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

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."
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11181064
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Gary:
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?"

Conclusion

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.
http://www.garymoller.com/Consultation/Private-Consultation.aspx

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):
http://www.garymoller.com/Products/Products/B/Back-Pain---guide-to-treatment-and-recovery.aspx

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

- William

http://blog.garymoller.com/2010/03/relationship-between-low-back-pain-and.html


http://blog.garymoller.com/2012/11/gluteal-butt-and-low-back-exercises.html


http://blog.garymoller.com/2008/05/low-back-pain-cycling-and-iliacus-and.html


http://blog.garymoller.com/2009/01/i-am-suffering-hip-and-buttock-pain.html


http://blog.garymoller.com/2013/06/it-feels-like-deep-pinch-in-my-hip-that.html

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.

Candida and Fungal Infections? Gary Moller recommends you explore this programme: Click Here!

Client Feedback: From "Severely Handicapped" to Hiking the Waitakere Ranges in Eight Months

Hi Gary:
Robin arrived home yesterday after visiting you in Wellington last week. I just wanted to thank you most sincerely for your management of her back condition. 

Eight months ago she was in chronic pain and severely handicapped. She was on the verge of applying for surgery, when I discovered your website (originally as a link from rustypanels!) and bought her your back pain book. I know you don’t claim to “cure” conditions like hers, but aim instead for effective management. 

She has followed your three-fold regime faithfully, and has achieved a long pain-free period, allowing her to resume our lengthy hikes on the rugged tracks of the Waitakere Ranges. 

So you deserve full credit for her recovery, but she also deserves credit for following the treatment plan meticulously, otherwise it wouldn’t have worked. 

Our heartfelt thanks to you!

Dr Alex Davidson MRSNZ
Research Analyst

(Note: Permission given to use personal details)
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Gary:

When Robin bounced through my door for the first time (Last week), I was enveloped in a huge, warm bear hug that took me completely by surprise.   It was hard to believe this was the same person I first dealt with earlier this year.

Sure she is not yet out of the woods and never will be (Most chronic health issues need to be managed to some degree for life); but now she is out and about living a life!

Your email address:


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Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Omega 3 fatty acids can relieve back pain

"Omega 3 fatty acids can relieve back pain according to a new study released in the journal Surgical Neurology. Omega 3 fatty acids are so beneficial; this just adds another complement to them.
In the study 250 men and women with neck and back pain were required to take omega 3 fatty acids from fish oil or placebo. The dosage was 2.4 grams per day. They also were on NSAIDs (Tylenol, Aleve, Advil), which were gradually tapered off according to pain relief with oils.
At completion more than 60% of those in the fish oil group reported decreased general pain as well as 60% said they had less joint pain. More than 80% stated full satisfaction with the fish oil treatment and 88% would continue to follow protocol results were so great.
What may be even better to hear is that 59% of the participants in the fish oil group were able to completely quit using the NSAIDs. Chronic NSAID use can help treat chronic neck and back pain, but comes at a cost. NSAIDs increase the risk for stomach ulcers and liver problems. As well recent news reports of prescription NSAIDs (Vioxx, Celbrex) point to even riskier complications."
Source: Supplement News
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Gary Moller comments:
I broke my left arm in January of this year which I self-treated. Despite the damage, I was able to comfortably get through the worst week or two without even an aspirin, preferring, instead to use natural products like fish and flax oil and MSM. Healing was rapid and 100% and without any complications. I competed in an 80km mountain bike race just 8 weeks after the injury and survived.

With regards to joint and other pains, please take careful note of the amount of Omega oil consumed daily by the subjects in this trial: 2.4 grams per day. In my experience, most people who try these oils for conditions like cardiovascular disease and arthritis do not take anywhere enough omega3 oil each day, consistently enough and for long enough to have a noticeable benefit.

Such therapies often are best when combined with body tissue mineral therapy such as provided by the Active Elements service.

Talk to Gary Moller (First 5 minutes are free):

Will glucosamine help my arthritic low back and relieve back pain?

"Hello Gary, I have just come across your website and I must say its bloody fantastic. I am an age group triathlete (41year female) who last year had diskectomy surgery on my lower back and am now suffering from painful degeneration that has caused me to cut my running right down (replacing with crazy fast walking) and I am finding the swimming painful too.

I have just started taking Glucosamine tablets and am trying hard to not take as many panadol as I am sure it cant be good for me. My goal is to NOT go and have fusion surgery but to still be able to race and train comfortably for as long as I can. I was interested in your u tube piece on the various joint supplements but am now a bit confused as to what I should be taking can you help. I have also been reading many online articles about it and some say its not been proven to work and some say its fantastic, what is your opinion?"
"L"
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Gary Moller comments:
I have been assisting people with low back pain for more years than I care to think about! In many cases, if not most, the pain suffered has only a passing association with the degree of degeneration of the spinal discs. Let me explain what may be going on and why further surgery is a poor option that should only be exercised as an absolute last resort:

OK, you injure your back, irritate it, stir it up for some reason. The immediate protective response is for the muscles about the spine, including the butt, to lock up in spasm. This is a natural casting effect to immobilise the spine while the damage is repaired. Unfortunately, the longer this spasm goes on the greater the possibility of secondary problems developing - chronic muscle weakness, hard gristle and permanent spasm.

When muscles are in spasm, there is little blood flow through them. In order to survive the cells switch to anaerobic mode to cope with the low oxygen environment. This causes a buildup further of toxins in the area which becomes swollen and painful. The toxins cause more spasm, thus setting up a vicious cycle of pain and inflammation that continues well after the original injury has healed (99% of healing is complete within 12 weeks. Exercise may make the pain worse as will sitting and standing without moving. Even sleep may be a problem.

The spine does not like a lack of normal movement and there will be an acceleration of degeneration as a consequence. Not a good look all round!

Let me give an overview of how I help people get over their back pain.
The first step in getting a full recovery is to try to identify any areas of nutritional deficiency because it is a waste of time trying to reduce inflammation, strengthen and mobilise if there is a nutrient deficiency. Exercise will just make the person worse. Each person is different. A person might be deficient in some key minerals. A low fat diet may cause fat soluble vitamin deficiency, the person may be slightly anaemic, etc. Many nutritional factors can contribute to ongoing pain and poor response to exercise. Once these are being dealt with I then introduce deep tissue massage about a week later.

This special form of massage can be most unpleasant initially. It is applied to break muscle spasm and to soften hardened gristle and to shift out metabolic toxins of which there can be several liters.

Gentle stretching can be introduced as can gentle exercise. For guidance about safe exercise for a dodgy spine, there is my book about Back Pain.

Where we go from there depends very much on the person.

Glucosamine?
Yes! Most definitely. It works in most cases when taken in accordance with directions of the manufacturer and for at least 3 months. Your spine is a series of fibrous joints and the same principles of joint nutrition for other joints apply. Chondroitin is most important for the spine since it hydrates discs that tend to dry with age and lack of movement. Add MSM (methylsulfonylmethane) which has a natural anti inflammation effect and builds strong collagen (double-click any words for their meaning). There are other important ingredients for joint health, such as vitamin C. The joint care powders that I favour have these added.

Will glucosamine & chondroitin assist an athlete with a bulging disc?

Hi gary
I'm an athlete and have a bulging or herniated disc. Are there any supplements I can take to help heal the disc? I was thinking glucosamine and chondroitin with high strength fish and msm, if so in what amounts? Thank you for any help Paul
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Gary Moller comments:
I always wondered myself if joint food preparations containing glucosamine and chondroitin were of any benefit for a herniated lumbar disc. After all, the joints of the spine are exactly that: joints. The only difference between them and, say the knee joints, is they are semi mobile with a thick fibrous outer sheath and a gel-like internal that provides shock absorption and flexing, extending, gliding and twisting. The physiology is the same, including the reliance on movement for nourishment. There are other joints in the spine: small articular joints of the spinous processes which can become worn and inflamed.

Chondroitin may assist with manitaining hydration of the spinal discs which tend to dry out as we get older and with damage such as suffered by Paul.

Several years ago I was working with a retired shearer who had had two spinal operations over the years, including a spinal fusion of L-4/L-5. He was suffering repeated severe bouts of back pain that had him buckled and bent to one side in spasms. After about a year of these disabling episodes, I suggested he try a course of Nutra-Life Glucosamine and Chondroitin which he dissolved in a drink bottle and sipped throughout the day having a steady infusion of about 8 rounded teaspoons per day.

To his and our immense delight, his back pain eased almost completely within about three months and I can report that he has not looked back since, despite suffering other though unrelated health problems since. I often recommend glucosamine and chondroitin - plus MSM for back pain nowadays and the results are generally very positive. It is a harmless and relatively cheap therapy. Even if there is no obvious benefit for the spine, at least the person is ensuring other joints like knees and hips are kept in good nick. After all, back problems can cause extra strain to go on these other hard working joints and the last thing a person with back pain needs is a crook knee!

So, I have no hesitation in recommending glucosamine and chondroitin preparations such as Nutra-Life Joint Food for back pain. I would add some MSM, preferably separately such as Kordel's MSM. MSM has a natural anti inflammatory effect and builds healthy collagen such as found in skin, hair, nails, ligaments and joint cartilage. An athlete can take extra a few days before, during and after anticipated extreme exercise and competition to aid recovery and healing.

How much should one take for a bulging disc? I recommend taking between 1500 and 3,000mg of glucosamine per day, spread through the day for about three months before backing off to a sustenance dose of about 1,000-1,500 per day. Doses of chondroitin are generally a few hundred mg less per day. MSM can be taken at about 2,000mg per day and then drop back to about 1,000mg after three months.

Once the three months are up, the idea is to fall into sustenance mode and step up the amounts around anticipated periods of stress or when pain is felt. After several months, relax and take some here and some there. I personally go in fits and starts with all supplements just for the sake of it.

Finally, exercise is essential for management of a bulging disc beginning with ensuring that the hips are strong and flexible. My book on Back Pain is a good start for exercises. If your hips are tight, then the stress of athletic exertion is transferred excessively onto the lumbar spine, so ensure you work on the hips. All the core exercise under the sun will be of no avail if the hips are tight and weak.

Kick Back Pain in the Butt

Purchase direct from the author and Save!

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

- William

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At some time in our lives, just about all of us will suffer back pain. Many will be plagued by ongoing and often unpredictable bouts of pain and disability. Low back pain, back injury, sciatica and nerve pain, muscle strain, back surgery, lumbar disk protrusion, sacroiliac pain - if any of these apply to you, or if you just want to keep your back strong and healthy, this is the book for you. While researching for this book, I was struck with the rather bland and sometimes depressing writing style of the books out there for people who are hurting. My decision was to write this in a chatty and sometimes humorous style, just to cheer up my readers and to also let them know that this is one so-called "expert" who knows all too well what a terrible affliction back pain can be.

 

I also identified a huge abys in most current advice: how who and where to get help and what to do as first aid when you first injure your back? The book includes 10 Tips for a Healthy Back. Back Pain guides the reader through the process of what to do from the moment a back injury happens, how to apply first aid, when to get medical help, and how to assess what works. It advises about ongoing care and maintenance, including advice on exercise and diet. Back Pain includes a helpful chapter "Ten tips for a better back" and has graded exercises that progress from a bed-ridden state to resuming full function.

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"This is the most refreshing and practical book I have read about back pain. Thank you." Mary

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Even if you don't currently suffer back pain, prepare now while you are able! Besides, the odds are that someone close to you is suffering back pain right now. Consider purchasing this book as a gift to them.

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“I just wanted to say that your Back Care book is great! I gave it to my mother who has some back problems and I was unsure if she would pay attention as she is not one for taking advice really. However, she obviously liked how you talked in the chapters and related to it as did I! So thank you very much for producing something that inspires all sorts of people into caring for a vital but often overlooked thing such as our 'backs'.

- Steph”

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At just $19 you simply can't go wrong with this offer. That's the equivalent to spending on just one bottle of pain killers. You'll pay twice that when you go to the doctor and that again each time you go to a Physiotherapist or chiropractor. You can't lose, so what are you waiting for? Take control of your back pain now and kick it! Getting your copy of the Back Pain guide is quick and painless, so act now.

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Purchase here:

https://www.garymoller.com/product-page/back-pain-guide-to-treatment-and-recovery