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!

The relationship between low back pain and an unhealthy cholesterol profile

From the Moller  files of the "Not so Useless Bits of Information".

Cholesterol

There is huge focus nowadays on keeping cholesterol low and getting rid of the "Bad" cholesterol.  Treatment focuses on interfering with cholesterol production by way of a statin drug and through dietary restrictions using margarines dressed up as "heart healthy" and prescribing low fat. high carbohydrate diets.  While these measures may slightly reduce heart attack risk, the patient generally ends up much unhealthier overall, while the companies who make the drugs and the special foods make millions of dollars in profits, as do the doctors who prescribe them.

These measures do not work because they do not deal with the real underlying biochemical causes of an unhealthy cholesterol profile.

Advice for a young man with degenerative disc disease of the spine

I was looking into something for my back injury, I have bulging discs and degenerative disc disease through my entire back. My neck, hips, upper back and especially lower lumbar experiences extreme pain through the day. I am 21 years old as well, and have lost my dream of becoming a firefighter. I have been #!@# around by about 10 different doctors in the past 3 years, all of them referring me to different types of ridiculous treatment or simple prescribing NSAIDS, yet I've only gotten worse.

I'm sure an honest businessman like yourself, only looking to profit from other people's physical discrepancies and utter desperation will have little to no realistic advice, but I think it's worth a shot. Maybe you could recommend multiple expensive and placebo-based supplements and vitamins, I'm sure that would cure my miserable #!@# life!

Thanks in advance!

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Gary responds:

Thanks for seeking my assistance: While I had a good laugh over the last part of your email, I understand, as well, your deep frustration (Thanks for the additional info, btw, which is not published).

As you have found, NSAIDs and most physical treatments are mostly a waste of time for the kind of back pain that you are describing. I am fascinated by the increasing number of cases of spinal disc prolapse in young people that seem to be more of a spontaneous event, rather than through usual causes of violent injury or repeated misuse. Rather than looking for a mechanical cause, the answer is surely to be found in biochemistry. And, so there is!

Let's assume that you have completed a Hair Tissue Mineral Analysis (HTMA) and found a number of biochemical imbalances, the most interesting of which is a disturbance between copper (Cu) and zinc (Zn).

The copper connection with back pain and disc prolapse

Adequate amounts of Cu are required for the normal production of elastin and collagen, which are the primary components of ligaments and the spinal discs. Cu is essential for the cross-linking of protein which gives strength and integrity to these structures. Zn is required for the body to synthesise protein, therefore an imbalance between Cu and Zn can lead to ligament and structural abnormalities, including spinal disc prolapse.

High tissue Cu is commonly found in patients with scoliosis. Scoliosis commonly afflicts young girls, especially at puberty. One possible reason is that Cu in tissues rises with hormones at puberty. If tissue Cu levels are already high, the impending increase can cause a weakening of the spinal structures, leading to the spinal collapse seen in scoliosis. The same phenomena occurs during pregnancy. Resulting elasticity enables the pelvic ligaments to relax during childbirth.

Within what I have just described lies a possible biochemical explanation for many cases of unexplained disc prolapse.

Therapy takes time and effort and relies on carefully adjusting the biochemical imbalance, as per the HTMA. This is done by changing the diet accordingly and administering specific supplements, such as zinc or copper. Therapy is not always as simple as this sounds. For example, Cu deficiency may be due to the excess of an antagonising nutrient such as vitamin A and vitamin C.

If there is evidence of a Cu overload, possible sources of environmental contamination, such as old copper piping, need to also be identified and removed. Even a Cu bracelet can lead to a Cu excess in the tissues.

How to order a HTMA

The next step, if you really do want my help, is to order a HTMA which you can do through me here. I must have from you a physical mailing address to send the kit and information to. You pay the lab's agents (Pacific Health) direct by credit card (NZ$225).

Once the results are back you need to contact me to arrange to arrange a time to review the results by phone, Skype or a physical meeting if living in Wellington (The first consultation is included in the HTMA fee).

Incidentally, a Cu excess exposes the person to viral infections while being resistant to bacterial infection, whereas low Cu exposes the person to bacterial infection and resistance to viral ones. This pattern of infection is observed in women who are comparatively more susceptible to viral infection during menstruation and bacterial infection after. This is also an explanation as to why teenagers are susceptible to either viral infections like glandular fever or bacterial ones like acne; but seldom both. This may also explain why these infections are extremely resistant to "usual" treatments.

Another interesting observation is that Cu/Zn ratio disturbances are associated with mental function. High Cu/Zn is associated with tendencies for emotional outbursts. Is your email to me really your Cu losing its Cool?

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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.