Do you really need spine surgery or drugs?

Dr. David Hanscom, M.D. (coasttocoastam.com, 10/28/19); Editors, Wisdom Quarterly

My surgeon said it was worth a try. It wasn't.

Renowned spine surgeon of 30 years, Dr. David Hanscom, MD (backincontrol.com), has quit surgery and opiate medication for healing pain.

• The rate of spine surgery has continued to rise in spite of evidence that most of it is ineffective. It rose rapidly in the mid-90’s with the introduction of new techniques that improved the fusion rate. However, outcomes haven’t improved. Disability keeps rising. Why? “Let’s try spine surgery”?
  Surgery works poorly if it is done for “pain” and the source of it is unclear. There is a widespread belief among most patients and many physicians that if everything else has been tried and failed, then surgery is the next logical step. Nothing could be further from the truth. More

He claims the majority of spine operations are unnecessary. Many procedures are actually performed on spines with normal, age-related conditions.

These "spinal fusion" operations are particularly unpredictable when trying to reduce pain. Dr. Hanscom revealed that he's retired from conducting surgeries because too often the results are unsatisfactory. In fact, most patients have stopped seeking this option.

"There's not one piece of data in 50 years," he claims, "that says we should be doing spine fusion for back pain." Only 22% of such patients have a positive outcome, whereas the chance of making the pain worse is 40%. This can push people into opioid abuse.

• It is well-documented that disc degeneration, bone spurs, arthritis, bulging discs, and so on are rarely the cause of back pain. So when a fusion is performed for lower back pain (LBP), we really don’t know the source of its arising (3). The success rate of performing a fusion for LBP is less than 30% (4,5). Most people expect a much better outcome, and the resultant disappointment is also problematic for their pain.

I didn't know there was an alternative!

According to Dr. Hanscom chronic physical pain is interwoven with feelings of anxiety. Mental turmoil and anxious symptoms are the triggers. By treating anxiety, pain greatly improves.

"The key is to rewire the nervous system," according to Dr. Hanscom, referring to the concept of neuroplasticity: The brain can adapt and make changes, potentially removing the pathways and associated chemicals -- triggered by inner turmoil -- of "memorized pain."

He addresses the related problem of osteoporosis, a condition where bones become weaker and more brittle. There are solutions, even free ones on his website. Surgery and prescription medicines are almost never the answer. Listen

• Do You Really Need Spine Surgery?
• Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain

3. Boden SD, et al. “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation.” J Bone Joint Surg (1990); 72:403– 8.

4. Carragee EJ, et al. “A Gold Standard Evaluation of the ‘Discogenic Pain’ Diag­nosis as Determined by Provocative Discography.” Spine (2006) 31:2115-2123.

5. Franklin GM, et al. “Outcomes of lumbar fusion in Washington state workers’ compensation.” Spine (2994); 19: 1897–1903; discussion 1904.