Are recommended back surgeries either unnecessary or too complex? In 2011, researchers documented that in a study of 274 patients, 17% with cervical/lumbar complaints seen in first or second opinion over one year were recommended “unnecessary” spine surgery (e.g., defined as for pain alone, without neurological deficits, or significant MRI finding).
In 2012, research was published that found that 69 (44.5%) of the 155 second opinion patients seen over a 14-month period were told by outside spine surgeons that they needed surgery; the second opinion surgeon found those operations to be unnecessary.
Increasingly, patients, spine surgeons, hospitals, and insurance carriers should not only be questioning whether spinal operations are “unnecessary”, but also whether they are “wrong” (e.g., overly extensive), or “right” (appropriate).
In the most recent research, of 183 second opinions seen over 20 months, the second opinion surgeon documented that previous spine procedures that were recommended were “unnecessary” (60.7%) or “wrong” surgery! (33.3%)1
What’s better—a physical examination or MRI?
Recent research tried to assess the diagnostic accuracy of taking a patient history for the presence of lumbosacral nerve root compression or disc herniation on MRI in patients with sciatica. A total of 395 adult patients with severe disabling radicular leg pain of 6-12 weeks duration were included.
Lumbosacral nerve root compression and disc herniation on MRI were independently assessed by two neuroradiologists and one neurosurgeon blinded to any clinical information. The study showed that a few history items (simple questions) had significant diagnostic value and diagnostic accuracy.1
Unnecessary surgery based on MRI
Are you being treating for your back pain, or for what the MRI is suggesting your back pain is?
“MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of cases (of back pain).” 2
British doctors and specialists at Southampton General Hospital in England noted in their own research that their own professionals could not agree on what the MRI said in diagnosing lumbar disc disease.
“We found in our study that there is wide variation in diagnosing lumbar disc disease between the Orthopaedic Surgeons and the Radiologists at our institution…Due to this amount of inaccuracy, it is risky to comment on degenerate disc disease on a plain radiograph alone. Therefore MRI scan should only be used to comment on the disc diseases of the low back, as plain radiographs are unreliable.” 3
Before you consider the surgical option based on an MRI, a consultation with a doctor trained in non-surgical treatment of ligament and tendon injuries, such as Prolotherapy and PRP (Platelet Rich Plasma) Therapy may be an option to avoid surgery.
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1. Epstein NE. Are recommended spine operations either unnecessary or too complex? Evidence from second opinions. Surg Neurol Int. 2013 Oct 29;4(Suppl 5):S353-8. doi: 10.4103/2152-7806.120774. eCollection 2013.
2. Verwoerd AJ, Peul WC, Willemsen SP, Koes BW, Vleggeert-Lankamp CL, El Barzouhi A, Luijsterburg PA, Verhagen AP. Diagnostic accuracy of history taking to assess lumbosacral nerve root compression. Spine J. 2013 Dec 7. pii: S1529-9430(13)01964-5. doi: 10.1016/j.spinee.2013.11.049. [Epub ahead of print]
3. Weiner BK, Patel R. The accuracy of MRI in the detection of Lumbar Disc Containment. Journal of Orthopaedic Surgery and Research 2008, 3:46