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Back surgery often doesn't make sense

Back surgery often doesn't make sense

When is surgery really useful in a herniated disc?

More and more patients with a herniated disc undergo surgery. In the past five years, the number of intervertebral disc interventions has increased by almost 43 percent. Critics claim that over half of the invasive procedures are unnecessary. But when does an operation really make sense and cannot other gentler treatments be carried out?

Rapid increase in back surgeries
Hardly anyone likes to have surgery. However, torture back pain because the intervertebral disc causes problems, many undergo an invasive procedure. In many cases, more gentle procedures such as back pain exercises, osteopathy or physiotherapy could achieve significant results. Many pain patients apparently lack patience and the pressure from some orthopedic surgeons often has an effect. An evaluation showed that from 2004 to 2009 the intervertebral disc operations increased by around 43 percent. It is suspected that numerous operations would actually be superfluous and that these are only undertaken to provide financial benefits for clinics or doctors. These and other topics are currently being discussed controversially at this year's congress of the German Society for Surgery in Berlin from April 24th to 27th.

Good treatment success even without surgery
But if you take your time and have targeted non-invasive treatments, you can achieve at least as good results as with an operation. This is also confirmed by some studies that have so far been carried out on this topic. "In the long term, the statistically recorded results are the same for intervertebral disc patients with and without surgery," says the future chairman of the German Society for Orthopedics and Orthopedic Surgery, Professor Dr. Bernd Kladny.

Back jokes have become a mass phenomenon in today's high-tech society. Depending on the evaluation, between 70 and 85 percent of all Germans experience back problems at least once in their lives. Many suffer from pain for a lifetime. For doctors, clinics and physiotherapists, the widespread disease of the herniated disc means enormous financial potential. Doctors therefore often resort to the scalpel prematurely.

Back jokes can also go away without surgery
A herniated disc does not always have to be the cause of the recurring pain. The most common diagnosis is tension or banal back jokes due to poor posture and insufficient exercise. Therefore, a more precise diagnosis is not always necessary, "because the pain usually disappears on its own," explains Kladny. Pain-relieving medication can also be used temporarily. This method has proven itself because scientists have recently found that careful posture does not relieve back pain. Rather, regular exercise can improve suffering in the short term. According to the expert, bed rest and protection often even lead to worsening of symptoms with unspecific back jokes.

Not a gentle cycle but active movement
Gentle cycle is the worst form of therapy. The less patients move, the more the back muscles are broken down. The lack of exercise leads to the muscles becoming weaker and weaker. If the one-sided load is too long, the pain can come back quickly. Therefore, the most important therapy for back jokes is exercise, the orthopedist warns. “It is the job of the doctors to protect those affected from this vicious cycle of inactivity. The most important measure for the prevention and therapy of back pain is exercise. “Doctors should therefore prescribe targeted back training for their patients. It does not have to be an outpatient therapy, swimming and long walks can help with harmless back problems. Because "every movement helps to prevent pain".

Chronic pain requires holistic treatment
If the pain in the back has manifested itself and is already chronic, movement may be advisable, but this alone is no longer able to overcome the pain. Therefore, the treatment should also take into account social and psychological factors such as the patient's environment. Ongoing stress in the family and or at work can adversely affect the course of pain. "Relaxation procedures such as meditation or autogenic training can reduce stress and relieve pain," says Hermann Peters, a naturopath from Kiel.

Unilateral therapy, which is only focused on eliminating organic pain, is usually accompanied by a low success rate if the course is chronic. The pain has already changed, according to Kladny. In chronic back jokes, "the pain has lost its warning function," explains the doctor. The complaints persist "even though there is no acute damage."

The goal of relieving pain in chronic conditions no longer comes first. Rather, an improvement in the patient's performance is to be achieved. Targeted exercise therapy, changing the mostly unhealthy lifestyle and psychological support can often alleviate the suffering of the afflicted.

Preventive measures to protect the intervertebral disc
Prevention is not always possible in the case of herniated discs. Even young people can experience an incident. A herniated disc occurs when a sudden or slow shift of the intervertebral disc to the back or to the side occurs. This can lead to symptoms of paralysis or emotional disorders because one or more nerve roots are affected by the pressure of the discs. Conditional sciatica is a painful, irritating symptom with radiation in one leg due to a bulging of the intervertebral disc or a herniated disc. Prevention of herniated discs is difficult because "the stability and strength of the intervertebral disc is also genetically determined," explains Professor Dr. Norbert Haas, head of orthopedics and trauma surgery at the Charité University Hospital in Berlin. “Physical activities that are accompanied by severe shaking of the spine can increase the risk of a herniated disc.” Triggers are often sports such as gymnastics or horse riding. These sports activities should no longer be carried out by the patient.

In general, the reduction of excess weight, if available and unusually strong physical exertion, should be avoided. Regular and instructed gymnastics to strengthen the muscles is recommended so that the spine is relieved.

The diagnosis of herniated discs is usually more difficult than assumed by laypeople. Not every MRI can provide a clear finding. Sometimes organic results don't cause pain. The other way around, there are often no visible changes, although the patient suffers from severe pain. Therefore, the symptoms of the patient are first of all in the diagnostics.

When a doctor's visit is urgently needed
In the event of an acute herniated disc, it should not take too long before a specialist is consulted. Complaints such as "sensations and numbness in certain regions of the body" indicate an incident. “Muscle weakness in the arm and legs can also indicate a herniated disc. In such cases, patients should urgently have their complaints clarified with the doctor, ”Prof. Kladny warns. Such neurological symptoms are a clear indication that surgery is necessary to prevent worse. If other organs such as the bladder or intestine are affected, the intervention must be carried out very promptly. Otherwise, serious illnesses such as incontinence and organ damage can remain.

Shrinking processes relativize herniated discs
The surgical decision becomes difficult if a herniated disc is detected during the diagnosis, but the patient's pain is absent. "Of course, a herniated disc that is visible on the MRI is often tempting to perform an operation," says Haas. Experience shows, however, that intervertebral disc incisions relativize again after some time due to so-called shrinkage processes. "In such cases, the symptoms improve on their own, even without therapy," reports the doctor.

Despite this finding, more and more patients tend to perform surgery, although alternative therapies such as osteopathy, physical exercise or spray therapy can heal pain. It is unclear whether more doctors are pushing their patients to take the step of an operation for financial reasons, or whether patients prefer “invasive surgery” due to lack of time instead of spending time on lengthy therapies. At the same time, those affected should make it clear that operations sometimes involve considerable risks. Infections, instabilities or scarring occurred in quite a few patients. These, in turn, lead to secondary diseases and possibly further interventions. (sb)

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Disc herniation: too many operations
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