Articles by JCS

Infomercial #1

Infomercial #1 Script:

“Avoid Back Surgery”

With

Dr. JC Smith, MA, DC

 

 

Preview Scene of office front and street sign (both sides)

 

Introduction Scene with Dr. Smith in Consultation Room

 

Hello, I’m Dr. JC Smith, a chiropractor working in WR for the past 30 years and I’d like to talk to you about two epidemics today—the epidemic of back pain and the epidemic of failed back surgeries.

 

I also want to give you hope that you can be helped without drugs, shots or surgery in my office on Russell Parkway, but first let me share with you the latest information on this back pain epidemic and the rash of failed back surgeries.

 

In fact, if you or someone you know may be contemplating back surgery, and you probably know someone already who has had a failed back surgery, this show will give you hope that you can overcome your back pain without drugs, shots or surgery.

 

The Hard Facts

A local medical orthopedist once told me that Macon is the back surgery capital of Georgia, and ranks 4th on the list nationally for the most surgeries per capita. In fact, America does 4 to 5 times more surgery per person than England and Scotland combined. Does this mean Americans have 5 times weaker backs or do we have too many surgeons doing too many surgeries? I’ll let you decide once you learn of the latest research.

 

The sad fact of this is not only that many of these surgeries are ineffective, but that most are completely unnecessary according to the latest research findings.

 

Don’t take my word alone on this because since 1990 there have been numerous research studies that all come to the same conclusion that most back surgeries are unnecessary, they are based on an outdated disc theory, and that chiropractic care and non-surgical methods are “proven treatments” for this epidemic.

 

The experts also now admit that chiropractic care is faster, cheaper, safer and longer-lasting than anything the medical world has to offer. Dr. Tony Rosner, PhD, testified to this opinion before The Institute of Medicine:

“Today, we can argue that chiropractic care, at least for back pain, appears to have vaulted from last to first place as a treatment option.”[1]

Today many medical guidelines now recommend chiropractic care including the American College of Physicians and the American Pain Society that endorse “spinal manipulation and exercise for acute, sub-acute and chronic low back pain.”

Indeed, it’s a new era in the treatment of this epidemic of back pain that you need to know about. Once you see what the experts say, you can make an informed decision about the best treatment for your back pain.

 

The Epidemic of Back Pain

Considering up to 90% of all adults will suffer from an acute low back attack, and the average person will have 6 or 7 episodes in his lifetime, and that there are over 200 treatments for low back pain (most of which are unproven), it does get confusing for the patients to make an informed treatment choice.

 

Few people realize that back treatment costs in the US alone are in the $100+ billion range or that the costs to patients are astronomical:

  • a lumbar fusion can cost as high as $169,000,
  • lumbar laminectomy: $82,614,
  • cervical laminectomy: $60,304, and
  • cervical fusion: $112,480. ([2])

 

Not only are spine surgeries costly, patients are rarely told beforehand that there are

  • 80,000 new cases of Failed Back Surgeries per year in US.[3]
  • 19% reoperation rate[4]
  • 71% to 95% of lumbar fusion patients will never return to work[5]  
  • up to 90% of these surgeries are now deemed unnecessary.[6]

 

The medical profession doesn’t want to let this cat out of the bag; it just makes too much money to be forthcoming that there are alternatives to this huge problem. Indeed, if only warranted back surgeries were done, most hospitals would go broke.

 

Changing Attitudes

In this era of evidence-based medicine, medical experts now clamor for a change in the management of LBP. According to Dr. Richard Deyo, the irony of doing so many back surgeries in light of the new research is dumbfounding.

''People say, 'I'm not going to put up with it,’ but we in the medical profession have turned to ever more aggressive narcotic medication and more invasive surgery.'' [7]

         

Researchers have noted this epidemic of failed back surgery with very distressing comments. Dr. Gordon Waddell, renowned orthopedist and spine researcher, mentions that

Low back pain has been a 20th century health care disaster … Medical care certainly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem… but 40% of American patients now seek chiropractic care for low back pain instead.” [8]

 

He continues to say:

Back surgery has been accused of leaving more tragic human wreckage in its wake than any other operation in history

 

He also admits:

“There is now considerable evidence that manipulation can be an effective method of providing symptomatic relief for some patients with acute LBP.”[9]

 

Dr. Richard Deyo, in his book, “Hope or Hype” mentions similar sentiments of ethical spine surgeons:

“Some surgeons, like Dr. Edward Benzel at the Cleveland Clinic Spine Institute, believe that too much spine fusion surgery is being performed. Benzel estimated to the New York Times that less than half the spinal fusions being performed were appropriate.

 

“Dr. Zoher Ghogawala, a Yale neurosurgeon, agreed that too much fusion surgery is done, saying, ‘I see too many patients who are recommended for fusion that absolutely do not need it.’”[10]

 

Another study conducted in 1994 compared international rates of back surgeries and found the startling fact that American surgeons are unusually excessive.

The rate of back surgery in the United States was at least 40% higher than any other country and was more than five-times those in England and Scotland. Back surgery rates increased almost linearly with the per capita supply of orthopedic and neurosurgeons in that country,”[11]  which explains why middle Georgia leads the state in back surgeries per capita.

 

The US Public Health Service conducted a landmark 2-year study of 4,000+ articles also issued in 1994 a guideline that again mentioned the low success rate of back surgery and fusion in particular.

 

This American guideline states that

“Surgery has been shown to be helpful in only one in 100 cases of LBP cases. Moreover, surgery increases the chance of future procedures with higher complication rates.”[12]

  

“There appears to be no good evidence from controlled trails that spinal fusion alone is effective for treatment of any type of acute low back problems in the absence of spinal fracture or dislocations…Moreover, there is no good evidence that patients who undergo fusion will return to their prior functional level.”[13]

Just this last year two more significant Random Controlled Trials on LBP revealed that conservative care was just as effective as spine surgery.

Dr. JN Weinstein of Dartmouth Med School conducted a study comparing fusion with non-invasive care and found people with ruptured discs recovered whether or not they had surgery and there was no harm in waiting.[14]

Another recent study done by Dr. WC Peul suggests discectomies for sciatica are no better than conservative care in the long term at 6 months.

The advantage was discernible six weeks after surgery but vanished by six months. And there were no significant differences between treatment groups in pain or disability beyond that follow-up point.” [15]

 

Not the Disc Scene

Dr. NM Hadler, MD, author of “The Last Well Person” and professor at the University of North Carolina School of Medicine, believes that
 ‘Ruptured discs and ‘bad back’ are terms that deserve to be relegated to the historical archives.”

Rather strong words especially considering coming from a renowned orthopedist and instructor at a medical school.

Unfortunately, here in Georgia the outdated disc theory is very much alive. The problem with failed back surgery begins with the assumption that any disc abnormality alone is the cause of back pain and requires surgery. While some disc protrusions may be the cause of leg pain, it is not the main cause of back pain, nor does it mean you need surgery.

Dr. NM Hadler, MD, is also very critical of the use of MRI and the disc theory as the sole reason for spine surgery for LBP.

“Whatever we see on the MRI is likely to have been present when the person heals. The discal hypothesis—the idea promulgated seventy years ago that the ‘ruptured disc’ is the culprit—has not withstood scientific scrutiny well. It is largely untenable for axial pain, and marginal for radicular pain.”[16]

Admitting the erroneous nature of the disc theory and the failure of drugs, shots and surgery, Dr. Hadler concluded, “Maybe you're better off not going to a doctor.'' Again, very strong words from a medical teacher, but not unfounded.

Obviously, you definitely should find a good chiropractor instead of relying upon your family doctor! Indeed, today’s chiropractic is not what your grandfather knew and the researchers now confirm the effectiveness of our care. When it comes to the spine, chiropractors are now considered the non-drug, non-surgical authorities.

 

The research also found that the average primary care provider—the family doctor—is not trained to diagnose or treat these problems. In fact, studies have found that the average PCP has only 1 to 4 hours of training in musculo-skeletal disorders whereas chiropractors have over 2,000 hours of training.

The disc assumption has been disproved by numerous spine researchers, including Dr. Scott Boden at Emory Spine Center in Atlanta. His seminal study back in 1990 showed that people without any back pain had disc abnormalities while other patients with back pain had no disc problems. (show disc degeneration chart)

I occasionally confer with Dr. Boden on cases and once asked him about the unusually high rate of spine surgeries in middle Georgia. He diplomatically said, “I just wish these patients would come to see me before their first surgery than after their third.”

The fact is back pain has more to do with the functioning of your spine, not the health or amount of degeneration.

Dr. Richard Deyo agrees that the disc theory often leads to a “false positive” misdiagnosis, which means, “yes you have a disc abnormality, but it may have nothing to do with your back pain.”

“Early or frequent use of these tests [CT and MRI] is discouraged, however, because disc and other abnormalities are common among asymptomatic adults. Degenerated, bulging, and herniated disks are frequently incidental findings, even among patients with low back pain, and may be misleading. [17]

If you’ve been told you have a disc problem and must have surgery, I suggest you keep in mind what these researchers have said to save yourself from a possible unnecessary and ineffective surgery.

You Don’t Slip Discs, but you do Slip Joints

Dr. Deyo jokingly refers to disc abnormalities as “incidentalomas” since they are incidental to the real problem of altered spinal mechanics, which is where chiropractors enter the picture. He concludes that 97% of back pain is “mechanical” in nature, and disk abnormalities account for only 1% of back problems.

While surgery is not the answer for most LBP patients, the editors of The BackLetter, a professional journal dedicated to back pain treatments, now recommend chiropractic as a proven treatment.

“Numerous international guidelines have endorsed the use spinal manipulation as a treatment for acute back pain—as part of an evidence-based treatment algorithm.”[18]

Dr. Richard Deyo also mentioned in the New England Journal of Medicine article that chiropractic is again a popular solution.

“Chiropractic is the most common choice, and evidence accumulates that spinal manipulation may indeed be an effective short-term pain remedy for patients with recent back problems.”[19]

Alf L. Nachemson, MD, regarded as the godfather of the evidence-based spine care movement, suggested that

“Many in the medical community, and spine surgeons in particular, have been slow to embrace the results of rigorous scientific research. As a result, many patients with back pain don’t receive optimal spine care. Many continue to undergo unproven and counter-productive treatments.”[20]

Unfortunately, it takes time to change attitudes about the best form of spinal care as the National Academy of Sciences mentioned years ago when it admitted it takes a long time for new treatments to be incorporated into health care.

An average of about 17 years is required for new knowledge generated by randomized controlled trials to be incorporated into practice, and even then application is highly uneven...”[21]

Certainly this time lag is very evident here in our area considering it has the highest rate of unnecessary back surgery in the state and ranks 4th on the national list.

 

Chiropractic Explanation Scene

So, if not the disc, what causes back pain in most cases? Let me give you the chiropractic model of spine care which makes more sense than the slipped disc concept. There is hope for you to avoid becoming another statistic of failed back surgery syndrome.

 

According to Dr. JL Shaw, MD (no picture available) and orthopedic researcher,

“Joint dysfunctions are the major cause of LBP as well as the primary factor causing disk space degeneration and ultimate herniation of disc material.”[22]

Let me explain what “joint dysfunction” means since it may save you a lot of money, suffering and disability.

If you were to ask what chiropractors actually do, the most people would say, “They crack bones.” In fact, we “adjust spinal joints.”

 

Actually there’s more to our science than only popping joints, but that’s a good place to begin with a quick anatomical lesson about the spine. Most people may recall from anatomy class that the human spine is comprised of 24 vertebrae sitting atop 3 pelvic bones—the sacrum and two hip bones (ilium). What even the most astute physician doesn’t know is the number of joints in the spine. This is essential to the paradigm shift from the medical model of “pulled muscles” and “slipped discs” that has proven to be so terribly ineffective.

 

The fact is there are 137 joints in the spine from the top (occiput or skull) to the bottom of the pelvis, including the two sacroiliac joints.

Chiropractors aim to restore normal joint function with alignment and motion, similar to setting any joint that’s buckled, twisted, compressed or slightly dislocated; in chiropractic parlance, what we call a vertebral subluxation. Once these joints are jammed or wrenched, the nerves inside the joint capsule will cause localized pain and muscle spasm. If the disc also swells, only then will it pinch the nerve root that goes down your leg. But this sequence starts with the joints, not the disc that is secondary. A disc does nothing until forced to by the spinal mechanics.

Until the joints are functioning properly, the healing process will not begin, tissues will not deflame,  and the pain will not be alleviated, which explains why manipulation should be the first form of spinal treatment, long before any drugs, shots or surgery is contemplated.

 

The Aching Sacroiliac

Imagine interconnecting the 24 vertebrae with 137 joints, and then you can see how unstable your spine actually is. I’ve found that many LBP patients actually have a sacroiliac problem instead of a disc problem. These joints cause severe pain in the buttocks and may radiate into the upper thigh and groin area. A positive sign is trouble getting out of a chair and severe pain twisting. Correcting the sacroiliac often comes quickly with chiropractic care, but too often these problems are ignored because there is no disc in these joints.

 

When you have spinal trauma from childhood falls, sports injuries, car accidents or just slouching in computer chairs, the spinal joints may become wrenched, twisted, compressed or misaligned. Soft tissue damage may also occur like torn ligaments, sprain/strained muscles and tendons. The chiropractor’s goal is to find these mechanical problems and to adjust them back to normal functioning.

 

In my 30-year career, I’ve found that the most problematic cases of LBP began in childhood when kids fell off bikes, roller skates, skateboards, horses or had sports injuries from gymnastics, football or playground accidents. Since kids heal quickly, these childhood injuries go unseen by mom and uncorrected until 30 years later their weakened back finally “goes out.” It’s equivalent to an old football trick knee that finally blows out later in life and only gets worse until correction action is taken. Indeed, most of my patients should have been to a chiropractor years ago when they first injured their backs.

 

As Bob Hope once said, “You know you’re getting old when your back goes out more often than you do.”

 

Just as a torn football knee is considered a joint problem, so are most back problems with the same goal to restore alignment, strength and flexibility. The chiropractic model of care is to adjust these problematic joints, strengthen the spinal muscles, and to restore joint motion—then to teach our patients how to maintain their spinal health for the rest of their lives.

 

DRX Scene

In most cases of neck or LBP cases, I have found standard spinal manipulation along with spinal exercises will do the job well enough, but for those 1% of cases with intense leg pain that don’t respond to spinal manipulation after a trial period of 2 to 4 weeks, a true disc herniation may be the problem. For these patients who don’t respond to traditional chiropractic care, or for those patients with failed back surgery syndrome, we now have another excellent tool at our disposal—the DRX non-surgical spinal decompression table.

 

Studies on patients with LBP and leg pain have shown that 86% have had successful outcomes in 20 visits over a 2-month span. This computerized table works to traction the spine at over 200 pounds/sq. inch. This creates a negative intradiskal pressure that literally sucks the herniated disc back into place as it decompresses the spinal joints. And for those patients with degenerative disc disease, the pulsating traction acts to nourish the disc material as it decompresses the spinal joints.

 

Close

If you’ve tried the pain pills, muscle relaxers, epidural shots and are considering spinal surgery, I urge you to come to my office first for a consultation. Bring your x-rays or MRI exams so we can review your case with you. While we don’t accept all cases for care, I would estimate over 90% of patients with LBP or leg pain respond well to our treatment. And if I can’t help you, I will refer you to orthopedists or neurosurgeons who can. My goal is to give you the best of both worlds.

 

And the cost of this program is less than the cost of 3 epidural shots or the cost of the deductible of one surgery, and we do have an affordable payment plan available so you won’t go broke getting well.

 

But your first step is to call my office at 922-4091 for your initial consultation. Come see our excellent equipment, learn about our spinal rehab program and learn how to care for your spine for the rest of your life.

 

You can avoid back surgery with our specialized care.

 

To learn more, visit our website at www.smithspinalcare.com  or phone our office at 922-4091.

 

 



[1] Rosner, A, PhD, testimony before The Institute of Medicine: Committee on Use of CAM by the American Public on Feb. 27, 2003.

[2] Schlapia A, Eland J. Multiple back surgeries and people still hurt. Available at http://pedspain.nursing.uiowa.edu/CEU/Backpain.html Accessed April 22, 2003.

[3] Ragab A and Deshazo RD, Management of back pain in patients with previous back surgery, The American Journal of Medicine, 2008; 121:272-8.

 

[4] Ragab A and Deshazo RD, Management of back pain in patients with previous back surgery, The American Journal of Medicine, 2008; 121:272-8.

 

[5] Berger E. Later postoperative results in 1000 work related lumbar spine conditions. Surg. Neurol 2000 Aug:54 (2)101-6.

[6] Widen, M. “Back specialists are discouraging the use of surgery.” American Academy of Pain Medicine, 17th annual meeting, Miami Beach, Fl. Feb. 14-18, 2001.

[7] “With Costs Rising, Treating Back Pain Often Seems Futile” by Gina Kolata, NY Times, February 9, 2004

[8]Waddell G. Low back pain: a twentieth century health care enigma. Spine 1996 Dec 15; 21 (24):2820-5

[9]Waddell G. and OB Allan, “A historical perspective on low back pain and disability, “Acta Orthop Scand 60 (suppl 234), 1989,.

[10] Deyo RA, Patrick DL, Hope or Hype: The obsession with medical advances and the high cost of false promises, AMACOM publication, 2002, pp. 191.

[11] Cherkin, DC et al., “International comparison of back surgery rates, “ Spine 19 (11): 1201-1206 (1994).

[12]S. Bigos, et al., “Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14,” U.S. Public Health Service, U.S. Dept. of Health and Human Services, AHCPR Pub. No. 95-0642, Rockville, MD: Dec. 1994.

[13]S. Bigos, et al., “Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14,” U.S. Public Health Service, U.S. Dept. of Health and Human Services, AHCPR Pub. No. 95-0642, Rockville, MD: Dec. 1994.

[14] “Surgical vs. Non-operative Treatment for Lumbar Disk Herniation,” The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA

[15] Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: Two-year results of a randomized controlled trial, BMJ, 2008.  

 

[16]JAMA, Need for less imaging, better understanding June 4, 2003 vol. 289 no. 21.

[17] Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70.

[18] The BACKLETTER  editorial, vol. 23, #1, 2008.

 

[19] Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001 Feb 1;344(5):363-70.

[20]Spinal-Fusion Surgery — The Case for Restraint, Richard A. Deyo, M.D., M.P.H., Alf Nachemson, M.D., Ph.D., and Sohail K. Mirza, M.D. Volume 350:722-726 February 12, 2004 Number 7.

[21] Crossing the Quality Chasm: A New Health System for the 21st Century, The National Academy of Sciences, 2001. page 13-14.

 

[22] Shaw JL, “The role of the sacroiliac joints as a cause of low back pain and dysfunction,” speech before the World Congress on Low Back Pain, University of California, San Diego, Nov. 5-6, 1992

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