Do you NEED Surgery?
Recent research is showing that surgery might not be needed as often as we think.
A Finnish Degenerative Meniscal Lesion Study Group was published in the New England Journal of Medicine comparing meniscus surgery to sham surgery and concluded that “In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”
A study published in the British Journal of Sports Medicine entitled Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial concluded that “Neither labral repair nor biceps tenodesis had any significant clinical benefit over sham surgery for patients with SLAP II lesions in the population studied.”
There is a condition called Failed Back Surgery Syndrome (FBSS). The International Association for the Study of Pain defines FBSS as “Lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location.”
Here are the unfortunate statistics of FBSS:
Rajaee et al • 170.9% increase of primary lumbar fusions from 77,682 to 210,407 between 1998 and 2008 • 11.3% increase in laminectomies from 92,390 to 107,790 between 1998 and 2008
Parker et al • 5%–36% recurrence rate of back or leg pain 2 years after discectomy for disc herniation
Skolasky et al • 29.2% of patients had same or increased pain 12 months after surgical laminectomy for lumbar stenosis secondary to degenerative changes
Arts et al • 35% success rate in terms of perceived recovery, functional disability, and pain. 15 months after instrumented fusion for treatment of FBSS
The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren't tried first, or lack of knowledge by the operating physician.
Every surgery, even "minor" ones carry risks. These include:
Complications from anesthesia……
Blood clots after surgery……
Delayed healing of the incision……
Unintended damage to nerves or other organs near the surgical site…..
And of course: INFECTIONS!
Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death.
For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.
For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery.
Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.
Physical therapy can't fix every problem, and for some patients surgery is the best choice.
However, research is showing that surgery isn't a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.