I know I need back surgery

Marc Darrow, MDMarc Darrow, MD

In our practice we often see patients who are in severe back pain with an MRI, X-ray and/or scan that shows an inaccurate picture to determining a treatment plan. For instance, a patient can have muscle spasm from a simple back strain which can cause excruciating pain and may limit one’s ability to walk or even stand. Conversely, a large herniated disc may be completely painless. Yet that large herniated disc will send the patient for a surgery.

Please see our article for more information about failed treatments for lumbar disc herniation.

A study from researchers at The Albert Einstein College of Medicine and the Department of Psychology, Columbia University say that of “274 patients seen in consultation in a single year, 45 were scheduled for “unnecessary surgery”, [i.e. based upon pain alone].

While these 45 patients experienced pain, they exhibited no neurological deficits, and, based upon review of the X-ray, MR, and/or CT studies showed no significant abnormal radiographic findings. Therefore, there was no clear surgical procedure that would benefit the patient. Nevertheless, spinal surgery, often quite extensive was recommended. Furthermore, an additional 2 patients were scheduled for unnecessary lumbar operations, when in fact they needed cervical surgery.” 1

British Doctors and specialists at Southampton General Hospital in England noted in their own research that their own professionals could not agree on what the MRI said in diagnosing lumbar disc disease.

“we found in our study that there is wide variation in diagnosing lumbar disc disease between the Orthopaedic Surgeons and the Radiologists at our institution. There is also systematic difference in the interpretation between all observers. These variations and differences are particularly significant on comparing it to the MRI scan. The General Orthopaedic Surgeon, the General Radiologist, and the Spine Surgeon were diagnosing less degenerate discs. The Spine Radiologist, and the Spine Nurse Practitioner were diagnosing more degenerate discs. Due to this amount of inaccuracy, it is risky to comment on degenerate disc disease on a plain radiograph alone. Therefore MRI scan should only be used to comment on the disc diseases of the low back, as plain radiographs are unreliable.” (2)

“we have found MRI to be 72% sensitive, 68% specific, and 70% accurate in detecting containment of herniated lumbar discs. Given that the success of indirect techniques of lumbar discectomy, other intradiscal therapies, and prognosis following herniation all rely upon accurate assessment of disc containment;

MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of cases.

Other methods to determine containment (when considering indirect techniques) should be employed/considered” (3)

Do you need back surgery?

As stated, in our practice, we often see patients who have a diagnosis of herniated discs based on pain in their back and pain in their legs.

Upon a physical examination, we often find that it is not a disc problem but referral pain from a ligament meaning they have a sprain.

This is difficult for people to understand because they see the MRI. After a visit to the orthopedic surgeon or the neurosurgeon, they come in with a recommendation for surgery because MRI revelaed herniation. We have seen patients with discs sticking out as much as 10 millimeters, and that would seem to be what is causing pain, but it is not because it is not pressing on a nerve.

So when we check in the back or neck area we look for trigger points – areas of the body that when we press on them it refers pain somewhere else in the body. You just can’t read an MRI to decide what is going on with a patient, you have to use your hands and do an examination.

1 . Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg Neurol Int 2011;2:83

2. Madan SS, Rai A,Harley JM. Interobserver Error in Interpretation of the Radiographs for Degeneration of the Lumbar Spine. Iowa Orthop J. 2003; 23: 51-56.

3. Weiner BK, Patel R. The accuracy of MRI in the detection of Lumbar Disc Containment. Journal of Orthopaedic Surgery and Research 2008, 3:46

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