340- The Top 3 Reasons to Not Have Spine Surgery

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now, here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today's episode, we're going to talk about a super important topic that happens in every single chiropractic practice and that is your patients who ask you about surgical intervention. I want to break down the three top reasons to not have spine surgery based upon my experience working within multiple surgery practices. This is powerful information. You have to have it to be able to give your patients the best, the most correct and the most objective information about what's going on with their care, what their best options are. And that is ultimately the best thing that we can do as their doctors, teachers, educators, healthcare providers. So we're gonna break this down on today's episode. Before we get started, I'll say a few words about the smart chiropractor. The smart chiropractor can power your patient journey to provide you with more new patients, better patient retention and more consistent reactivations without spending any money on advertising. How do we do this? We do this by helping you teach and invite consistently. That is the foundation of how you attract more of your ideal patients, how you retain more of your ideal patients, and how you reactivate more of your ideal patients. So we provide you with all of the content you need and we automate an overwhelming majority of it to make it super easy for you to stay top of mind with your current patients, for you to become exposed to new patients, more of your ideal patients in your community and, and so that you can consistently teach and invite. Check it all out at the smart chiropractor.com Again, that is the smart chiropractor.com but as on today's episode, I want to talk about the top reasons to not have spine surgery. The pendulum on this has been all over the place in my opinion. If we look at chiropractic over the last hundred years, you know, back in the day, there probably was, and for good reason, some divide between what we do as chiropractors, what the surgeons and traditional healthcare system was doing. Now, over time, the pendulum in some cases swung back the other way, where a lot of chiropractors would practically pride themselves on the amount of patients they're referring out of their practice and the truth probably lies somewhere in between. But as a chiropractor who is one of the first to practice in a true orthopedic group, and then moved on to, at the time, the world's largest outpatient surgical company practice. I got to really see behind the curtain of what goes on in surgical practices and hopefully be able to share some of those lessons with you so that when your patients are asking you about their options, or when they're going for a surgical consult, or if they've been to a surgical consult and they're asking you what they should do, you can have really objective and really informed information to be able to give them the best path forward. So that is the goal of this, and I'm going to frame it in the way of the top three reasons not to have spine surgery, because this is super, super important. Number one at the top of this list is that there's a belief that surgery is a permanent fix. It's just not true. And of course, with everything I discussed, there are always exceptions, but by definition, those are the exceptions. So in general, surgery is not a permanent fix. And here's the thing, here's why this is important. Many people in your practice, in your community right now, believe that that is the case, that if something gets cut out, then the problem is over and it's just not true. Why is it not true? For a variety of different reasons. Number one is often, often the daily habits, gravity, their DNA, how they're built, how they move their body, previous injuries, they. Their habits and lifestyle directly impact what's going on in their body. Of course. Right? So when you have surgical intervention, one of the reasons why it's not a permanent fix is quite often people go back to doing the same thing that got them into that situation to begin with. Long periods of inactivity, sitting, too much heavy lifting, with poor ergonomics, whatever it might be that got them into the situation to desire or quote, unquote, need surgery, those things typically don't go away. And when you have a area that is biomechanically compromised, AKA surgery happened, every time surgery happens, the segment or segments become biomechanically compromised. And why is this? It ties into a little bit about what we talked about on last week's show. The body doesn't like open space. So when a surgery occurs, if bone, ligament, or disc are removed, which is basically what's gonna happen during a lung laminotomy, foraminotomy, laminectomy, or a spinal fusion, something's being removed out of the body. The body's gonna fill in that space. What is the body gonna fill in that space with body's gonna fill in that space with scar tissue or fluid most of the time. So you end up with a biomechanically challenged area. You go back to the same habits that got you in that to begin with. And of course, you can see now why surgery is not a permanent fix. So anybody that's coming into your practice and believes that that's the case, well, I'm gonna try chiropractic, these other things, but I know if I need to have surgery that's gonna fix my problem, it's just quite often not the case. Also, I practiced with a Johns Hopkins trained neurosurgeon who once told me, and I don't think he was saying it in secret, he was happy with this. He was saying, and about a third of his patients get better after surgery, About a third are the same, and about a third get worse. Now, us as chiropractors, we gasp at that because we say, man, if I asked every chiropractor, you, you know, what's the percentage of patients that are happy, satisfied, and get a great result with your care, you're probably going to tell me 80 to 90%. And that's probably true. And with surgery, he's probably correct as well. He's probably on the higher end, with a third getting better, a third saying the same, and a third getting worse. He's probably on the higher end of skill. But when you open up the body, when you change biomechanics, when you are cutting, when you are ablating, you create permanent damage to the body. Now, the goal is, is that the amount of benefit you provide during the surgery is going to outweigh the inherent damage that the surgery does, and therefore, the patient will have a net benefit. But that happens about a third of the time. So it's important to keep in mind as patients are engaging with you, as patients are discussing their options. Most, believe me, if you go on YouTube and check out the comments, believe me, you'll see this really quickly. Many people, most people out there, believe that surgery is a permanent fix to their issue. And it is important for you to shatter that myth because it's one of the top reasons not to have surgery. For anybody that believes it is a permanent fix, because they're going to be woefully disappointed, and they're also going to create more challenges down the road. You know, there are those cases, of course, when surgical intervention is warranted and necessary, but over a million surgeries per year with elective spine surgery, many of those individuals have not gone through a complete conservative care regimen. They have checked the box on X weeks of physical therapy, X weeks of medication. Let's move you along to that surgical consult. I see a disc, I can cut it out. Let's do it. And that is a travesty. And it's partially why we've ended up in the situation we are regarding spinal care. Second reason, top reason not to have spine surgery is, is that you had previous surgery. So we would see a lot. I sat with 25 to 30 patients a day reviewing MRIs at my last position in the orthopedic surgical group. And I can tell you many of them were frequent flyers. So if you've had previous surgery and you think more surgery is going to fix the problem, probably not a good idea to have subsequent surgery. So previous surgery is a big challenge. We know that there's about, it depends on the intervention, but about 20 to 30ish and that can flex up as well. About 20 to 30% of the time, if you have one spine surgery, you will have another. So the resurgical rate is around 20 to 30% historically. And that's a big deal because if somebody's. Again, it ties back to reason number one not to have surgery. If you think it's a permanent fix, well, you got a one in four chance. Once you start down that road, you're going to be going back to that well multiple times. And more often than not more surgery does not fix the problem. So if you've had previous surgery, you have scar tissue in an area, you have a re herniation of a disc in an area, you have whatever it might be that's brought you back to a second surgical consult. Post first surgery, it becomes dramatically more challenging for the surgeon to get a good result. Why? Because the area's been compromised. You know, the many of the best surgeons, I use air quotes here. Cherry pick cases, one single level with a huge big disc herniation, and you chop that out, the patient's probably gonna have symptomatic relief for a period of time. But as you age and as you've had previous surgery, it can become much more challenging to identify the source of the pain. And you see this. I'm not telling you anything you don't know. Think about the last MRI report you read. There's probably findings at every single level. As I used to sit with patients, I would say, great, think about it like a deck of cards. Your MRI report throws all the cards on the table. The doctor's job is to sort through the not perfects to find the problem. Because every not perfect is not necessarily a problem. And once you start having surgery on a spine, you're compromising the biomechanics, you're bringing in scar tissue, you're altering ultimately how that patient moves. So going back and doing more surgery can become more and more complex each and every time. And the other aspect of this is the general rule is that you get two bites at the apple, meaning you can do two laminectomies, AKA one surgery, and then a revision before at that point you've compromised the tissue so much, a fusion is necessary. So there's usually a maximum. There's a couple exceptions here, but usually the maximum amount of bites at the apple you get from a minimally invasive perspective is two before the next one is an absolute fusion. Now, why is that the case? Because you can only take so much of the facet, you can only only take so much of the bone, only take so much of the disc before everything's gonna fall apart. So that's where, quite literally, so that is where the fusion and placing hardware in there and stabilizing the joint becomes necessary. Because as you're chopping away at the joint, you're really negatively affecting its ability to displace load, to displace stress, and you're really loading up the stress on the segments around it. So all of those things play a huge role in. One of the reasons not to have surgery is that you had previous surgery. Of course there's exceptions. And then number three, top reasons not to have spine surgery are the risks and the complications. They are just real. It's been estimated up to 20% of spine surgeries have some form of a complication. Now, every complication does not mean it's severe or death inducing, but it's a complication nonetheless. Everything from the extreme but paralysis, nerve issues, all the way down to infections and things like that. It's about a 20% complication rate when you look across all the spine surgery being performed. So 1 in 4 chance once you have surgery that you're gonna have surgery again. 1 in 5 chance that you're gonna have a complication anytime you go under the knife. These are real things that many people don't take into account. They believe. You know, again, if you look online, it's wild, but I'm just telling the truth. As it is, people believe a cervical adjustment to be risky, yet they are happy to go under the knife and receive orthopedic or a spinal surgery, to quote, unquote, fix the problem. And it's just a knowledge gap. It's a dramatic knowledge gap and it's gonna take all of us, each and every day, not to scare people, to not have surgery, not to badmouth the other professions, but to just showcase exactly what's going on out there and why, unless it is an extreme case, movement based care actually is the best long term fix because it provides an empowering component to it. And movement based care is what you're gonna do anyway after you have a surgery. So, and we've seen these microdiscectomies versus spinal manipulation articles where 5, 10 years down the road, the results tend to be the same, but you don't have any of these risks and complications. So thankfully, risks and complications are low. But of course I mean low meaning 20%. I mean us as chiropractors. I don't even know what the complication and risk rate would be. 1%, 2%, maybe 5%. And the risk of that is gonna be, would be soreness. You know, I can pretty much guarantee you the soreness risk after a surgery is 100%. So it's an upgraded criteria when we talk about the 20% with surgery. And it can become much more of an impact on that person's long term viability and long term health, of course. So all of these things are super, super important to keep in mind as people have questions about what their best healthcare options for them are. So what are those top three reasons again, as a recap? One, is anybody not to have surgery, anybody that believes that it's a permanent fix? That's a tough situation. Number two, anybody that's had previous surgery, they're fighting an uphill battle. And, and the risk and complication rate, if somebody believes it to be low or is unaware of what that looks like, it's important that they do have a great understanding of that. Because what we see time and time again is taking the conservative route. Focusing on movement based care is what provides the best result in most cases, most of the time. And that is critically important information for you to get out there, share with your community and accurately answer questions for the people that are coming into your practice and help them understand their best healthcare options. Now, when surgery is warranted, I'd highly recommend you build relationships with some great surgeons in your community. But you want to use that when it's actually appropriate and when it is actually necessary. Because just like every carpenter, you know that, you know, the hammer and the nail kind of thing, the surgeon feels the same way if they see a disc challenge. It is very likely if that patient has gone through some conservative care, that they'll recommend surgery not because that they're bad physicians, but because that's what they're seeing. I can take care of that. I can do that. Let's get you in here. You've already done some form of conservative care. They're going to see the case that way. And it's important for you to be a powerful ally, you know, ally for the patient in helping them understand what they're getting into. So those are the top three reasons, in my opinion, based upon my experience, not to have spine surgery. That's There is a whole spider web of other conversations that can go on in and around this topic, but that's what I wanted to touch on today. Thank you so much for listening into this podcast. If you have not left us feedback or a review, please scroll on down on your phone. Do so. It helps more and more docs find out about this podcast and I super, super appreciate you tuning in. And before we wrap up, I want to also encourage you Click in the episode Show Notes, Head over to Power Step Pick yosef up a free pair of of orthotics. I love Powerstep Orthotics. My father has used Powerstep Orthotics. They were designed by a podiatrist over 30 years ago. This team puts out a fantastic product and they're willing to give you a free pair for being a listener of the Evidence based chiropractor podcast that is pro.powerstep.com sample I'll drop that link down below. Have a fantastic week in practice and I will talk to you soon.

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