Surgery vs Chiropractic: Surprising Stats on Success & Recovery | Podcast Ep. 203

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Can surgery fix your back problem? Today we are going to dive into some of the surprising research behind surgical results and, and some really, really exciting research that showcased manipulation versus a microdiscectomy. Who fared better? What were the long term outcomes? We're going to dive into all of that and more on this week's episode of the Evidence Based Chiropractor. Also, a little bit of housekeeping. If you are listening to this on Monday morning and you're in Southern California, you may be in luck. Tuesday and Wednesday, November 5th and 6th through respectively, I am hosting happy hour meet and greets in Los Angeles on Tuesday evening and in San Diego on Wednesday. This is an opportunity. I'm bringing some of my medical doctor friends. We are hosting a happy hour. This is your opportunity to bridge the gap, meet other healthcare providers. These docs are looking for chiropractors to refer to. This is a next step, a huge evolution. I don't mean to undersell it here with the evidence Based Chiropractor because historically we, we've been focused on helping you bridge the gap and build referral relationships. We've done it more and better than anybody else out there. But now we are taking the show on the road a little bit. So if you are in LA or San Diego, shoot me an email, Jeff, the evidencebasedchiropractor.com and I will send you all of the details. It's completely free. Come on over, have a cocktail, you know, eat some food and meet some docs who are looking to bridge the gap with you. That's what it's all about. I am super jazzed about it. And if you are not in LA or San Diego, stay tuned for future episodes where I'm gonna be doing this in other parts of the country. But as we talked about today, maybe aptly in light of that, we're gonna talk about some of the unsuccessful pieces of the puzzle in regards to surgery and where chiropractic care kind of fits into that. So can surgery fix your, your back problem? This is really consumer facing when I say that because hey, we know 90% of individuals will experience back pain at some point in their life, right? Pretty much everybody. But less than 5% will need a surgery. So way less than 5%, probably like 2% might have a red flag throughout time. So the questions then become how come so many surgeries are being performed? Does the surgery really fix the problem as most people believe it to be the case. I just didn't want surgery to fix my problem. I heard that time and time again at the orthopedic groups I worked at. So you may not be surprised to learn that a majority, an enormous number I should say, of back surgeries, don't give patients long term relief. So jumping over conservative care options is probably not the best idea. And we've seen in the research that up to 94% of individuals who have back surgery will still have pain after the surgery. We split this down a few different ways, right? So when we look at surgical intervention, typically non instrumented surgeries perform better than instrumented surgeries. So the effectiveness. Now again, I'm taking out these red flag cases where effusion is absolutely necessary, which are very, very few and far between. So by and large, when we look at surgical intervention, uninstrumented procedures perform better than instrumented procedures. And secondarily to that, we see about 10 years after surgery, almost 20% of people who have a first surgery will have a second surgery. So not only are nearly 95% still having pain after their first surgery, but almost 20% of those will have a follow up operation and failed back surgery syndrome, which kind of a catch all term for people who have challenges after surgical intervention, has been found in up to 20% of people. So these stats are not exactly overwhelmingly positive. Now again, there are, there is a time and a place for surgical intervention. There is, you know, as was said in the chiropractic textbooks, limitation of matter, right? You have too big of a disc that no matter what you do, it is just crushing the nerve root, it's crushing the lateral recess, it's crushing the spinal cord. And hey, in those cases, surgical intervention can provide a tremendous amount of relief for individuals. However, for most people, that's not the case. In skipping over steps such as chiropractic probably is not in their best long term interest. When we look at stats again in light of 95% of people still have in pain after surgery, quite frankly, what I used to hear from the neurosurgeons that I practiced with was their goal was about a 30% reduction in pain. Now if most people knew that going in 30%, sometimes I think us as chiropractors, we get overly dramatic. If we can't take somebody from an 8 or a 9 out of 10 pain to a 2 or 3, we're like, oh, was that successful or not? Gosh, in light of surgical intervention, absolutely. Probably double the result in that case. Additionally, once an area is compromised, once tissue is compromised, there's no going back. Whether it's minimally invasive and outpatient, whether it's rods and screws, there's a, you know, there's a gamut there. But the bottom line is once the skin has been penetrated and the structure has been altered, there is no going back. So inevitably, challenges have a tendency to pop up over time as that area continues to age, as it undergoes gravity, as additional injury may occur, and as deconditioning takes place. So these things are all really, really important to keep in mind as you get out there and have these conversations with, with the people in your community. And this is actually an area of focus for us within the Smart Chiropractor coming in December, which is really tying in a lot of these concepts. Smart Chiropractor is social media for docs like you, that's completely automated. You've probably seen some emails from me about it lately. We have been in an open enrollment cycle, so if you're interested in that, you can check out thesmartchiropractor.com but when we look at surgery versus chiropractic, let's take a look there. Right. So, okay. Surgery has its challenges. We all can agree with, hey, there's a high prevalence of pain, probably more than you thought when I said 95%. We also know that there's a 20% reoperation rate. That's very important for people to know. And certainly we know that there are challenges from a biomechanical standpoint when the structure has been altered. But let's take a look through the lens of chiropractic. You know, what happens when we put chiropractic up against surgery, so to speak. So there was actually a paper done specifically on this and it was titled Manipulation or microdiscectomy for sciatica. And it was a prospective randomized clinical study. It came out in 2010 10. And they found, quote, these patients must. The patients in the study, these patients must have failed at least three months of non operative management, including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy and or acupuncture. This is an important framing before we get into the results of this study, because the patients in this study had already failed physical therapy. So I know probably you and I have both heard either from patients or from medical doctors. Oh, well, if they went through and failed physical therapy, oh, there's no sense in sending them to the chiropractor. No, this study actually took directly the individuals who had failed PT and medication. And so That's a tough challenge, right, to then send either to surgery or a chiropractic office. What they found was, quote, most of the patients who were considered surgical candidates for the treatment of radiculopathy from lumbar disc herniation improved with spinal manipulation to the same degree as those who had undergone surgery. Of those who failed spinal manipulation, subsequent surgical intervention provided excellent outcome. Let's break that down a little bit. Surgical outcomes on their own aren't fantastic. They have a lot of risks. There's anesthesia, there's dangers with that, there's reoperation rates. There's a lot more risk and danger to having surgery than getting a chiropractic adjustment. I think we can all agree on that. So when we look at that and we say, man, people benefited to the same degree undergoing what we do as chiropractors in this study compared to if they went under surgical intervention. Forget about even the cost savings, right? The expense of surgery is outrageous. People had the same benefit undergoing chiropractic care or spinal manipulation. Now we take that even one step farther. And the people who then failed chiropractic care and actually had excellent outcomes in surgery, I'm trying to frame for you. In my opinion, outside of red flags, there is no way, shape or form anybody should be going through an elective spinal procedure without having exhausted chiropractic care first. It just does not make any sense whatsoever. When we look at the success rates of surgery, when we look at the reoperation rates, when we look at the risks, the dangers and the costs, and then we see studies that pit chirophractic against a microdiscectomy, this starts to become pretty darn compelling. And I believe this is an opportunity not only to have these conversations with the other healthcare providers in your community, we've touched on this through the evidence based chiropractor, our referral building program. But also, again, taking this to the streets, as they say, taking this to the people in your community and letting them understand that, hey, second opinions are probably a good idea. And before you have surgical intervention, here are some facts that you should be aware of. If you are leading that conversation in your community, I can nearly assure you you're the only one doing it, which puts you in a fantastic position. The other thing about this is it doesn't alienate other healthcare providers. It does not alienate medical doctors or surgeons. Because the bottom line is, as we saw here, subsequent surgical intervention provided excellent outcome. There's very few surgeons that don't want good outcomes for their patients. So if you can basically position it as, hey, we believe chiropractic care is great for first. Now, the benefit for you is new patients into your practice. And obviously the benefit for the patients is overwhelming. But the gist of it being, hey, those patients that don't perform well in our practice, these are actually completely ideal candidates if they're thinking about surgery and qualified for surgery before and they fail what we do in our practice, these are people that have a exceptionally high likelihood of being great patients for the surgeons. And now if you start to bridge with them from that thought process, you have an excellent opportunity to again bridge the gap. Get referral relationships going with other healthcare providers in your community, open up the eyes of patients in your community. All of this is just so, so important to practice building. So whether you want to take it from the approach of the smart Chiropractor, fully automated social media, email, et cetera, get out to your community videos, video scripts, et cetera, I'd encourage you to do so. Take a lot of what we spoke about on this podcast episode and utilize it or become a member@the smartchiropractor.com or subsequently. If you say, man, I'd really like to have more relationships with other healthcare providers in your community. Well, as we talked about at the top, if you're in LA or San Diego tomorrow or the next day, you're really in luck. Email me and I'll give you all the details to come out and meet some MDs right then and there. However, if you are not in those two areas, then visit us at the Evidence Based Chiropractor and check out our program there where we give you these tools and much, much more to really be able to firmly establish relationships with other healthcare providers. The research is out there. The key is knowing how to frame it, putting it into action and ultimately then seeing the result. So I hope this episode was enlightening to you. I hope it was inspiring. In the face of man, what we do is so effective, it's so safe and it fits so well in with what is going on in our communities and the conversations that people are having in our communities. Now the onus is on you to get out there and start those conversations. I hope you have a great week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.