Dr. Allan Horowitz, published newspaper article, The Liberal, Copyright April 24, 1991

Dear Dr. Horowitz:

How does one get an accurate assessment as to the expected effectiveness of lower back surgery.

I have a back problem which has been getting worse lately. I am overwhelmed by the amount of information available to me through books, newspapers, doctors, chiropractors, physio-therapists and friends.

Several friends from work have gone to chiropractors. Some swear by them. Others say the treatment didn’t help.

The one I went to treated me four times and told me that my condition would not respond to the treatment and that surgery likely would help me. My family doctor agrees, as does the surgeon I saw. They are all awaiting my decision. Two friends have had surgery on their backs. One was cured, while the other thinks his back and leg pain got a bit worse since the operation last year.

I have had physiotherapy and the therapist told me that surgery for back problems like mine is not effective very often. You can see why I am confused, and the more people I talk to the less I understand about my chances of recovering. How do you know if back surgery will help?

A.M., Richmond Hill.

Answer:

I will tell you what I tell my grandmother when she calls me to ask questions regarding her sore knees, back, eyes and arm.

I tell her to pick a health care practitioner very carefully and trust that person. It is O.K. to obtain a second opinion, or even a third when something like surgery is being considered, but listening to many different individuals, some knowledgeable and some not, will just confuse the issue.

If the physiotherapist is presently treating four patients who had unsuccessful back surgery, and therefore still require some physiotherapy, of course her opinion at that time will be biased against surgery.

Maybe the other 50 patients in the last few weeks who had the same operation were “cured” of their problem and therefore didn’t require any further treatment. This physiotherapist doesn’t see them and therefore doesn’t appreciate the benefits that the surgery often does provide. Your friend who was helped by the surgery has one perspective and the other obviously has another view.

It seems like your doctor and chiropractor are looking at it from an objective viewpoint and hopefully have your best interests in mind when they suggest the surgery be done. Some people feel that surgeons are “knife-happy” and want to operate on every poor soul that walks through their door. This isn’t true.

No surgeon that I know wants to operate on a patient if he/she doesn’t honestly feel that the patient will be better off after the surgery than before.

Functioning in that manner would be unethical, immoral, dishonest, and not good for the doctor’s liability insurance rates. Some surgeons are known as being more cautious than others when it comes to selection of patients for surgery. Some will wait longer and try many alternative methods first, before suggesting the surgical option.

However, I don’t feel any competent orthopedic surgeon would ever operate on a back if there was not a very good likelihood that the end result will leave the patient in a better way than they were before.

Reading books will also give confusing information. A book titled; “How Back Surgery Ruined My Life” might be a best seller, but probably is a biased account. A book titled; “How a Simple Teeny, Weeny, Operation Is Guaranteed to Cure Your Back….Or Double Your MoneyBack”, is also not likely accurate information.

My advise to you is… read next weeks column.