How Back and Neck Surgery Can Destroy the Spine 101

Summary

In this educational video, Dr. Centeno discusses the often surprising consequences of back and neck surgeries, using a case study of an elderly patient. After undergoing a laminectomy and later a cervical laminoplasty, the patient faced new symptoms and instability due to the removal of critical stabilizing structures like spinous processes and ligaments. Dr. Centeno emphasizes that while some patients truly need surgery, many suffer from iatrogenic issues that could be avoided with alternative treatments. He aims to inform viewers about the risks of surgical interventions and the importance of understanding their implications for spinal health.

Takeaways

• 👨‍⚕️ Many patients are surprised by the consequences of back and neck surgeries, often not realizing how these procedures can impact their spine.
• 🧠 Only a small percentage of patients truly need surgical intervention for spine issues, estimated at 10% to 20%.
• 🔍 A comprehensive evaluation, including confirmatory block studies, is crucial before proceeding with spine surgeries to identify the actual source of pain.
• 💔 The removal of critical structures such as spinous processes and stabilizing ligaments during surgeries can lead to instability in the spine.
• 🦴 The lumbar multifidus muscle plays a key role in stabilizing the lower back; its removal or damage can lead to recurring pain.
• 📉 After surgery, patients may experience a loss of muscle stability, leading to further complications and pain, as seen in the case presented.
• 🔄 Cervical surgeries like open-door laminoplasty can also damage stabilizing structures, negatively affecting neck support.
• 🔗 The supraspinous and interspinous ligaments are vital for maintaining spinal stability; their disruption can lead to significant issues.
• 🧑‍🔬 Alternatives to surgery, such as precise orthopedic biologic injections, could be pursued to treat spine conditions without invasive procedures.
• 💡 Educating patients about the risks and potential outcomes of spine surgery is essential to ensure informed decision-making regarding their treatment options.

Q & A

What is the main focus of Dr. Centeno's discussion?

Dr. Centeno discusses how back and neck surgeries can have detrimental effects on spinal health, often leading to unexpected complications.

What percentage of patients truly need back or neck surgery, according to Dr. Centeno?

Dr. Centeno estimates that only about 10% to 20% of patients actually require surgery for their spinal issues.

What happened to the elderly gentleman discussed in the case study?

After undergoing a wide laminectomy, the gentleman experienced a return of leg pain due to the removal of critical stabilizing structures in the spine.

How did the surgeon incorrectly address the patient's leg pain after the first surgery?

The surgeon shifted focus to the neck MRI and performed a cervical laminoplasty without confirming the cause of the leg pain, which was rooted in the complications of the previous surgery.

What are the supraspinous and interspinous ligaments, and why are they important?

These ligaments provide stability to the lumbar spine during movements such as bending forward, and their removal can lead to spinal instability.

What impact did the removal of the L4 spinous process have on the patient's spine?

The removal destabilized the lumbar spine by disrupting the attachment points for the multifidus muscles, leading to nerve irritation and recurrent leg pain.

What was the outcome of the cervical open door laminoplasty performed on the patient?

The laminoplasty damaged essential ligaments and muscles, resulting in a straightened neck curve and further complications, including difficulty supporting his head.

What alternative treatment options did Dr. Centeno suggest could have been pursued instead of surgery?

Dr. Centeno suggested that ortho biologic injections might have provided relief without the risks associated with surgical procedures.

What does Dr. Centeno mean by 'iatrogenic leg pain'?

'Iatrogenic leg pain' refers to leg pain that arises as a direct result of medical intervention, in this case, the previous surgery that compromised spinal stability.

What key message does Dr. Centeno want to convey to patients considering spinal surgery?

Dr. Centeno emphasizes the importance of being informed about the potential risks and consequences of spinal surgery to make educated decisions regarding their treatment.