it when the only options left are a wheelchair or worse. You would not believe how many botched back operations are performed in this country alone. I've added a link to one of the sites I contribute to so that you can see for yourself what you face. The other link is to a site that deals specifically with spinal issues and operations, and the risks.
It depends on the reason for the surgery as well. In my case, I have a problem that's genetically passed on that makes me more susceptible to disk herniations, and it only gets worse over time as structural damage worsens. What happens is that the disk collapses to the point where the vertebrae are actually touching bone to bone. To say it's painful doesn't even come close. So for me, I knew that at some point a fusion was inevitable, but I was able to put it off for quite some time with alternate therapy. Eventually I was forced into formal Pain Management, as the pain in the year prior to my first lumbar fusion required the use of much stronger meds. I'm still in Pain Management today, now in my 11th year, requiring the use of opiates for the past 10 years. I'll likely require them for the rest of my life, due to the nerve damage caused by my first surgeon.
Prior to my first operation in '96 (cervical fusion at C5/6/7 / pelvic bone removal for graft) I had 10 years of dealing with the usual stuff - bedrest, epidurals, facet injections, exercises, blah, blah, blah - you know the drill. My neck problem was sudden and completely out of thin air - I woke up one morning with a pinched nerve in my shoulder, and two weeks later I couldn't move my left arm and my fingers were numb to the first knuckles. I was immediately admitted and went through the pre-op stuff, literally having to put my life on hold.
After that, my lower back pain continued, until the point finally came where I could no longer stand or walk for more than a few minutes at a time. At that point it was either a fusion or a wheelchair, and that wasn't an option.
At first it seemed it was okay, but after about 6 months the pain started to increase steadily, to the point where I had to start on Duragesic patches for primary pain and Percocet 10/325/s for breakthrough. Other than the times in the past few years where I've needed to augment that with 100mg Demerol and 30mg MSContin, I've had to remain on Duragesic and Percocet for the past 9 years.
The reason for the increase in pain was always attributed to a failed fusion, but after the collapse of my L3 disk in 2006 ( the fusion in '99 was for my L4/L5/S1 vertebrae), pictures (and a new surgeon) determined the real cause: the first 2 fusions were botched by my first surgeon. Whether it was due to negligence or the fact that he didn't have the newer technology my new surgeon and hospital had, I don't know. All I do know is that a$$hole has irreversibly changed my life.
What was found after the pics for my 3rd surgery were taken was that in my lower back fusion, the surgeon had screwed 2 pedicle screws (the screws that are screwed into the vertebrae to hold the rods) too far into and through the bone, and into leg nerves, 1 for each leg. Prior to that, in my first fusion in my neck, he had actually screwed one screw through a disk, with only the last 2 or 3 threads inserted into bone. The old hardware in my lower back was removed during my last surgery in 2006 that fused the L3/4 vertebrae, but the pain from the nerve damage still remains. As for my neck, I still need to get the screw and plate removed, but I'm not ready yet. It doesn't affect me as much as the lumbar screws did. And while it has reduced my pain a lot, it's not enough to be able to come off of the opiates, nor do I think it will ever be. I resigned myself to that fact some years ago even before I knew what was causing the pain.
Aside from surgeon screwups, there's also the possibility of a hospital mistake. Although my first operation was a breeze, the second nearly ended in my death. It was only the presence of my family that saved me. During my period in post-op recovery, the morphine infusion pump began to have problems. When I got to my room, a pharmacist nurse came in and tried to fix it, but couldn't. She then got a new pump, which required a new morphine IV bag as well. She hooked me up and left.
About a 1/2 hours later (according to my wife) I was going in and out of consciousness, so my wife wrote me a note to tell me if I woke up that they were going to go eat and come back. Apparently at that point she realized that I had started to choke and was turning blue. She told me that she tried to wake me but couldn't, and at about that time my daughter came into the room and saw what was happening and ran to get a nurse.
What happened was that the nurse who changed the morphine pump/bag failed to properly account for all the morphine in my system, and what my wife witnessed was me lapsing into respiratory arrest from a morphine overdose caused by her mistake. They coded me, and fortunately there was an ER doctor on the floor and he revived me with a shot of Narcan, which if you don't know is a drug used to instantly counteract the effects of any narcotic in the system. It's widely used in OD cases, and works within 90 seconds. That of course, wasn't the worst part.
Keep in mind that I'm literally an hour off the operating table, with 8 screws and 3 rods newly inserted into my lower spine. It took about 15 seconds after I regained consciousness for my brain to realize that I no longer had the benefit of any painkillers in my system. All I can remember is screaming in pain - my wife said I was so loud you could hear me the length of the hospital. And the worst of that was that they couldn't give me any other painkillers for at least an hour - the Narcan still in my system would've just counteracted anything they could've given me. To this day I still avoid that hospital whenever possible.
Does this mean that all back operations can go bad? Of course not, as my 3rd surgery went well and corrected problems that should've been taken care of years ago. What it does mean is that you need to completely research your problem, the different therapies and options available, and secure the proper surgeon before making a decision.
1. Without knowing as much as possible about the reason for surgery (underlying cause/diagnosis) yourself, you run the risk of being led into an operation you might not need at all. All of us are raised to believe and completely trust doctors at their word - nothing can be more dangerous to a patient than to blindly trust their doctor at their word. While there are many good doctors out there, the change in the health care system in the past 20 years has resulted in more bad ones than good. Also, not all doctors keep up with the latest technology and techniques because they're too busy.
For example, my Mom asked me when I was home for a funeral this past summer to meet her allergist, as I've had several years of involvement at Johns-Hopkins in their asthma/allergy research studies. Even though he was an older and experienced allergist, I was flabbergasted when Mom told me that she had taken a Pulmonary Function Test (the test measures lung function by having the patient blow hard into a tube) without having ceased taking her allergy medications before the test. It's standard procedure to cease taking any meds for several days before a PFT as any trace of antihistamine can affect the PFT result and give a bad measurement. When I asked, she said no one had told her to stop taking her meds, which is also standard procedure. I've had asthma for 22 years and have done PFT's many times over the years, and ceasing meds and being notified by your doctor beforehand to stop your meds is a widespread and standard practice each time I've had to do it. When I asked her allergist about it though, he said that antihistamines didn't affect the test. Naturally I told her to start looking for another doctor.
Knowledge is the best protection you have in having a successful surgery if it's in fact needed. By educating yourself as much as possible about your condition, you can then determine if the care your doctor proposes is in keeping with current practice and medical procedure. It's also a good idea to educate your family, kids included, on the various aspects of your problems as there may come a time where you're incapacitated and need their awareness to save you. My daughter has been instrumental in helping to save my life twice because she had the knowledge and presence of mind in knowing what to do, as did my wife.
2. Picking the right doctor is essential, and is the most difficult thing to do as evidenced by my first surgeon. Even though he's ultimately responsible, I do feel that the lack of better technology at the local hospital where my first 2 operations were contributed to my problems.
In any event, when dealing with back surgery there is no question that you want a Neurosurgeon and NOT an Orthopedic surgeon. Orthopedic surgeons are bone doctors, and statistically are responsible for more bad back surgeries than Neurosurgeons. Neurosurgeons typically are brain and spine specialists, so they know how NOT to paralyze you, which is always a good thing.
3. Pain Management - given the choice, I'd certainly rather not be in a pain program, but the alternative is no real life at all. Even though I take opiates in strengths that would kill most people, my tolerance level is such that if you didn't know me or I didn't tell you, you wouldn't even know I was taking anything at all. The trade off is that I can pretty much do most things I could do before my operations, I have full range of motion, and a fairly normal life considering. The only inconvenience is that the meds I take are all Schedule II narcotics, which means they can't be refilled. I need to get a new prescription every month from my Pain Doctor, which I've done every month for over 10 years now. But it's a minor inconvenience compared to the alternative.
4. Pain Specialists - Don't ever count on your surgeon or general doctor to deal with pain. Not only will they not give you what you may need for your pain, they don't know enough about pain management to give you the proper drugs as well. There are thousands of patients with chronic severe back pain who really need long lasting pain medication, yet regular doctors always prescribe acute pain meds. Acute drugs last only 4-6 hours, whereas chronic pain meds last anywhere from 12 hours to 3 days.
When seeking a pain specialist, avoid any doctors masquerading as a pain specialist, like anesthesiologists or osteopaths. Anesthesiologists don't know diddly about pain control, they just know how to put people to sleep and wake them up. They know pain drugs, but not about pain management. And many like them, even pain specialists who ARE pain specialists, don't want to deal with patients at a medical end-point, where they can't heal anymore and are only good for monthly prescriptions. For me they're the worst kind of doctors as they're violating their oaths. Just because someone might not be able to be healed completely, that doesn't mean they don't still require care. I've literally been to the best and worst in Pain Management.
Pain Specialists are MD's who have specialized training in Pain Management - they use every tool in the book, including acupressure, acupuncture, steroid injections everything that might be needed to control pain, but not necessarily drugs. A good pain doctor will only give you what you need to ease your pain, and won't prescribe something just because you think it'll help or it's the latest treatment.
Chiropractors are good for manipulative medicine, but eventually they can wind up causing more damage than they heal. Finding a good Chiro is not easy. Osteopaths are just Chiropractors that are MD's and can prescribe all drugs, but not much else.
Regardless of what you decide, make sure that there is no other recourse available. Pain pumps are a 50-50 toss-up - their manufacturers are afforded legal protections unheard of if their devices fail. There are many pumps that have failed or led to increased problems in the back that they were intended to help. Be cautious if they're ever mentioned as a treatment option. One, it's a surgery - two, if the leads detach, they have to re-operate to re-attach them, and three - it's not guaranteed to help anyway. I decided early on that traditional meds were better suited for even my problems if I can avoid another surgery.
Successful back surgeries do occur, but you need to give yourself every available advantage to achieve success. Don't do it because a doctor says it's required, find out yourself if it's required, unless you're facing a wheelchair or paralysis and there are not other options available. If there are other options, take them - too much can go wrong with a back operation.
I've added links to the American Pain Foundation and The Spine Universe websites, two of the best sites I've used and recommend to people who ask me about back surgery. Research your problem and visit the community areas so you can see how others in your situation have fared with surgery. For all that's happened to me, I'm actually one of the lucky ones.
Always remember that no matter how bad your back pain is, it can always be worse - and usually is for someone else.
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