For years, the MRI has been the determinant used to determine who is a candidate for more aggressive forms of treatment including surgery. A new study was published in the Journal of Neurosurgery: Spine. written by Abdelilah el Barzouhi, MD, Ph.D., and colleagues is now suggesting that this test according to the data they collected is a poor test to determine who should consider aggressive surgery vs. more conservative proven methods such as chiropractic.
Failed back surgery syndrome is when a surgery done to the lower back has failed to relieve the problem or perhaps made the problem much worse. MRI scans are usually part of the diagnostics to determine if surgery is indicated. With this new information, we may be beginning to understand that the test is a poor way to determine who should have surgery.
Back surgery for pain or sciatica is still common but more conservative less invasive methods are more commonly used and may help relieve the condition, with a faster recovery time.
The problem with our current understanding of back problems, disc problems, and the rationale for surgery is that more information is suggesting that back pain is more than a lifestyle problem. It is a movement problem. A common surgery called a laminectomy actually reduces movement and more surgeons are realizing that surgeries that allow damaged segments in the spine to continue to move to have better outcomes.
While sciatic pain and the loss of sleep and ability to function can often move someone to want their doctor to order an MRI, wouldn’t they be better off seeing a chiropractor first and seeing how they respond to care? Most chiropractors will use proven methods such as flexion distraction to reduce pain and improve mobility while giving the patient exercises to help them improve the way they move and function. Now that we know that MRI scans may not be a good determinant on their own, you may consider conservative options allowing them up to 2 months to resolve the condition. Sciatic pain can have many causes including sacroiliac joints, ankle problems and gait issues.
For Patients who are considering more aggressive options, they should be aware that patients who have done conservative care will improve markedly over a period of time with less risk. There may be little or no benefit to surgery if the mechanism of pain has been alleviated.
Who should you see first for back pain and sciatic pain? Visit your chiropractor first. Evidence suggests that the person you see first will determine the cost and success of your back pain journey.
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