Dr. B’s Thoughts: Surgery

Intro

Current research indicates that surgery, while usually an expensive option and a major trauma to the body, can be the best healthcare option in certain cases. Transplants save lives. Total joint replacement has brought pain relief and improved quality of life for millions. Cataract surgery has staved off vision loss. The list of surgical accomplishments is extensive. But . . .

Is Surgery the Best Option ?

Not necessarily.  There are major downsides to surgery, not the least of which is the possibility of losing your life due to complications. Even with successful surgery, two persistent downsides are present.  First, the surgeon typically makes a permanent alteration to the body. Whether removing a bulging disc, or replacing a joint, the result of surgery will alter biomechanical relations among the regional structures. There is a direct alteration when a structure is changed or removed. There is an indirect alteration when the surgeon’s scalpel creates a scar tract from the body’s surface leading inward, with resulting more or less permanent changes in myofascial pliability and force transfer. Second, whenever a powerful tool exists, the temptation to overuse it also comes into play. Surgery is not appropriate for every ache and pain we experience.

Should I Try PT ? – We say YES !

The likelihood of success for both surgical and non-surgical interventions varies directly in relation to the state of the patient/client’s overall health.  In general, the better genetics, lifestyle and preventive care the patient/client has had, the more likely they will be able to have a positive outcome.  So, it behooves us all to eat well, exercise, and in general take care of our bodies.

For many orthopedic complaints, newer research is suggesting that a less-aggressive approach may be equally good or better than surgery, and is certainly more cost-effective.  This is the case for low back pain, neck pain, shoulder pain, knee pain, foot/ankle pain, and joint pain in general, where the first intervention should routinely be non-surgical (see below)*.

For example, read JAMA’s review of studies on radio-frequency ablation vs exercise for low back pain, which showed that ablation offered no additional benefit, when compared to exercise alone.

And, although your physician may make some interesting discoveries on Xray, CT or MRI, these findings aren’t necessarily causing the symptoms you are having.

Here’s a chart from a study of perfectly healthy people in different age groups, with no symptoms at all, and what researchers found when they did an MRI.  You can also see what happens as we age. Data from: Brinikji,W. et al., 2015. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.”  Am J Neuroradiol. Apr;36(4):811-6. You can read the FREE full text article here.

You can get advice for creating your own health improvement plan on our Client Resources page.

The Bottom Line:

Surgery can have many potential benefits, but each benefit comes with a cost. Unless your problem is life-threatening or you have some very special circumstances (some professional athletes with devastating injuries, for example), surgery should never be the first option to treat it. The role of preventive care cannot be over-emphasized. Staying healthy is so much better than the alternative. Encouraging healthy living and routine check-ups should be the primary tenets of modern healthcare.

*Research supporting the value of conservative interventions (physical therapy) versus surgery:

SPINE
1. Franz, E.W., et al., Patient misconceptions concerning lumbar spondylosis diagnosis and treatment. J Neurosurg Spine, 2015. 22(5): p. 496-502.

2. Shin, J.S., et al., Long-Term Course of Alternative and Integrative Therapy for Lumbar Disc Herniation and Risk Factors for Surgery: A Prospective Observational 5-Year Follow-Up Study. Spine (Phila Pa 1976), 2016.

3. Zaina, F., et al., Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev, 2016. 1: p. CD010264.

SHOULDER
1. Kukkonen, J., et al., Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up. J Bone Joint Surg Am, 2015. 97(21):p. 1729-37.

2. Petri, M., et al., Clinical Results After Conservative Management for Grade III Acromioclavicular Joint Injuries: Does Eventual Surgery Affect Overall Outcomes? Arthroscopy, 2016.

KNEE
1. Marsh, J.D., et al., Cost-effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open, 2016. 6(1): p. e009949.

2. Kise, NJ., et al., Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 2016;354:i3740.

HIP
1. Wright, A.A., et al., Non-operative management of femoroacetabular impingement: A prospective, randomized controlled clinical trial pilot study. J Sci Med Sport, 2016.