Complications of surgery

Complications of surgery include risk of infection, anaesthetic Alzheimer's disease and thrombosis; and a host of other problems. That should surely cause one to consider the alternatives before going under the knife.

I quote here from a major orthopaedic website, weighing up the pros and cons of surgery for lumbar stenosis, a narrowing of the spinal canal that causes a deep-seated ache in one or both legs.

Interestingly, they advocate chiropractic help as one of the alternatives to be considered.

Dr. Barrie Lewis

  

This page was last updated by Dr Barrie Lewis on 6th September, 2021.

There are some risks from surgery for lumbar spinal stenosis, including the following. Whilst they obviously don't occur that frequently, it is obviously often enough to be worth a mention.

• The possibility of injury to one or more of the spinal nerves. See the case file below.
• There may be a need for yet more surgery.
• Failure of the screws, plates or rods to hold firmly in place is always a possibility, particularly in the osteoporotic patient. 
  
• Failure of the bony chips used in the cage to fuse the joint.
• There's always the possibility that pain, tingling and weakness may after a time return; that is true after chiropractic help too. 
  
• The surgery may fail to relieve the pain, tingling and numbness particularly if the wrong level is operated on. 
• A rupture of the bag surrounding the nerves may occur; a tear in the dura mater.
  
• A serious drop in blood pressure causing anaesthetic Alzheimer's disease.
• Fatty emboli can always break free after orthopaedic surgery, entering the blood stream and ending up in the lungs, heart or brain. 
  
• Hospital-acquired, also known as nosocomial infection, by drug resistant bacteria is not uncommon. 1.7 million such infections causing 99,000 deaths per year in the USA occur.
  
• Bleeding after surgery can be problematic.
  

Complications of Surgery

Complications of surgery should cause one to consider the alternatives before going under the knife.

The risks of surgery depend on the patient and the exact procedure being performed. Elderly patients have higher rates of complications from surgery. So are overweight patients, diabetics, smokers, and patients with multiple medical problems.

Chiropractors are not against good surgery, just the same as surgeons are not against good chiropractic. Both are an art and a science and neither are developed in a flash. I am a 1000 times better chiropractor than I was even ten years ago. I hope and believe that will still be the case in another ten years time; we cease to improve only when we become old dogs, unable to learn new tricks. Or think we know it all; and that's sometimes in the twenties.

Obviously, its always makes good sense to try the simpler treatments first, those which have less serious potential side effects and cost less money. The complications of surgery are clearly greater than those of chiropractic.

If your thumb hurts, try rubbing it and putting some ice on it before consulting any sort of doctor.

Do you bruise easily? If you bleed and bruise easily, think parsley and sweet basil pesto. It may save you from one of the complications of surgery. It's rich in vitamin K, the vitamin that promotes coagulation of the blood.

If you are taking anticoagulants for any reason, then discuss with your doctor before swallowing bucketloads of parsely benefits! Read more at our PARSLEY BENEFITS page.

Chiropractic Help coalface

Chiropractic help is only for those prepared to go through the discipline of treatment, plus exercising great care for at least six weeks and a proper rehab program.

It was distressing this week to meet a patient who either lost confidence in me, after only two treatments, or wasn't prepared to go through with this routine. Six months ago she had a cage fitted and has been and still is in excruciating pain; far worse. Chiropractic does not always win with severe lower back and leg pain, but give your doctor a chance to do something positive. Rome was not built in a day.

Complications of surgery

Complications of surgery should cause one to consider the alternatives before going under the knife.

Everyone has a distressing day periodically, I suppose. Yesterday was an unhappy day. I had an elderly new patient, and woke up several times in the night thinking about her.

Mrs P, aged 75, has she assured me never had a sore back. Never. Well, not until the last eighteen months. Now she has unrelenting, continuous pain. She can't sit, she can't stand and walking is a nightmare.

It all started three years ago with pain in the right groin. Her doctor correctly, I believe, diagnosed hip arthritis. 

When the pain didn't respond to anti inflammatory drugs he referred her to an orthopaedic surgeon who concurred, but said the arthritis was so minimal, that he suspected a pinched nerve in the back, and referred her to a neurologist. And hence to the surgeon. An scan suggested a condition called lumbar stenosis, a narrowing of the canal.

But I've never had a day's back pain in my life, doctor, said she. Hard to believe actually, having seen the xrays of her spine, but apparently so.

You'll be a wheelchair within six months if you don't go through with this operation, retorted the surgeon.

From the moment she woke up after an extensive decompression surgery she has had severe low back pain, and pain radiating down to her big toe, and she still has the hip and groin pain. What's more, it's getting worse, not better. Now she can't raise her big toe; that's called paresis.

Can chiropractic help? Time will tell; whilst the complications of manipulation are acknowledged, they are, with very few exceptions, minimal compared to the difficulties after surgery.

Testing for paresis can be done in your own home; see the video below.

So, it's important to make a correct diagnosis.

There is still a hard core of chiropractors who scoff at making any sort of  diagnosis. Whilst it's true that research shows that doctors in general make the correct diagnosis less than 50 percent of the time, I believe it's still vital that we try. The above case is simply a case of a wrong diagnosis. Mrs P's general practitioner knows more about examination and diagnosis it would seem than her orthopaedic surgeon, neurologist and a neurosurgeon. She has the classic signs of pain in the groin, and restricted painful ranges of motion of the hip. Period. Hip arthritis.

Ah, jumping to conclusions, was I, just like her surgeon? Now that I've seen the X-rays of her hip, Mrs P has a most unusual hip; a combination of two conditions

• Femoro Acetabular Impingement Syndrome, that is causing the decreased range of motion (it's not arthritis)
  
• And a classic unroofed hip, Developmental Hip Dysplasia (that causes increased range of motion in the young person, gradually becoming stiff as the patient ages.
  

Neither have caused significant arthritis. I've never seen it before.

So we will start with Mrs P's hip, it's certainly to be helped. After that botched surgery of her back... of that, I'm not so sure. 

• ARTHRITIS IN LOWER BACK ...
  
• Femoro Acetabular Impingement Syndrome case file 
  
• DEVELOPMENTAL HIP DYSPLASIA CaseFile ...
• HIP ARTHRITIS ...

The expected improvement in her hip and groin pain was realised. Not cured, but much better; and she could walk relatively normally again.

Interestingly, in the beginning rotating the hip (one of her rehab exercises) was very painful in the groin; she was very surprised that after six weeks of treatment she could move the join with virtually none of those stabbing jabs.

I wasn't satisfied with the progress of her back, but where to refer her? She was adamant she wouldn't consult another surgeon, so she joined the folk who consult me once a month. Some relief, certainly no cure.

NB. An anecdote like this has no scientific value.

• CHIROPRACTIC HELP Lumbar stenosis

Fish oil

• FISH OIL ...
  

ORTHO INFO

This is a very useful medical site on the complications of surgery^[1].

Typical letter received at Chiropractic Help:

Complications of surgery.

I had surgery three years ago to remove a spinal cyst and underwent subsequent lumbar laminectomy at level 2/3.

I was doing well for 18 months and then over time the pain returned and became worse. I currently suffer severe back pain and sciatica which is worse in the mornings and relieved by two tramodol and one codomol which gets me into work and through the day.

Six months ago I was diagnosed with disc bulging in lumbar 4/5 and encouraged to strengthen my core stability.

I have tried to do this but haven't really kept it up.

I work as an OT; it's community-based work, home visits and long hours on the computer. 

Recently I've been experiencing pins and needles in my foot together with a cramp like throbbing pain which makes me feel nauseous sometimes.

The symptoms I currently experience are all made worse after periods of inactivity; sitting longer than an hour and the early mornings; however they are aggravated by walking and standing still too. I used to take my border collie on three hour walks; now I am lucky if I manage forty five minutes. Why has my doctor not mentioned chiropractic intervention and do you think it would help?

Hello Amanda,

There's nothing simple about your tale of woe, I'm afraid. When you have symptoms in both legs, it's going to be complicated.

1. Accept that you are going to do back exercises EVERY morning for the rest of your life BEFORE you get out of bed. You give your teeth that amount of attention, why not your back?

At chiropractic help you'll find some lower back exercises in the navigation bar. Start slowly, listen to your body and forget the core stuff for a bit until you're feeling a little better. Do the gentle stuff. Faithfully.

We Dutch have a nasty little saying: Those who will not hear, must feel. Got it? Every morning for the rest of your days. They take less than two minutes.

2. It's no coincidence that you have more problems when you sit. Lots of research confirming that sitting is the greatest enemy of the lower back. So sit less, especially when you don't have to sit. Don't sit and watch television for example. Get on the carpet and do the exercises whilst you are down there.

3. The fact that standing and walking cause pain suggest you may have a short leg. Ask someone to stand behind you, place their hands on your hips and compare. And insert in the shoe may help.

4. Don't bend. If you have to pick your shoe up, go down on ONE knee. One is usually better than the other.

5. Avoid the vacuum cleaner and broom, and absolutely no moving furniture or playing silly buggers. Be sensible.

6. Try and walk even if it's difficult. Hopefully an insert in the shoe may help. Regularly. If the dog tugs, and wants to chase cats, leave him at home.

Do all of that religiously, with great fervour, for a month or so, and see what happens. If there's zero progress, gather your scans, and start hunting for an experienced conscientious chiropractor. Be patient, Rome wasn't built in a day. Let us know you get on in a month or two.

I hope this has contributed.

Dr B

Moral of the story: If you've had surgery, or a serious incident with any form of treatment for that matter, chiropractic too, accept that certain changes in lifestyle are vital. Otherwise the pain will surely return. You will have noticed that one of the complications of surgery listed above is that the pain returns. 

Nothing, but nothing, will CURE a serious lower back condition. Exercise regularly and use common sense, keep fit, or pay the price.

Another sad letter

"I am twenty seven, and was an active person until the birth of my first child nearly three years ago. I have  never been the same. My first surgery was eighteen months later for a L5 S1 fusion. The pain continued and worsened.

So I had a second surgery five months later for bolts and screws and rods.
On coming around from surgery, I had severe back pain. One of the screws was impacting on the spinal canal. The surgeon went back in and unscrewed the screw slightly.

That was five months ago and I still have low back pain and it's getting  worse as the months have passed. The nerve is very painful and swollen and my lower back so tense and sensitive. I cannot perform any activities without being in severe pain for several days following; basic tasks like sweetping and vacuuming are impossible.

Further scans reveal sacroiliac degeneration. An EMG study shows L5 nerve damage. Analgesics help a little bit but I continue to be in such extreme pain."

Atherosclerosis and the complications of surgery

Insufficient blood reaching the site of surgery is considered the greatest risk factor of the complications of surgery. If the tissue that has been operated upon doesn't receive adequate oxygen and nutrients it simply doesn't heal. What is this nasty condition, aka "hardening of the arteries?"

• Pathophysiology of atherosclerosis

Active rehabilitation

Active rehabilitation of any serious injury, be that an antalgia as the lady above has, or torn ligaments or tendons, should be the norm; the alternative is a relapse, often worse than the original tear, and a good deal more frustrating; that's true whether you've been to a chiropractor or are suffering from the complications of surgery, or even a good operation; mostly a true cure is elusive and exercise and good nutrition is what is needed. 

Part of that rehabilitation is the making of certain dietary changes. That might be the inclusion of vitamin C, for example, which is vital in the formation of healthy collagen, or engagement in our free weight loss programs.

More difficult may be the addressing of a chronic hayfever problem; vigorous repeated sneezing is very hard on the lower back. Interesting research in Nature is that raw honey and the pollen therein may help alleviate the problem.

• Vitamin C deficiency symptoms include fatigue and poor collagen healing.
  

50 percent less pain rule

50 percent less pain rule is vital is you want to avoid chronic lower back pain and months of chiropractic, and the possible complications of surgery.

The problem is that the pain of a lower back injury abates with chiropractic help much faster than the tissue heals. Once the bulging disc is reduced with the appropriate adjustment, the stabs in the spine are immediately much less; but it takes a minimum of six to eight weeks for the annulus fibrosis to heal.

Relapse is common if you don't keep the 50 percent less pain rule in mind. During the period you can gradually increase your activity, but if you get up to silly buggers you can expect a relapse. 

That means more chiropractic adjustments, and the ever present complications of surgery loom in the background.

Knee surgery

Arthritis pain in knee is sometimes treated with a technique known as microfracture. The cartilage that lines the bones gets worn away in arthritis, and won't regenerate of itself. So surgeons drill small hoes into the bone marrow so that stem cells can leak into the arthritic lesion and lay down new cartilage.

The research done is generally weak as no controls have been used, but it does seem to be reasonably effective in younger athletes. However in persons over 45, in the obese, and if the cartilage lesion is greater than one inch, researchers agree that microfracture in the treatment of knee arthritis is not advisable.

Another technique showing promise is the use of a distraction device that allows the knee to move whilst the cartilage is healing. Of particular interest is that cartilage can certainly regenerate. Proven.

Chiropractic Help

Chiropractic help is a website dedicated to helping you understand the nature of your problem, and what you can do to help yourself.

Not a day at the coalface passes when every single chiropractor is caring for patients with serious problems who are facing surgery. That might be for a serious slipped disc in the lower back, a frozen shoulder, knee replacement surgery or something as seemingly mundane but very disabling like metatarsalgia and Morton's neuroma. 

For my money, faced with the complications of surgery, I would always consider conservative care first; but then I'm biased!

LINKS @ Complications of surgery

• Leaking bladder since surgery? Kegel exercises ...
• Slipped disc symptoms
• STROKE CHIROPRACTIC.
  
• Back surgery alternatives ...