Surgery to Avoid #5: Lower-Back Surgery


The fifth of 5 operations you don't want to get—and what to do instead.

Since the 1980s, operations for lower-back pain and sciatica have increased roughly 50 percent, from approximately 200,000 to more than 300,000 surgeries annually in the United States. That rise is largely due to minimally invasive advances that include endoscopic keyhole tools used in tandem with magnified video output.

To its credit, surgery (endoscopic or the traditional lumbar-disc repair) does relieve lower-back pain in 85 to 90 percent of cases, docs say. “Yet the relief is sometimes temporary,” says Christopher Centeno, MD, director of the brand new Centeno-Schultz Pain Clinic near Denver. And that adds up to tens of thousands of frustrated patients who find the promise of surgery was overwrought or short-lived.

What to do instead
Try painkillers and exercise. Despite the relentless nature of lower-back pain, the most common cause is a relatively minor problem—muscle strain—not disc irritation, disc rupture, or even a bone problem, experts say. Despite its severity, this type of spine pain most often subsides within a month or two. Thats why surgery, or any other invasive test or treatment beyond light exercise or painkillers, is rarely justified within the first month of a complaint. Even pain caused by a bulging or herniated disc “resolves on its own within a year in some 60 percent of cases,” orthopedists claim.

“Seventy to eighty percent of the time we can get to a concrete diagnosis, find a way to manage pain, and get patients off the drugs without surgery,” Centeno says. “Or, more appropriately, never start the drugs.”

“We used to prescribe 30 days bed rest for patients with herniated discs, but that was 15 to 20 years ago,” says Venu Akuthota, MD, medical director of the Spine Center at University of Colorado Hospital and associate professor of medicine at the University of Colorado School of Medicine. “Actually, movement is very helpful for treating back conditions. Nowadays, we prescribe moderate, low-impact exercise, like walking, or working out on an elliptical trainer or treadmill.”

Learn about stem cells. Ive seen the future of back surgery firsthand. And it looked to me, from behind my surgical mask, as if a womans bare behind was doing much of the work. Up close, huddled inside the Centeno-Schultz Pain Center, I joined a team of MDs, a PhD, and two nurses to witness orthopedic history in vivo: an adult stem cell (ASC) transplant to help bones and joints grow anew.

In the midst of the huddle, Centeno, the back- and neck-pain specialist, is plunging a needle that looks big enough to use on a horse deep into the hip bone of a 54-year-old weekend athlete and skier whos been forced to the sidelines by injury and long-term lower-back pain. The patient is tired of pain pills but wary of major surgery. Instead shes undergoing one of the first ASC orthopedic transplants in the nation.

The harvested stem cells will be used to grow millions of new ones that will be implanted in her back to spur and regenerate more youthful, healthy joint tissue—if all goes as planned in this part of an ongoing study approved by a medical research institutional review board, that is. So far, at least, it has. Early MRI pictures of related procedures have shown impressive growth of regenerative tissue. And theres even better news: By using the patients own stem cells, the surgical team avoids the ethical debate over using embryonic tissue for research purposes.