Is surgery harmful?

March 1, 2022

This post discusses some outcome data and risks associated with surgeries. There are a few good points that I'd like to discuss in regards to this statement in particular.

- "Sometimes surgery is recommended because non-surgical treatment has not worked. Unfortunately, the failure of non-surgical treatment does not make the ineffective surgery any more effective. It still doesn’t work any more than not operating." -

This is an excellent observation. A thought about that is, was the problem accurately diagnosed? A favorite example of mine was patient with back pain who had a spondylolisthesis. That is, one of her lumbar vertebras had shifted out of place relative to the others as noted with MRI and XRay. Fusion was proposed to "fix and stabilize" it. Long story short was that her pain was actually coming from a kidney stone, not the displaced vertebra! Thankfully for her, the doctor and I didn't think her pains clinical behavior matched the imaging and we sort another answer outside of the most obvious one, that her bone was not aligned. Turned out that bone had been that way many years and was in fact NOT the cause of her pain. It's also why PT was not working either. We were in the wrong system (Orthopedic vs Urological). This can easily happen once imaging enters the system. Abnormalities are frequently found in painfree individuals. so you must make sure the behavior matches the imaging. The clue was the behavior of her pain. Motion with PT did not affect her pain (make it better or worse). One would expect that a bone moving unfavorably would create more pain if moved more out of place, or less pain if moved in a direction of unloading. Clinically that was not the case, and that was cause for raising an eyebrow. She really didn't understand what made her pain better or worse and how could she if it was just based on how and where the kidney stone moved around.

Another thought is the power of the brain. I had one patient who told me she hurt he back caring for ailing husband. She had the pain for many years after he had passed. She realized that her pain never got better until she had fully grieved for her loss. The pain was in a way her bodies way of holding onto her husband.

Pain can have many causes. Our challenge as clinicians is to make sure we connect the correct dots. A favorite saying on mine is "the one thing that never lies is clinical response". Imaging can be misleading, clinicians can have pre-existing beliefs or biases that affect what tests they use (self confirmation) and this can cloud the picture. We can literally test a problem to confirm our thought, rather than actually trying to challenge it and disprove it. Truth is we can usually learn more trying to challenge the hypothetical diagnosis than prove it.

In closing, this is again why I love the McKenzie approach. It uses the patients history and tissue loading strategies to better understand the problem and thus treat the problem in a more effective manner. If you failed conservative care (PT) before you might also consider the provider themselves. Not all clinicians use the McKenzie approach. Not all clinicians have the same skills, experience, or outcomes. Read reviews of your provider, seek word of mouth, and make sure you are working with someone adequately trained and experienced to treat your issue.

If you would like to work with a master clinician and someone trained in the McKenzie approach give us a call today (907) 561-1711.

If you are still considering surgery these questions they mentioned were very good one:

  1. am I more likely to get better with surgery than without it?
  2. what happens if I choose not to have surgery?
  3. what are the risks of having this surgery? Both during surgery (for example, anaesthesia) and after surgery (for example, complications)
  4. have I received enough information about the benefits and harms of having surgery compared to other treatments (including doing nothing)?

back to blog