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Posts Tagged ‘surgery’

I read an article in the local paper today that was entitled “A Pain in the Budget: More back surgeries, not improvements.” The essential point of the article was that back surgery is not necessarily the answer to back problems. In a past blog post, I have discussed how diagnostic tests don’t always tell the whole story. And yet a patient presents with a positive MRI result or a patient’s complaint of pain that goes unresolved, surgery is quite often the next option.

I found this quote by Dr. Richard Deyo from the article quite profound.

“Intense pain is not necessarily an indication for surgery.”

If you have heard Mike Boyle speak or read his recent book, Advances in Functional Training, you have probably heard him talk about the 3 I’s. When a patient goes to see a surgeon – there are three options.

  • Ingestion – take anti-inflammatories; if that doesn’t work
  • Injection – if that doesn’t work;
  • Incision or surgery

Those are really the three choices when a patient goes to see a surgeon. Injury rehabilitation may be part of that picture but is not always a given. Essentially, there are three options for a patient with pain that doesn’t subside.

And so that is where the rubber meets the road: a patient presents with pain and the conundrum is what is the best way to rid that patient of the pain. When it comes to back pain, 80 percent of the population will suffer from back pain at some point in their life.  And yet the article alludes to several studies that indicate that 90% of low back pain will heal (or let’s just say the pain will dissipate) on their own.

So what is the best choice? – that is the question.

Deyo went on to offer another great quote:

“Many people have a very mechanical view of how the body works and imagine it is like a car. So if a tire wears out, you’ll just put in a new one. It just doesn’t work that way.”

And yet I think he is correct. Many of us look at our bodies like that. And yet we all know that the replacement parts are not as good as the originals.

So what does this mean for us – I think it means what it always has. We owe it to those in our care to continue to improve our skills and make sure we are providing the best service possible. Some surgery can’t be avoided – we know that. But let’s keep improving – expanding our knowledge and examining all that we can to do best by those in our care.

I’ve always maintained that just because everyone is doing something or just because that is how we have always done things, it doesn’t mean it is right. Just because surgeries, such as spine fusion operations, are on the rise doesn’t mean this is the best option. Let’s keep searching…

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Sports Health published a meta-analysis in the January-February 2010 issue. It was entitled: Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Autograft Versus Allograft Tissue.

Although autografts are much more commonly used for ACL reconstruction, the comparative studies of the two are very limited. The research team searched exhaustively to find studies to qualify for inclusion. After reviewing 5000 studies, the researchers found 576 studies that warranted further review. When all was said and done, 56 studies were deemed to meet every aspect of their criteria, one of which directly compared both autograft and allograft reconstruction.

The meta analysis compared the following outcome measures: positive Lachman test, positive pivot-shift test, IKDC grade C or D, graft failure, and joint laxity as measured by a KT-1000 arthrometer.

In a comparison of all the studies, the only statistically significant difference was that allograft patients presented with increased joint laxity when measured by the KT-1000 arthrometer compared with autograft patients.

While the other negative outcome measures proportions were larger for autograft than allograft, statistical analysis revealed that these differences were not statistically significant.

So based upon the available data, the researchers concluded that patients who undergo allograft ACL reconstruction may have more joint laxity as measured by the KT-1000 arthrometer compared to patients who undergo autograft ACL reconstruction. They go on to further recognize that a large multicenter randomized clinical trial comparing both is warranted and would be beneficial.

On a final note, I found this particularly interesting – the researchers had this to say in the discussion:

“Furthermore, data suggest that the incidence of osteoarthritis is similar for patients who have sustained an ACL rupture 15 years following injury, regardless of whether or not they undergo reconstruction. 40 It would be important to ascertain if graft type has an influence on the incidence or progression of osteoarthritis following ACL reconstruction.”

This was a significant undertaking and the researchers should be applauded for their efforts to help provide us with the information needed to more accurately instruct and educate those who face the prospect of ACL reconstruction.


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