Back Surgery and Its Alternatives

Back surgery is a complicated subject. Many people have back pain, and as a personal injury law firm, we speak with a lot of potential clients about their experiences. Over the years we have come to realize that most people lump “back surgery” into a broad category without really understanding what it entails or that there are different kinds of surgery, all of them with different goals, risks, and success rates. It is also surprising how few people are familiar with the alternatives to major surgery.

In our experience with our clients, the majority of back surgeries such as laminectomies and fusion are successful, in that the patient has less pain and disability, but a substantial percentage of back surgeries are not successful and sometimes people even get worse. There is a term for this: “failed back surgery syndrome.” The fact that a back surgery is not successful in alleviating pain and disability does not necessarily mean that medical malpractice was committed. Sometimes problems are caused by recognized complications, and sometimes the scar tissue following surgery and the accompanying swelling just makes the pain worse.

We recommend that you read through the Mayo clinic web page about back surgery, if you’re considering it, but here is their breakdown of some of the common types of back surgery:

“Different types of back surgery include:

  1. Diskectomy. This involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. It’s done as an open surgery and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
  2. Laminectomy. This procedure involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
  3. Fusion. Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.Usually devices such as cages and bone grafts are utilized in such procedures.
  4. Vertebroplasty. During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar but more expensive procedure — called kyphoplasty — a balloon-like device is inserted to attempt to expand compressed vertebrae before bone cement is injected.
  5. Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it’s not yet clear what role they might play as a back surgery option.”

As you can see, these are all very different procedures, and each one has unique and specific risks and potential benefits. Obviously, any decision about surgery should be made with your doctor, but it is always a good idea to familiarize yourself with the benefits and risks of any kind of surgery you’re considering. Far too often, we receive calls from those who are suffering, and are unable to help them because the issue they’re having is an understood and accepted risk of the surgery they had. These people may have signed their acceptance of these risks without even reading the information they were given, much less doing any research. That is not to say that this happens with every surgery, or even the majority of them, but it is better for you to take a moment and consider whether the risk is worth whatever good the surgery is trying to achieve, especially since the benefit of a successful surgery is not guaranteed either.

The alternatives to major back surgery are varied and include injections, lasers and minimally invasive surgery. These alternatives can be a better choice, depending on the situation. For instance, if someone suffering from the pain associated with a herniated disk is fairly young, steroid or novocaine injections (epidural block) can be a better choice than fusing the vertebrae and sandwiching the damaged disk, because one result of that surgery is added stress to adjacent disks. Over time, those disks are likely to herniate as well, requiring additional fusions and reduced flexibility and range of motion. This might not be as much of a concern for an older person, with less time in which to be concerned about the other disks’ deterioration, but a younger person who opts for the steroid injections, a temporary solution, may then begin a physical therapy regimen to strengthen the surrounding muscles and reduce pressure on the herniated disk, reducing pain without surgery.

Another example of an alternative procedure is a percutaneous endoscopic laser discectomy, in which the surgeon uses X-ray monitoring and fiber optics that display images on a monitor similar to a TV screen, allowing the surgeon to see what is compressing the nerve during the procedure and removing it with a laser, often with quite a high rate of success. Procedures like this one or the steroid injections do not require general anesthesia, move muscles aside instead of cutting them, and require small or no incisions, drastically reducing or eliminating many risks, not to mention recovery time. Again, however, even these more conservative procedures are not without risks, and we have represented a patient who was rendered paraplegic in such a procedure. In that particular case a man had this procedure performed by a physiatrist- not a spine surgeon- and the thecal sac near the spine and the spinal nerves were burned, causing paraplegia. This surgery was performed in a medical office next to a Blimpies in a shopping mall. We recommend that you have a qualified spinal surgeon perform surgeries like this.

Minimally invasive spine surgery is one more alternative, and like the others, is not always presented as an option. It is possible that these alternative procedures may not solve your issue, but then again, they might. It is your job, as your own health advocate, to educate yourself about the options available to you. Remember that it is always possible to advance to a more drastic procedure at a later date, but once you’ve had a surgery, there’s no taking it back. A fused spine is forever. This may be the only option, and successful, in some cases, but please be certain before you proceed. It hurts nothing to get a second opinion or to look up information on your own.

It is unfortunate that some surgeries go awry, but in deciding to have back surgery, one accepts some risk, although certainly not the risk of malpractice. We are deeply saddened by the plight of those who have suffered as a result of this type of injury, but are hopeful that by helping to make people aware that they have choices, we might help reduce the numbers of these tragic situations. It is our job to help those who need it seek justice for malpractice, but as we’ve said, often these types of cases are not malpractice at all.

We are always ready to answer questions and help you figure out how to move forward if you, regrettably, suffer a bad result from spinal surgery. We will, without charge, determine if actionable malpractice was committed. If you were the victim of medical malpractice we are ready to help you on a contingency fee basis. We are paid a percentage if you win, and if you don’t, you don’t owe us anything.