Avoiding Back Surgery

Always start with the most conservative type of treatment first. Chiropractic is noninvasive with no drugs and no surgery. Once there is surgery, there is no turning back. You can’t undo the surgery so jumping to surgery as a first choice is really not the best idea.  Chiropractic, physical therapy, acupuncture, pain management, massage are all conservation choices before surgery should be considered.

When people say they have a bad back what are some conditions they might be experiencing?

Dr. Gregg Rubinstein: Well, you know a bad back is a very general term. It could mean an awful lot of things. It could be sprains, strains. It could be arthritic degeneration of the spine. It could be a host of issues. Herniated discs. There are tons of things people will come in to see a chiropractor, or that they’ll say they have a bad back for. Scoliosis can cause problems that can lead to painful conditions as well. There’s a myriad of things that when people say they have a bad back. That’s why it’s really important to make sure you go to someone who can do a proper examination and actually figure out what the cause of your problem is.

For a new chiropractic patient, what is the process you follow to find the cause of their back pain and diagnose their condition?

Dr. Gregg Rubinstein: Well, whether you’re a chiropractic patient or a medical doctor’s patient, it’s always going to be the same process. You’re going to start off by doing an initial screening. You’re going to ask them a series of questions to draw out the information as to what their problem is, how long they’ve had it, what makes it worse, what makes it better? Then, you’re also going to get into the questions of their history. What happened to them? What brought them to this point? You look back, even things way back in childhood, accidents, falls, car accidents, sports injuries, things, falls off the bed. All these different things that happened. You’re going to want to know about everything because every little incident that happens to your spine leaves an imprint on your spine. When you take an x-ray, you’ll actually be able to see it.

The first process is gathering all your information, the history, the present illness and what their history has been prior to that. The other things you’re going to want to do is do a proper examination. An examination is going to help you determine what structures are involved. You’re going to basically start off checking their posture. You’ll check range of motion. Range of motion really can tell you an awful lot about the condition of a spine, as can doing a postural evaluation. The other tools that we use on the new patient evaluation is palpation. Actually checking the alignment. Feeling is this segment in line with the one above it and the one below it. Going down and checking the motion. Something called motion palpation will tell you how well or how fluidly each joint is moving.

Then, the thing that helps us the most is the imaging. Either taking an x-ray or an MRI if warranted will tell you an awful lot. I always tell my patients, “When you take an x-ray, a picture’s worth a thousand words.” To see is to know and to not to see is to guess. I know that my patients don’t come to me for me to take my best guess. I want to see an image so I can actually look at the alignment and then take a few measurements, draw a few lines, then report back to the patient very succinctly what specifically their problem is and if I can help them. If I’m not the one who can be able to help them, then maybe make the appropriate recommendations.

What are some treatments that you provide that have proven to help patients avoid back surgery?

Dr. Gregg Rubinstein: Well, it’s interesting. With chiropractors, we only really have one treatment. That’s called the chiropractic adjustment. We use the chiropractic adjustment to realign vertebrae, which are subluxated. Subluxated just means that if the bone is misaligned, it’s fixed or stuck in an abnormal position and it’s usually irritating the neural structures of the nerves. When you really look at the design of the spine, we have this stack of bones which completely encases the spinal cord. Then, exiting from in between two bones are the spinal nerves which go and deliver the messages from the brain to the rest of the body. Now, if these bones are misaligned, they’re going to irritate the same nerves they’re designed to protect.

That irritation to the nerves will prevent proper communication from your brain, your generator, getting the information out to the rest of the body, and prevent proper information from getting back to the brain, so your brain can make the adaptations and control and coordinate all the actions for the survival of the individual. I mean, that’s really what your nerve system does. It’s a big old communication center. If we can keep that spine in good alignment, the communication from your brain to the rest of your body is better. That’s like the difference between having dial up and a T1 line. Dial up internet took so long to get everything done. Now that we have DSL and T1 lines, we would never go back to that old system. The faster the communication in the body, the more apt you’re able to get things done including healing and that’s the basic principle of chiropractic.

In what type of cases is back surgery the only option to fix the problem?

Dr. Gregg Rubinstein: You know, that’s a great question. Also, now that I thought about it. I don’t think I fully answered your other question. The treatments that we provide is really the adjustments. To realign the vertebrae, get pressure off the nerve, enhance the body’s ability to heal. In some cases, that’s enough for the body to start getting back on track and improve the alignment, improve the mechanics of the spine, and very often those problems will go away and those patients might not need surgery. The determination to whether or not someone needs surgery or not is really determined by two things. Number one, there are some cases where emergency surgery is warranted right away. If you’re doing an examination on someone and they have lost control of their bladder or lost control of their bowels or their leg is totally numb or they have zero strength in it or they have what’s called foot drop because there is no more nerve energy and the leg just goes flaccid, those cases are emergencies.

Those usually go to surgery right away but the majority, other cases that people end up going for surgery or considering surgery is truly about their quality of life. If you can get through your day with minor discomfort and you’re living your life and you’re doing all the things you want to do then chances are you’re not going to want to have surgery and you probably don’t need it. But if your quality of life is very poor and you can’t sit, you can’t go to work, you can’t sleep, you can’t exercise and you can’t do all the things you need to do in order to have a decent quality of life then sometimes surgery is an option but really in my opinion, only after you’ve exhausted all your other options. Always start with the most conservative type of treatment first. Chiropractic is noninvasive. There’s no drugs. There’s no surgery. Once you do a surgery there’s no turning back. You can’t undo the surgery, so jumping to surgery as a first choice is really not the best idea. I would try everything, from chiropractic, physical therapy, acupuncture, pain management, massage, whatever I could do to avoid surgery. Surgery should always be the last result.

Have you helped patients avoid back surgery after it had been recommended by their medical doctor? 

Dr. Gregg Rubinstein: Absolutely. People have come in there and I don’t tell them that they shouldn’t have surgery, I just ask them to give me a chance. I said, “When is your surgery scheduled for.” They’ll be like, “It’s two months out.” I’m like, “Well, are you committed to staying with me, doing some work to see if we can improve your condition?” If your condition improves, you can always postpone, put off, or cancel the surgery if you so desire. That’s the important thing because people think because surgery is recommended that they have to have it. It’s truly a quality of life decision that the patient gets to make. If your life is of good quality and you’re able to get through your day, great. If you’re not then maybe you would need surgery and it could actually help.

I’ve seen plenty of people where lower back surgeries have helped. They’re not as successful when they do the cervical surgeries. They usually end up with some failed neck surgeries, which I see coming into my office even after they’ve done fusions and other types of surgery but it’s different for every person. It truly is a quality of life decision. There are certain cases. The most common thing that people have back surgery for, usually the herniated discs. Those are the most common type of surgeries that you’ll see in the spine.

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