06/02/2025
I regularly see patients who have undergone two or more (up to five+) spinal operations before the age of forty. By the same or different surgeons. This saddens me because the chances of each new operation to be succesfull gets lower and lower every time.
What is however more shocking is that a high percentage of these patients are surprised to have a clinical back- and neurological examination. They say that the surgeon just discussed the MRI, showed them the " dangerous abnormalities" and booked the surgery that will save them from "becoming paralised if they stumble".
This breaks my hart for mainly two reasons:
Firstly it has been widely known for years, proved and published in different studies, that a high percentage of MRI "abnormalities" can be seen in random, asymptomatic individuals. From the age of twenty, (getting higher in each age group),these individuals showed disc protrusions, narrowed and ruptured discs as well as degenerative changes of bone and joints - which is now seen as normal signs of the aging process. Few healthy, people over fifty have "normal" MRI's.
Secondly it is also well-published that permanent paralysis from degenerative, disc- related spinal problems is highly unlikely in conservatively-managed patients and occur much less than complications during and after surgery. This becomes more and obvious in higher age-groups.
Unfortunately doctors are not trained pre-and post-graduately how to do active conservative treatment of disc-associated spinal pain. It becomes the easier way out (for the doctors) not to do a time-consuming clinical examination, explanation of the normal healing time, exercises and pain control measures but to do a expensive MRI and operation.
The financial costs of these procedures and time off from work etc. in South Africa and the unnecessary damage to patients has enormous consequences. Good for the hospital industry and service providers and bad for patients and medical aid premiums.
Medical schemes pay for more than 85% of spinal surgery for disc-associated degenerative spinal pain in our country. This is done to the less than 10% of the populace that can afford medical aids.
During their studies spinal surgeons get experience in training hospitals mostly in surgery for indications like unstable fractures, spinal infections like Tuberculosis, tumors of the spine or spinal cord, congenital defects, etc. Surgery for degenerative conditions is done much more seldom. These patients usually get better by themselves, being as active as possible, in one to three month's time. To keep on working is recomended. (Unused muscles get weak within days and delay healing).
In private practice these operations usually are the main source of income for spinal surgeons.
Please do not have surgery done to you or your loved ones by a doctor who just looked at the MRI and did not examine you clinically. It is your back and your life. Get a second opinion.
The facts stated here is supported by studies that I have at my disposal. You can visit: pubmed.ncb.nim.nih.gov/11568190/
Be well.
