The image above represents a real patient of mine. You don’t want to end up like this.
HOW DOES THIS HAPPEN?
Mrs. Z had a work-related injury and developed low back pain. She failed all conservative therapies and was then referred to a surgeon. This particular surgeon typified too many surgeons out there—the ones I call Dr. Shuffle. These doctors perform one surgical procedure after another to address a house of falling cards. And it almost always turns out badly.
SURGERY, AND MORE SURGERY…
In Mrs. Z’s case, she first underwent a two-level lumbar fusion because her MRI showed some annular tears. She was absolutely no better after the surgery, so she underwent another fusion procedure using a different technique with rods and screws. The assumption was that in the first approach, what’s called an anterior fusion, the construct was not solid enough. But because the original pretexts for surgery were incorrect, the second fusion also failed to provide any relief. The surgeon then went ahead to extend the fusion from L3 down to the sacrum.
Still no better, Mrs. Z endured yet another fusion that was extended to the sacroiliac joints. Still seeing no improvement, she then had a dorsal column stimulator implanted, and went on to have a morphine pump implanted. She finally came to see me, still experiencing pain after all these invasive procedures!
It was clear to me that the woman was depressed and anxious (who in her condition wouldn’t be?). The chances of her getting better with the first of her many operations were small, because from the beginning she was never a good candidate for the surgery.
The statistics on failed back syndrome reveal that almost one-half of the patients have psychological and psychiatric disorders that preclude a happy ending.
This failure rate is even greater when patients with workers’ comp injuries or active litigation are involved.
For those who deal with chronic pain, and are liable to suffer from depression as a result, it’s unlikely that any further surgical intervention will help. Do you think you fall into this category? If so, don’t schedule more surgery; instead, work on developing a multidisciplinary pain management team with a heavy emphasis on supportive strategies to boost your psychological needs and regulate your medication.
Say good-bye to Dr. Shuffle and find someone who can help. And when in doubt, get a second opinion.