SPINE SURGERY(BACK SURGERY)/NON SPINAL SURGERY/INVASIVE PROCEDURES/FAILED BACK SURGERY SYNDROME
THE FIGURES SPEAK FOR THEMSELVES: IN THE UNITED STATES ALONE, EVERY YEAR OUT OF THE 1.5MILLION PEOPLE WITH SCIATICA (LOW BACK-BUTTOCK-LEG PAIN) WHO UNDERGO MRI EXAMINATION, ONLY 200000-300000 OF THEM DO EXHIBIT DISC HERNIATION. THE REST 1.2 MILLION OF PEOPLE DO NOT HAVE ANY DISC HERNIATION AT ALL. SIMPLY PUT, THE PRESENCE OF SCIATICA ALONE DOES NOT DEPEND ON WHETHER SOMEONE HAS OR NOT DISC HERNIATION!!!
THIS REPORT IS THE RESULT OF SUCCESSFUL RESOLVING OF LOW BACK PAIN AND SCIATICA (AND NOT ONLY) FOR TEN YEARS AT THE CYPRUS SHIATSU CENTRE, WHILE ALSO INVESTIGATING THOROUGHLY VARIOUS FIELDS OF WESTERN MEDICINE SUCH AS NEUROLOGY, NEUROSURGERY, ORTHOPAEDIC SURGERY, REUMATOLOGY, IMMUNOLOGY, etc.
DID YOU KNOW THAT THE DIAGNOSIS AND TREATMENT OF LOW BACK PAIN AND SCIATICA STILL REMAINS A CONTROVERSIAL AND CHALLENGING ISSUE FOR WESTERN MEDICINE AND ESPECIALLY EVEN MORE FOR SPINE SURGERY?
UNLIKE WESTERN MEDICINE, IN SHIATSU THE DIAGNOSIS AND TREATMENT OF LOW BACK PAIN AND SCIATICA IS AN UTTERLY STRAIGHTFORWARD PROCESS!!!
PEOPLE WHO PLAN TO HAVE AN OPEN SPINE (BACK ) SURGERY OR A MINIMALLY INVASIVE SPINE SURGERY ARE STRONGLY ADVISED TO READ THIS TEXT THROUGH THE END!!!
IN THIS TOPIC WE MAKE REFERENCE TO THE VARIOUS SURGICAL AND OR INVASIVE PROCEDURES THAT ARE EMPLOYED BY WESTERN MEDICINE, BY HIGHLIGHTING THE VARIOUS POSSIBLE COMPLICATIONS .
WE ALSO DO PRESENT A VERY BASIC OUTLINE ABOUT THE REAL CAUSE OF SCIATICA BY EXPLAINING THE REALITY BEHIND DISC HERNIATION, AS WELL AS BY EXPLAINING THE REALITY BEHIND THE SO-CALLED "FAILED BACK SURGERY SYNDROME".
FURTHER WE PROVIDE AN EMERGENCY NOTICE, SHOULD THERE BE A POSSIBILITY FOR EMERGENCY SURGERY !!!
COMMON AND NEW PRIMARY SPINAL SURGICAL/INVASIVE PROCEDURES
DISCECTOMY/NUCLEOTOMY/HEMILAMINECTOMY/LAMINECTOMY/ LAMINOTOMY/ FENESTRATION PROCEDURES/ MICRODISCECTOMY /AUTOMATED PERCUTANEOUS DISCECTOMY/ PERCUTANEOUS MANUAL/LASER DISCECTOMY /MICROENDOSCOPIC DISCECTOMY/ TRANSFORAMINAL ENDOSCOPIC DISCECTOMY/ARTIFICIAL DISC REPLACEMENT/ PROSTHETIC DISC NUCLEUS/INTRADISCAL ELECTROTHERMAL ANNULOPLASTY (IDET )/ SPINAL FUSION (ANTERIOR LUMBAR INTERBODY FUSION/POSTERIOR LUMBAR INTERBODY FUSION/INVERSE LAMINOPLASTY/POSTERIOR INTERTRANSVERSE PROCESS FUSION/ INTERBODY CAGE FUSION) / SPINAL INSTRUMENTATION/ CHYMOPAPAIN (NUCLEOLYSIS)/EPIDURAL STEROIDS/DIFFERENTIAL NERVE BLOCKS (SUBARACHNOID AND OR EPIDURAL INJECTIONS) MYELOGRAPHY/ DISCOGRAPHY/SPINAL ANGIOGRAPHY/CLOSED BIOPSY OF THE LUMBAR SPINE.
POSSIBLE SUBSEQUENT COMMON AND NEW SPINAL SURGICAL PROCEDURES
HEMILAMINECTOMY/LAMINECTOMY/FACETECTOMYFORAMINOTOMY/ VERTEBRECTOMY (CORPECTOMY)/ SPINAL FUSION (ANTERIOR LUMBAR INTERBODY FUSION/POSTERIOR LUMBAR INTERBODY FUSION/INVERSE LAMINOPLASTY/POSTERIOR INTERTRANSVERSE PROCESS FUSION/INTERBODY CAGE FUSION) / SPINAL INSTRUMENTATION/ ARTIFICIAL DISC REPLACEMENT/PROSTHETIC DISC NUCLEUS
RARE BUT POSSIBLE SUBSEQUENT SPINAL NEUROLOGICAL SURGERY/INVASIVE PROCEDURES
DORSAL ROOT GANGLIONECTOMY/DORSAL RHIZOTOMY/ PERCUTANEOUS RHIZOTOMY/PERCUTANEOUS DORSAL ROOT GANGLIONECTOMY/LUMBAR SYMPATHECTOMY/ SPINAL CORD AND OR PERIPHERAL NERVE STIMULATION IMPLANTED ELECTRODES/IMPLANTED INTRATHECAL DRUG INFUSION/PERCUTANEOUS CORDOTOMY/ CORDOTOMY
EXTREMELY RARE BUT POSSIBLE SUBSEQUENT NON SPINAL SURGERY
DEEP BRAIN STIMULATION IMPLANTED ELECTRODES/ PERIAQUEDUCTAL AND OR PERIVENTRICULAR STIMULATION IMPLANTED ELECTRODES.
Unfortunately, it has been observed that many patients had undergone and still do undergo unnecessary spine surgeries. Although we are not totally against spine surgery, people need to know that as someone undergoes a spine surgery, then the stability of that person's spine is being compromised —provided pieces of bone (vertebral lamina/facet and or vertebral body) are removed, and/or even the whole disc.
Simply, the more surgeries someone undergoes, then the less stability of the spine is being created. Instead of resolving the problems, spine surgeries in their majority are in fact worsening the situation!
From the above common/new primary and/or subsequent spinal surgical and/or invasive procedures, other complications are possible too, such as dural tear, nerve root injury, pseudarthrosis, laceration of the abdominal vessels and or abdominal viscera injury, cauda equina syndrome, wound infection (spondylitis, discitis, etc), urinary retention, muscle wasting, retrograde ejaculation, muscle spasm, cerebrospinal fluid fistulae, haematomyelia, intradural/intraradicular disc herniation, pseudomeningocele, spinal arteriovenous fistulae/ malformations, thrombophlebitis, enzyme anaphylaxis, transverse myelitis, tuberculous meningitis, aseptic meningitis, sclerosing spinal pachymeningitis, severe paraesthesia, transient hypotension, cardiac angina, postural headache, difficulty in voiding, transient hypercorticoidism, breakage of the metal plate, implant dislocation, spinal epidural abscess, spinal subdural abscess/empyema, vertebral osteonecrosis, lumbar adhesive arachnoiditis, pulmonary embolism, etc.
For clarity purposes, all the above complications do not occur simultaneously for any of the aforementioned surgical/invasive procedures. However, there are both common as well as specific complications among these procedures.
Mostly, these operations are performed in order to correct the herniated intervertebral disc —commonly known as ruptured /prolapsed/slipped disc—, that is supposed to be causing the pain and/ or causalgia (strong burning sensation) and/or even numbness that radiates from the low back to the buttock, back of the thigh and leg, namely sciatica.
Unfortunately, this notion had prevailed in the circles of Western Medicine since the 1930's, and consequently both the doctors and the patients had been led towards wrong directions, that resulted in ineffective treatments!!!
The intervertebral disc, or simply the disc, is a flat structure that fits as a ‘ pad' in between the vertebrae (vertebral bodies). A lumbar vertebra when viewed from above, is composed a) by the vertebral body at the front that displays an oval-kidney shape, and b) by the vertebral arch at the back, which is formed by the two pedicles and two laminae, that respectively lie posterolaterally and posteromedially to the vertebral body.
The posterior aspects of all the lumbar vertebral bodies along with the anterior aspects of the lumbar vertebral arches (neural arches) form the vertebral foramina, i.e. the openings that accommodate/ house the lower end of the spinal cord and cauda equina.
The disc is internally composed of a soft material (more or less like the consistency/softness of toothpaste) the nucleus pulposus, that is externally surrounded by a tough/fibrocartilage material, the annulus fibrosus.
The annulus fibrosus is circumferentially composed of multiple layers of collagen fibres, which lend to the firmness of the annulus fibrosus. On the upper and lower surfaces of the disc, there is a thin cartilaginous layer, the vertebral end-plate that separates the disc from the osseous (bony) body of each vertebra.
The external surface of the annulus fibrosus is at the front attached to the anterior longitudinal ligament, laterally it is attached to the origins of the psoas muscles, and at the back it is attached to the posterior longitudinal ligament .
Therefore, it must be noted that the lumbar intervertebral disc herniation, primarily involves the posterolateral and/or posterior extrusion/sequestration some of the nucleus pulposus material, out of the annulus fibrosus circumference towards the outer surface of the dural sheath (the hard and outer meningeal layer) of the spinal nerve roots (cauda equina) and/or spinal cord (conus medullaris, i.e. lower end of spinal cord). In some cases, along with the nucleus pulposus material, some minor fragments of the annulus fibrosus and/or vertebral end-plates could also be extruded/sequestered. Therefore the annulus fibrosus inner and/or outer periphery must be ruptured first, in order to have a disc herniation.
For clarity purposes, the intervertebral disc herniation does not in any way entail any posterior detachment or dislocation/ translation of the whole disc . On the other hand, disc detachment and/or dislocation / translation may of course happen in case of severe injury (trauma), however that is a different matter that will eventually affect other parts of the spine too.
By the end of the twentieth century, some circles of Western Medicine after long research and experiments, had also recognised that the herniation of the intervertebral disc being the cause of sciatica does no longer exist— this cause did not exist in the past either —, e.g. there is a great number of individuals who undergo MRI testing for other disorders apart from Sciatica, and despite the fact that these individuals do exhibit intervertebral disc herniation, still they experience no pain at all. In fact more than 75% of these individuals do not have sciatica.
Had it been true for the intervertebral disc herniation to be the cause of Sciatica, then other serious neurological problems should also have occurred from the compression of the spinal nerve roots!!!
Further, even the individuals who do exhibit intervertebral disc herniation and also do feel pain in the low back-buttock-back of thigh-leg (accounting for less than 25% of the cases), then that alone does not necessarily imply that their pain is indeed caused from the disc herniation itself.
On the other hand, A GREAT NUMBER OF PATIENTS WITH SCIATICA DO NOT HAVE ANY DISC HERNIATION AT ALL. In the United States alone, every year more than 1200000 of a total of 1500000 cases with sciatica do not exhibit any disc herniation on MRI .
THE REAL CAUSE OF SCIATICA
Primary Sciatica is due to the presence of inflammation within the sciatic nerve, and the inflammation itself, is primarily caused by psychological factors, i.e. stress —in other words, it is an organism reaction to various mental and emotional stimuli such as worrying over financial matters, anger, grief, pensiveness, feeling injustice, even matters concerning love affairs, health matters, mourning, etc—and in rare cases Secondary Sciatica is caused by infections and/ or by other rare factors. In the latter cases, other symptoms along with sciatica are included too.
The condition of inflammation must not be a frightening one to the patients. It must be clarified that any infection is also characterized by the presence of inflammation too, whereas any inflammation does not necessarily imply that there is also an infection involved.
In the case of infection you should be treated immediately by anti-infective drugs and/or by surgical procedures/drainage of Western Medicine. On the other hand, in the case of sciatic nerve inflammation without infection things are SAFE, simply because the situation is induced mentally and/or emotionally—there are no bacteria or viruses involved.
Sciatica patients reply positively when asked directly or even indirectly for the presence of any psychological factors that either existed in the past, and/or are still affecting them now. These factors may in some cases involve very trivial situations, whereas in other cases they may involve very serious situations.
Further, these patients do remark that doctors never mentioned to them the aetiology of sciatica being from mental/emotional causes. Of course we must say that there are doctors who recognize the psychological aetiology of sciatica and therefore label the pain as psychogenic and/or neuropathic. However doctors do come to these conclusions unfortunately after several “failed back surgeries”, at a time that, according to current guidelines of Western Medicine, doctors must assess each patient for the presence of psychological factors prior to planning surgery.
At this point—provided you are a sciatica patient—you will probably already know if there was/were one or more situation/s in your life that caused you psychological (mental/emotional) disturbance prior to the appearance of sciatica.
It is useful to say that the various situations that do affect us negatively on the psychological level as humans, do not only somatize (manifest in the human body as disease) in the form of sciatica . There are many other diseases that are caused from negative mental/emotional feelings.
Despite the intense pain you might be having right now, still as paradoxically as it might sound, you are lucky, simply because other individuals with the same psychological upset might manifest far more worse diseases than sciatica.
However it must be clarified that the aforementioned situations will not necessarily cause sciatica in every person. So, each individual is different, and one person may therefore never present any disorder (including sciatica) at all, whereas another individual may present sciatica with or without other disorders.
Even after a ‘successful spine surgery' (meaning surgery without subsequent complications) sciatic pain still persists, since the main focus of surgery was to extract the herniated disc material and not the inflammation within the sciatic nerve—the inflammation of the sciatic nerve is also recognized by Western Medicine. Moreover, even in cases where anti-inflammatory drugs are given, the result is not as effective as it should have to be.
THIS IS THE MAIN REASON FOR THE HIGH RATE OF THE SO-CALLED FAILED BACK SURGERY SYNDROME, WHICH IN ESSENCE IT IS AN UNNECESSARY BACK SURGERY SYNDROME, SIMPLY BECAUSE SURGERY FAILS TO TARGET THE REAL PROBLEM. OF COURSE, WE HAVE TO SAY THAT WITHIN THE CONTEXT OF THE SO-CALLED FAILED BACK SURGERY SYNDROME, A WIDE RANGE OF THE AFOREMENTIONED COMPLICATIONS ARE ALSO INCLUDED. SO ANYONE WHO DOES NOT DEVELOP ANY COMPLICATIONS AFTER BACK SURGERY (OR GENERALLY ANY SURGERY) SHOULD CONSIDER HIMSELF/HERSELF AN EXTREMELY LUCKY PERSON.
Some circles of Western Medicine have correlated the inflammation of the sciatic nerve as being a chemical reaction from the contact of the herniated nuclear disc material with the spinal nerve roots. Had this correlation been valid, then everyone presenting with intervertebral disc herniation would feel pain (not necessarily sciatica), and consequently the majority of spine surgery would have remarkable results.
Unfortunately it must be mentioned that spine surgeries are performed even in the absence of true herniation where the disc material is still contained within the annulus fibrosus. Indeed, this is true for the majority of minimally invasive techniques, since their approach is mostly intradiscal (within the disc).
Even the smallest surgical and/or invasive procedure can lead the patient into a vicious circle of any of the aforementioned complications that might require further surgery. So, people should not be excited and/or rest assured that they are safe, should they plan to have a minimally invasive surgery. Once the body surface is ‘violated', then someone is at risk . However, most patients undergoing spine surgery will not experience any severe complication at all.
Despite the fact that the severe complication rate among the majority of the surgical techniques is relatively low, i.e. < 5% according to figures given by western medicine, still, the price that an unlucky patient has to pay in the likely event of a complication is indeed very high, considering the fact that intervertebral disc herniation per se, does not constitute a serious pathology/threat to the human body.
In extremely rare cases however, surgery must be performed in case the herniated disc material enters through the spinal dura mater ( intradural/ intraradicular herniation )—the dural tear may of course happen from a previous surgery and/or other reasons. Also surgery must be performed in cases where there is a massive central herniation of all the components of the intervertebral disc in conjunction with a limbus vertebral fracture (fragmented vertebral body).
CAUTION: POSSIBILITY OF EMERGENCY SURGERY!!!
INDEED, IT MUST BE MENTIONED THAT IN CERTAIN CONDITIONS SURGERY IS A MUST/LIFE SAVING i.e. INFECTIONS (SPINAL EPIDURAL ABSCESS, SPINAL SUBDURAL ABSCESS/EMPYEMA, PSOAS ABSCESS), CAUDA EQUINA SYNDROME (CAUSED BY SPINAL SEVERE TRAUMA/ FRACTURE), ABDOMINAL AORTIC ANEURISM, SPINAL ARTERIOVENOUS MALFORMATIONS/ FISTULAE, HAEMATOMYELIA, SPINAL EPIDURAL/SUBDURAL/ SUBARACHNOID HAEMORRHAGE, SPINAL CORD INFARCTION, NEOPLASTIC (TUMOUR) SPINAL CORD COMPRESSION, PSEUDOMENINGOCELE etc.
IN THESE CASES YOU HAVE NO ALTERNATIVE, BUT TAKE THE RISK TO UNDERGO SPINE SURGERY!
IN OTHER WORDS, IF SCIATICA OR EVEN BILATERAL SCIATICA OCCURS CONCURRENTLY WITH FEVER, AND/OR LOW GRADE FEVER, AND/OR PROFUSE PERSPIRATION WITH RIGORS, AND/ OR 5% OR MORE UNINTENTIONAL LOSS OF BODY WEIGHT OVER A PERIOD OF 6-12 MONTHS WITH OR WITHOUT AGGRAVATION OF PAIN DURING THE NIGHT/ RECUMBENCY, AND/OR SEVERE/ CONSTANT MUSCLE SPASM IN THE LOW BACK AND/OR SADDLE ANAESTHESIA (LOSS OF SENSATION/DULL ACHING PAIN IN BETWEEN THE LEGS, i.e. PERINEAL AND PERIANAL-SACRAL REGIONS), AND/OR PARTIAL/COMPLETE LOSS OF BOWEL AND/ OR BLADDER CONTROL (URINARY AND FECAL INCONTINENCE), AND/OR MOTOR WEAKNESS OF THE LEGS, AND/OR SENSORY LOSSES/ DECREASED REFLEXES OF THE LEGS, AND/OR POSTOPERATIVE POSTURAL HEADACHE, AND/OR POSTOPERATIVE BACK DISCOMFORT ASSOCIATED WITH A LUMBAR SUBCUTANEOUS SWELLING CONSISTENT WITH A FLUID COLLECTION...
THEN YOU SHOULD SEEK IMMEDIATE MEDICAL ASSISTANCE AT A GENERAL HOSPITAL!!!
IT MUST BE NOTED THAT THE SYMPTOMS OF FEVER AND/OR UNINTENTIONAL WEIGHT LOSS ALONG WITH LOW BACK PAIN AND/OR GLUTEAL (BUTTOCK) PAIN/SCIATICA, MAY ALSO OCCUR IN OTHER DISORDERS THAT DO NOT REQUIRE SURGERY AT ALL! EVEN YET, IN THESE CASES YOU ARE STILL ADVISED TO SEEK HELP AT A GENERAL HOSPITAL FIRST!
IN CASE OF AN ABDOMINAL AORTIC ANEURISM — A CONDITION THAT MIGHT BE MISTAKEN AS SCIATICA BECAUSE OF THE POSSIBILITY OF EXCRUCIATING TEARING PAIN RADIATING TO THE BUTTOCKS — REQUIRES IMMEDIATE VASCULAR SURGERY (NOT SPINAL SURGERY). OTHER SYMPTOMS INCLUDE DULL PAIN GNAWING BACK PAIN WITH ABDOMINAL MASS PULSES, AND/OR IN CASE OF A RUPTURED AND/OR EXPANDED ABDOMINAL AORTIC ANEURISM, THERE IS SUDDEN, EXCRUCIATING TEARING ABDOMINAL OR BACK PAIN RADIATING TO THE GROIN/SCROTUM, OR THIGHS, HYPOTENSION, TACHYCARDIA AND SHOCK.
IN CASE OF A PSOAS ABSCESS — A CONDITION THAT MIGHT ALSO BE MISTAKEN AS SCIATICA BECAUSE OF REFERRED PAIN TO THE HIP OR KNEE — REQUIRES IMMEDIATE PERCUTANEOUS OR OPEN SURGICAL DRAINAGE (NOT SPINAL SURGERY). OTHER SYMPTOMS INCLUDE, FEVER, AND LOWER ABDOMINAL OR BACK PAIN.
ALSO KEEP IN MIND THAT ALL THE INFECTIVE SPINAL DISEASES AND/OR ALL THE TUMOUR CASES ARE NOT TREATED WITH SURGERY ALONE!
ON THE OTHER HAND, SURGERY IS NOT ALWAYS A DEFINITE GUARANTEE FOR A SUCCESSFUL OUTCOME!
HOWEVER, THE SYMPTOM OF SCIATICA ALONE DOES NOT CONSTITUTE A SERIOUS PATHOLOGY/THREAT TO THE HUMAN BODY. BOTH ACUTE AND CHRONIC SCIATICA CAN BE RESOLVED EASILY WITHOUT SURGERY!!!
It must be made clear, that spine surgery has not been developed solely for the purpose of intervertebral disc herniation. Although every surgical/invasive technique had been devised in good faith, solely for the benefit of human kind, still, we as humans must be very cautious about the exact use of these techniques.
As practitioners of alternative medicine we do believe that every human being must have access to any kind of therapy, be it western medicine or alternative medicine. We do support any good and safe techniques that are performed by western medicine but on the other hand we do criticize any techniques (diagnostic and therapeutic) that are indeed detrimental to human health.
Therefore, each patient must by himself/herself be informed, and even in a rudimentary manner must be able to weigh up the various dangers that might be implicated in each therapy. Living now in the 21 st century, at least a great number of individuals do have access to a great variety of information, and therefore the role of the patient must at least gradually cease from being the one of the ‘passive receiver' only, and therefore the patient must switch to the role of the informed patient. After all it is the patient himself/herself that will pay the price in the event of a serious complication.
Patients who are covered financially, either by an insurance scheme, or by the health system/service of their country, or even because they can afford it, they must not rest assured that they are safe, because money cannot buy everything. We do recommend to all patients to act in good faith but never in a blind one, prior to any kind of diagnosis and treatment!
On the other hand, doctors and/or alternative medicine practitioners are obliged in informing their patients about the possible complications and/or permanent damages of any forms of treatment or diagnostic methods.
For example, you cannot have a patient undergo myelography just for the sake of diagnosis, and then risk to have that patient get lumbar adhesive arachnoiditis, and consequently have that patient suffering for the rest of his/her life from intractable pain 24 hours a day, simply because there is no cure for that disease.
EVEN IF YOU ALREADY HAD A SPINE SURGERY, WE CAN STILL HELP YOU. WE HAVE BEEN HELPING PATIENTS THAT EVEN HAD MULTIPLE SPINE SURGERIES!!!
DISCOVER INTERNAL SELF-SHIATSU!!!
It is equally important to be mentioned, that in cases where the pain is limited from the low back to the buttock only, or even in the buttock only, then, the problem may arise apart from the inflammation, and from the compression of the sciatic nerve from the piriformis muscle.
1. LOW BACK PAIN AND SCIATICA
3. PRIMARY LOW BACK PAIN (LUMBAGO)
4. SECONDARY LOW BACK PAIN AND/OR SCIATICA
5. SYNOPSIS FOR LOW BACK PAIN AND SCIATICA