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Sunday, January 05, 2014

Is spinal fusion a safe and effective treatment for disc prolapse?

State-funded fusion surgery near level in the US — where critics say procedure is over-used

Shanil Vellaidan, who needs spinal-fusion surgery for a disc prolapse, is one of more than 1,000 people who may have the procedure this year. Photo / Natalie Slade
Shanil Vellaidan, who needs spinal-fusion surgery for a disc prolapse, is one of more than 1,000 people who may have the procedure this year. Photo / Natalie Slade
The number of patients who received state-funded spinal fusion surgery doubled in the decade to 2011.
This is approaching the rate of increase for the complex and risky - but often life-changing - procedure in the United States, where it has been suggested it is over-used in treating back pain and may be no better than physical therapy.
Leading New Zealand spinal surgeon Dr Peter Robertson acknowledges the controversy over spinal fusion for back pain in working-age people but says: "No one knows what the right incidence of fusion over a population is."

Spinal fusion is the treatment of last resort.  Its a path traveled for which there is no return: So opting for surgery for back pain must be carefully considered and exercised only after ALL conservative options have been thoroughly exercised.

The problems with spinal fusion

  •  Surgery does not deal with the underlying causes of low back pain.  Why did this person suffer disc prolapse and not the person next to him doing the exact same activity that was thought to cause the injury?
  • All surgery involves risk: Risk such as reacting badly to medication, a slip by the surgeon having a "bad hair day"; or contracting a nasty hospital infection (this is a huge problem that hospitals are trying desperately to keep quiet).
  • Spinal fusion may give relief for a number of years but not forever: Fusing one or more spinal joints ends up increasing the stress on the joints above and below the surgery.  With time, these joints may begin to fail.  Disaster!


When may spinal fusion be necessary

In my opinion, surgery may be justified where there is significant loss of function and sensation affecting the limbs, bowel, bladder and sexual organs - with failure to respond significantly to conservative therapies.

Many people have disc prolapse and other abnormalities of the spine while suffering little or no symptoms.  The existence of a disc abnormality in the absence of disabling symptoms does not justify surgery.

The most common cause of low back pain

Spasm of the gluteal (backside muscles).  These muscles are easily thrown into spasm from doing activities such as lunging, sitting or standing for long periods, lifting and bending.  These are the biggest and strongest muscles in the body.  They are your heavy lifting muscles.  If they become weakened and in spasm, then the stress of everyday activities is thrown on the muscles and joints above and below them - the knees below and the sacroiliac joints and low back above.  If this goes on for long enough then the intervertebral discs of the spine may begin to degenerate and disintegrate.  The problem is to do with the gluteals - the low back pain is the symptom - not the cause.  Got the idea? 

Treatment that works:  

Relieve symptoms of pain and dysfunction while treating the underlying causes


What are some of the underlying causes of disc prolapse?

  • One of the symptoms of exposure to toxic elements such as lead, cadmium and arsenic, is knee, hip and low back pain - disc prolapse specifically.  These toxins affect the cross-linking of collagen in structures such as the intervertebral discs.  I note, with interest, that the man in the Herald article is a mechanic: When I do hair tissue mineral analyses, mechanics are tops for exposure to nasties like lead.
  • Poor posture, poor lifting methods, weak muscles and imbalances.  This is epidemic in industry and life in general.  It takes months of instruction in a gym to replace sloppy technique and to develop a strong physique.  Most ACC funded rehab programmes are too short in duration for lasting benefits and instruction in weight training and lifting is not learned in a university lecture theatre.
  • Workshop and equipment.  Many mechanic workshops are unsafe: How many are back street operations are there out there without proper hoists etc?  How many workbenches are there that are sited adjacent to the solvent bath?  How may workshops are adequately ventilated?
  • Poor nutrition.  The modern diet is lacking many nutrients that are essential for strong, healthy bodies.  For example: Iodine, magnesium and zinc are all required for strong, healthy collagen, including that of the spinal discs - all are seriously lacking in the modern diet.  90% of us are seriously iodine deficient.  Lead and other toxic elements interfere with zinc and magnesium, as well as calcium.
  • Muscle spasm. Principally affecting the gluteals.  By the way, a back strain can set off a protective spasm of the gluteals.  This gluteal spasm may continue long after the original back strain has healed.  Spasm is self-sustaining.  Treatment involves nutrition, stretching, some exercise and weekly deep tissue massages lasting an hour each time.  In my opinion, physiotherapy, acupuncture and chiropractic only give temporary relief, if used as lone therapies.
  • Being idle.  One of the worst things anybody with pain can do is sit about.  The brain is a funny thing in the way it processes stimuli, including pain:  If there is a heap of chatter coming into the brain from sound, movement, touch, heat, cold and so on, when one is busily rushing about, the brain tries to filter out that which is not important so you can concentrate on the most important task of the moment.   Pain is filtered out.  If you are sitting idle at home with little in the way of stimuli; guess what?  Yes! - Pain is at its worst, because there is no filtering of the pain messages.  Keep busy.  Set tasks and deadlines.  If you can't work, then go do some exercise like dancing, visit a friend, listen to music, study, have a hot bath - but don't sit about watching television.

"I have tried everything, Gary, and nothing worked!"

I would be a rich man if I was given a dollar for each time I have heard this excuse! 

I do not like the word, "try": If I was delegating an important job with deadlines to an employee and the response is, "I'll try Gary".  I will immediately challenge that person: 

"When you say the word "try", does that mean you are going to fail me?  "Try" means failure before you even start:  You either do it properly, do it on time, or do not do it at all - You do not try - Take it out of your vocabularly".

When a client tells me they have tried everything I will respond with questions such as:

"Please list exactly what you have tried is that really everything?"
"when you say physiotherapy or chiropractic, what do you mean by these words: Describe what the therapist actually did to you?"
"How long and how frequent was the treatment?  Therapies take time: Months rather than days or weeks".
"Has treatment for muscle spasm and inflammation been taken to completion?"
"What sort of tests and measures of progress were there - strength, mobility, pain?"
"Horses for courses, I say: One physiotherapist may work wonders for one patient but not for another with exact same symptoms: Did you consult another physiotherapist if the first one did not work for you, or did you just give up?"
"have you been tested for things like lead poisoning?  If not, then you have not tried everything"  I have clients who have suffered lead poisoning from cast iron bath tubs, lead residue from firearms, hair dye, lead paint and even lipstick!
"have you been tested and treated for nutritional imbalances, such as iodine deficiency?  If you have, where is the evidence that you have actually corrected these?"


If the disc prolapse is not a medical emergency, as is the case for the majority, then one is best advised to thoroughly exhaust the conservative options before heading down the one-way surgical path.  If you are suffering from disc prolapse and are uncertain about what to do, you can contact me for independent advice and guidance.

Even if you can not come in to see me, much can be achieved by Skype video conferencing.  I have clients as far away as Alaska!

Further reading

My book about back pain (One of the very few ever published by a New Zealander):

"Gary, When I read the Introduction Chapter of your book, I laughed so much I forgot all about my back pain!"
- William

About this website 
The advice in these articles is given freely without promise or obligation. Its all about giving you and your family the tools and information to take control of your health and fitness.
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