The back pain and sciatica sufferer facing surgery today faces a much happier future than the prospective back surgery patient of a few years ago. Years of pioneering work, focusing on the integration of a multidisciplinary approach to the evaluation and care, just before and after surgery, has completely changed the prognosis for literally thousands of back pain and sciatica sufferers facing multiple surgeries. For patients who have had back surgery that has failed, a new hope is now justified as a result of improved techniques and advances in the science of orthopedic surgery. Back discomfort and sciatica sufferers who have had previous surgery or surgeries and who were integrated into this new system, evaluated through a multidisciplinary approach, had success rates as high as 80% versus a rather discouraging 30-35% described in the medical journals. Interestingly, the success rate not only applied to single incidence patients but to patients who had undergone a number of back surgeries, like the author of this article.
The focus on the back pain and sciatica patient as a whole person, referred to as a holistic approach, is the primary reason for the success of this surgical method. The addition of a team concept, engaging physicians, practitioners, and therapy specialists, to evaluate the individual singularly and as a group, looking at the entire history of the patient, has offered new and exciting insights. The holistic approach has resulted in an entirely new process, one that works for a remarkable number of back discomfort and sciatica patients.
Ultimately, the support system of the patient, combined with their motivation to return to an active, productive lifestyle was crucial to the overall success of the intervention. In other words, the mind plays a pivotal role in the recovery of the back discomfort and sciatica sufferer. We will return to this.
The remaining 20% of back discomfort and sciatica sufferers, having undergone one or multiple surgeries, remain a source or frustration, as these patients present with a myriad of symptoms. Not only does this failure affect the back discomfort and sciatica sufferer, it impacts the family, friends, co-workers, associates, and even the physicians involved in the individual’s care. It is not uncommon for individuals to experience and express, anger, frustration, despair, and even depression as symptoms persist and even grow worse over time. Unfortunately, in many of these cases practitioners are at a loss to explain exactly what is going on and why.
As the back patient and sciatica sufferer succumbs to the pain, inactivity and disability only feed into the loop that ultimately contributes to further disintegration, discomfort, despair, depression, and hopelessness. The symptoms of back pain and sciatica sufferers in this group often include but are not limited to: severe and debilitating discomfort; numbness in the feet, legs, and back; overall weakness and loss of muscle tone; sciatica in one or both legs; possible neurological deficits such as foot drop and/or a loss of function; and, other physiological problems beyond the scope of this article. The typical back discomfort and sciatica patient in this negative, failed-back loop deal with: weight gain and obesity; a de-conditioning or atrophy of the musculature; inactivity leading to a sedentary lifestyle; and, chemical or drug dependency often occur, as well. The back pain and sciatica sufferers in this group, and their support systems, often families, are often stressed and even dysfunctional. The entire negative feedback loop closes in on itself and fuels the disintegration of the patient and their support network until the patient is fully and completely incapacitated and isolated. The problems are myriad and unless something is done, the outlook is not encouraging. The above condition, and it gets worse, is referred as “failed back surgery” or “failed backs” or “failed spine surgery.” The name is really secondary to the impact the failure has on the individual and individuals involved.
The question becomes: When is enough, enough? And, when is enough, too much? The focus and central issue, particularly for the latter 20% is, what are the chances of an additional surgery being even remotely successful? If a potential surgical problem still exists, is it wise to pursue it or are other alternatives available? If they are, why aren’t they fully exhausted prior to additional surgical intervention? These are all questions the patient should be exploring with his or her physician and, given a multidisciplinary approach, clinicians should be asking each other prior to another surgical event.
Ultimately, the 20% should pursue other means of rehabilitation if they are to have any chance for a real life, ever. It is this author’s personal experience that, beyond a certain point, the surgical alternative is a doomed pursuit, one that will only cause more harm and, ultimately despair, discomfort, and depression. This is the point where the back discomfort and sciatica sufferer ought to take things into their own hands and seek alternative solutions. Exercise, ice, positioning, diet, weight loss, and other methods can, and will, help but the individual will have to be motivated and the importance of support from family and friends cannot be overstated. It is up to the individual but the end result does not have to be a life of discomfort and hopelessness. This author was in the 20% for a long time, years, and I know there is a way out, you just have got to want it! Start with an intelligent, individually designed and supervised exercise program and work from there. We will discuss addition strategies in upcoming articles.