When is it Possible to Avoid Having Back Surgery?
Hundreds of thousands of back surgeries are performed every year in the US. Overall the successful outcomes from these surgeries range dramatically depending on why the surgery was performed and the technical skill with which it is performed.
How can a back operation be avoided and how is an individual to know if he or she is in the category of having the choice to successfully opt out of surgery and have it not be harmful in the future?
The primary thing to understand up front is what exactly is the diagnosis. Most common diagnoses for back pain include:
1. Degenerative Disc Disease (DDD)
2. Herniated Lumbar Disk
3. Degenerative Spondylolisthesis
4. Degenerative Osteoarthritis
5. Vertebral Compression Fracture
Once the patient has an understanding of what’s causing the pain, the diagnosis can be placed into either a 1) Surgery Indication or 2) Elective Quality of Life diagnosis
Let’s look first at Degenerative Disc Disease, which often occurs in patients between the ages of 30 and 60. Degenerative discs do not always result in pain, there is actually a significant portion of the population who has DDD noticeable on MRI but no back pain at all. In some patients, though, it may cause significant back pain and lost time from work.
DDD is not a diagnosis that necessitates surgery, it is a quality of life decision. In fact, surgery for DDD, which is typically a fusion, only results in 50-70% success rates and a significant amount of patients end up needing future surgery and continued pain medications. Non-operative treatment for DDD may help considerably including chiropractic treatment, aerobic exercise, NSAIDS, and pain management treatments.
Most low back pain problems are quality of life decisions. If considerable nonoperative therapy doesn’t work, then an operation can be undergone electively. A lumbar pinched nerve is often in this category when it is resulting in numbness or pain. If an individual can handle the pain, research shows that the outcomes with an operation vs nonsurgical treatments are the same after one year.
If however, one of the above diagnoses is causing a worsening neurologic deficit such as a foot drop, then surgery may in fact be indicated and not elective. The longer one waits when a neurologic deficit exists, there is a question of whether or not it will improve even with a surgery performed perfectly.
This is exactly the point with spinal arthritis. No one ever died as a result of arthritis. So if arthritis causes degeneration or a spondylolisthesis along with spinal stenosis and there’s no muscle weakness from pinched nerves, the situation is elective. Opting for surgery is fine if conservative treatment has been exhausted, there is a surgery for the specific condition with a successful track record, and the patient is healthy enough to undergo it. But if the condition is in fact elective, patients need to weigh the pros and cons considerably to make sure they are comfortable with the potential for a poor outcome compared to the potential for marginal improvement with nonsurgical treatments.
These may entail spinal decompression, chiropractic, physical therapy, and pain management.
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Lower Back Exercises To Relieve Back Pain
Lower back exercises can be a lifesaver for individuals suffering from pain in the lumbar or lower back region. However, it is advisable to discuss a regimen of exercises with your doctor before you start, to make sure they are the right ones for you. These are the most common exercises suggested to people suffering from lower back pain.
Curl your spine backwards with the Cobra exercise.
You must begin by laying down flat and face down, with toes extended out and hands flat to the ground at waist level; pushing on your hands, lift your upper torso and head, so that your spine curls. Your hips should remain down. Do not stretch more than is comfortable. If you can, try to hold this position for a couple of minutes, and then lower yourself back down slowly.
Do some hamstrings stretches and curve your spine forward.
This exercise should always follow the previous one, to ensure that you gain balance. In yoga, this position is called Janu Sirsasana.
Sit on the floor with the right leg stretched out in front of you. You should instead bend your left leg and keep your knee pushed toward the floor; the left foot should be flat against the right leg. Bend down over the right leg with head down and arms extending as far as possible along the leg. You may be able to take hold of the toes, foot or ankle.
Feel the stretch in the hamstring along the back of the leg and in the lower back, but again do not push yourself too far. Stay in position for a minute or two, then slowly straighten up, rest, and repeat with the other leg.
Bend to the sides.
This exercise can be performed sitting, standing, or even sitting on an exercise ball. Keep your hands together and raise your arms high above your head. Keeping the body in the vertical plane (so you do not bend forward), slowly bend the whole upper body over to one side, then the other.
Twist the spine.
Take special care not to go too far with this example of our lower back exercises. Seek medical advice first, especially if your back pain is the result of an accident or a neck injury.
Sit on a chair without arms and keep your feet on its side, firm on the ground. Keeping the hips firm in place, turn your body around to the right. Place the left hand over the right knee, and the right hand behind you. Twist as far as you comfortably can to the right. Keep the head upright but turned to look over your right shoulder.
Count to 15 or 20, and then slowly turn back toward the front, turning your head first. Do the same for the other side.
If you are sitting on a chair with a back, sitting with your feet on one side will allow you to do the exercise without the back of chair getting in the way. You should have the back of the chair to your left when you turn to the right.
This exercise can also be performed sitting on the floor. When twisting to the right, the left leg is bent and flat on the floor in front of you. The right leg is bent with the knee up in the air and the foot on the floor, hooked over the left knee. The left elbow comes to the outer side of the right knee and you twist around to the right. Do not move the hips, so the buttocks stay on the floor. This position is known as Ardha Matsyendrasana in Yoga.
The lower back area is very important and delicate, and if you are experiencing any kind of pain you should seek the advice of a medical professional. Discuss these and other exercises with your doctor before attempting them, to make sure that you are doing the right thing for your condition.
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