I have blogged several times before about the epidemic of unnecessary spine and joint surgeries performed in our country. Spine surgery is the single most costly surgery for Medicare. The rate of spine and joint surgeries in the USA is 2-3 times higher than in any other industrialized country, with incredibly large regional variations. The widespread use of MRI scans, and other high tech diagnostic studies, have led to a large increase in frequency of these surgeries. MRI scans show the human anatomy in great detail, allowing doctors to see anatomical changes that are assumed to cause the patient’s symptoms. However, many of these are simply incidental, or age related changes. MRI scans of the spine, for example, frequently show the presence of bulging and herniated discs. But, MRI abnormalities (including herniated discs) do not correlate well with prevalence of back pain. More than 50% of people over the age of 50 will have abnormalities in their spine MRI scans, with only a fraction of those people suffering from persistent back or leg pain. MRI abnormalities are still widely used as a deciding factor to recommend surgery of the spine. Same is true for the presence of meniscal tears in knee scans. MRI scans have probably contributed to more unnecessary surgeries than any other diagnostic study in the history of medicine.
We saw today in our office a patient that clearly shows the perils of this type of medicine that is focused in treating the diagnostic imaging studies and not the patients. Mr. P is a gentleman in his 70’s with on and off episodes of low back pain, that has developed increased difficulty walking over the past 2-3 months. For those reasons he went to see a neurosurgeon who ordered a CT myelogram of his lumbar spine. A CT myelogram is a diagnostic study where a CAT scan is dome after the introduction of a contrast dye into the epidural space (around the spinal sac). Mr. P’s CT myelogram showed two herniated (protruding) discs as well as severe stenosis (narrowing) of his spinal canal. After reviewing that CT myelogram, Mr. P’s surgeon recommended spine surgery as soon as possible. Mr. P wisely sought a second opinion. He went to another neurosurgeon who, after reviewing the same myelogram, advised him that he would likely need surgery at some point, but, to delay it as much as possible.
Mr. P was unsure about having spinal surgery, so he came to visit us, to ask us if stem cell therapy could help him. We also reviewed his CT myelogram study. But, then, we did something that apparently is becoming more and more rare in our modern medical system: we took a detailed medical history, and performed a detailed physical examination. You know…what used to be called the practice of medicine. Mr. P told us that his back and leg pain was almost completely gone now; that his main complaint was his decrease in function, and an inability to walk due to unsteadiness. Mr. P did show an unsteady, wide based gait. He did have good muscle strength in his legs, but sensation to light touch in the distal legs and feet was severely decreased. He also had decreased sensation to vibration, and decreased proprioception (the ability to tell the position of our limbs without looking at them). Those are typical signs of peripheral nerve damage, i.e. peripheral neuropathy. After more detailed questioning, he finally admitted to daily, heavy use of alcohol. M. P’s symptoms had nothing to do with his spine, or the findings on the CT myelogram. His symptoms, his chief complaint, his reason to seek medical attention were due to an alcohol induced peripheral neuropathy (alcohol use is the second leading cause of neuropathy in the USA, diabetes being the first).
We discussed with Mr. P that stem cell therapy has a neurogenic effect, and that it has been used effectively to treat cases of peripheral neuropathy. Unfortunately, Mr. P is not only a heavy drinker, but also a heavy smoker: something that can seriously inhibit the ability of his stem cells and his body to heal itself. Since Mr. P had no interest in stopping his use of alcohol or tobacco at this time, we had to inform him that he was not a good candidate for stem cell therapy.
Had Mr. P not come to our clinic he would have likely proceeded to get an ill-advised, complex, very costly surgery with a very long recovery period, and relatively high risk of complications. All for something that had nothing to do with his spine. Simply because his surgeons had concentrated in treating the abnormal CT myelogram, and not the patient in front of them. There was zero chance that a spine surgery would have helped this patient, and probably would have worsened his condition.
Lesson to be learned here? Be extremely suspicious of any surgeon willing to operate on your spine (or joints) based solely on diagnostic imaging findings. Unfortunately, now we see many large clinics doing minimally invasive and laser surgeries advertising using some variation of the same message: “Send us your MRI, and we will tell you if you are a candidate for our surgery. Free MRI consultation”. The vast majority of patients that send their MRI reports will be told that, of course, they are candidates for surgery. And, those who agree to have the surgery, are not likely to meet their surgeon until just a few minutes before being wheeled in to the operating room. If you ever see those advertisements, do not walk away, run away from them. We should be treating patients, not MRI scans.
To learn more about non-surgical alternatives to back surgeries go to: www.dontoperate.com.