I wrote this article in honor of Dr. Allan Dyer, who passed away in 2019. He was such an innovative man — the founder of Vax-D and considered by many the father of decompression. He was a former Ontario deputy minister of health whose extensive research contributed to the development of the heart defibrillator. Dr. Dyer was a bright, sincere man. I feel blessed to have spoken with him and learned from him and his passion for nonsurgical spinal decompression. He understood the disc and put millions of dollars into solid medical research to advance nonsurgical spinal decompression into mainstream treatment for disc injuries. Having worked with both him and Dr. Norman Shealy who has over 500 published papers has been a gift from the heavens.
It’s amusing how, once again, our profession is at odds with a component that is beneficial to it, especially with the medical profession now acknowledging failed back surgery syndrome. Studies show that lumbar fusion succeeds in barely 40% of patients. In this context, the word “success” does not mean much, though. In a study two years after spinal fusion was performed in “successful” procedures, pain barely had been reduced by half for patients, and most of them continued using painkillers. In another study, also two years after the procedure was performed, about one-third of patients reported that their pain was as bad as it had been before the operation. Fourteen percent believed that they were in worse shape after spinal fusion.
It amazes me today that many experts on decompression have difficulty explaining the difference between traction and decompression. The most sound study on this is the Sealy-Bergmeyer study. Decompression is not a specific table or technique; it is an event assisted by the table and the technique. That differentiates us from the medical profession because only chiropractors can remove kinesiopathology effectively.
Many doctors utilize decompression, although the equipment and technique were not taught when 98% of us were in school. That is changing as we speak. Back pain is a huge industry, and Americans have been searching for the cure. The cost of this pain became broad public knowledge when Time magazine published an article titled “The Price of Pain.”
Surgery is not the answer. Failed back surgery syndrome has now reached pandemic proportions. One clear example is The Laser Spine Institute, which is now out of business. The laser spine-surgery craze took hold in the mid-1990s. It took more than a decade for a well-designed Cochrane Collaboration review to show that the minimally invasive procedure, which resulted in higher levels of nerve root injury, dural tears, and reoperation rates, was not safer than a conventional microdiscectomy. The minimally invasive group had a 38% revision rate, more than double that of the group that underwent the standard procedure. Patients who had conventional microdiscectomy recovered faster than those who had laser surgery, and they required fewer than half as many return trips to the operating suite.
..."Stepping into that vacuum, direct-toconsumer marketers had made minimally invasive spine surgery look much better than it actually was."...
In my clinic, I used to say, “The difference between major surgery and minor surgery is that minor surgery happens to somebody else.” The fact is Golden State Warriors head coach Steve Kerr and golf legend Tiger Woods would tell you that plenty can go wrong. Kerr’s conventional microdiscectomy in the summer of 2015 to relieve sciatic pain culminated in a dural tear and a cerebrospinal fluid leak, leaving him to suffer excruciating headaches and fatigue. Even after a second surgery to fix the leak, Kerr was stuck at home for more than half the Warriors’ season. He is now an advocate for avoiding back surgery.
Tiger Woods, the winner of more than 100 professional golf events worldwide, had a conventional microdiscectomy in 2014 and another in 2015. Both failed, leading to a third procedure in October 2015. Eight months later, Woods was downcast at a press conference. He did not know when or if he would play again. “I have no answer for that. Neither does my surgeon or my physio,” he said. “There is no timetable. There’s really nothing I can look forward to, nothing I can build toward.” He eventually had a fourth and fifth surgery.
I often ask why anyone would choose surgery over spinal decompression with such unpredictable outcomes. Patients remain drawn to the mystique of the quick, bloodless, minimally invasive procedure. Cedars-Sinai spine surgeon Hyun Bae explained that the high incidence of “failed backs” had put patients off conventional procedures. Stepping into that vacuum, direct-to-consumer marketers made minimally invasive spine surgery look much better than it actually was. “It’s not because the procedure is good,” he said, “It’s because of errors that spine surgeons have made over the last quarter-century. We’ve done it to ourselves.”
The American Journal of Medicine observed that in the United States about 80,000 spine surgeries fail annually. Patients who have not done well are referred to as “failed backs,” and they often return to the operating room repeatedly, losing ground after each procedure. About one in five patients who undergoes spinal surgery for a degenerative disorder returns for a revision procedure — a second operation.
Studies show a second back surgery has a 30% chance of success. That prognosis drops to 15% for a third back surgery and 5% for a fourth. Oregon Health and Science University spine medicine researcher Roger Chou believes that surgeons should be required to reveal the odds to their patients before going forward. “If [the surgeon] said, ‘Yes, we can do this $70,000 surgery, but you know, there’s still more than a 50% chance that you’re going to have a lot of pain, and you still won’t be able to work, and you’re going to need pain medicine, and you’ll have complications related to the surgery’ — and all this is well documented — then most people would say, ‘I don’t want it.’” That is where we fit in as chiropractors.
More people are seeking treatment for back pain while the price of treatment per person has risen. In a study in The Journal of the American Medical Association, researchers at the University of Washington and Oregon Health and Science University compared national data from 3,179 adult patients who reported spine problems in 1997 to 3,187 who reported them in 2005. Researchers found that inflation-adjusted annual medical costs increased from $4,695 per person to $6,096, and that was 15 years ago.
Interestingly, they do not want to go under the knife themselves. At an American Academy of Orthopedic Surgeons conference in the summer of 2010, a hundred surgeons were polled about whether they’d personally have lumbar spinal fusion surgery for unspecific low back pain. All but one answered “absolutely not.” The risk-reward ratio just wasn’t good enough.
When I was in school, I was taught, “Chiropractic is a philosophy, art, and science.” For 40 years, I have disagreed with that paradigm. I have altered it, and it is the center of all my teaching. The paradigm of the 21st century should state, “Chiropractic is a science that has an art and embraces a philosophy.”
So if you’re not doing decompression, you’re missing out. I hope to see you at Life University in November. You will learn about the differences in tables, protocols, failed back surgery syndrome, epidurals, billing, coding, and so much more. Additionally, a national certification program (12 CEUs) will be presented at Life University on November 6 and 7, for more information go to: Life.edu/PostGrad.
Dr. Eric S. Kaplan is president of Disc Centers of America, the largest group of chiropractic clinics in the U.S. utilizing nonsurgical spinal decompression. He has worked with two presidents of the United States and two U.S. surgeon generals. He is CEO of Concierge Coaches (www.conciergecoaches.com), the number one chiropractic firm specializing in spinal decompression and neuropathy training nationwide. For more information on coaching, spinal decompression, or seminars, visit www.thechiroevent.com or www.decompressioncertified.org, or call the Chiropractic Q&A Hotline at 888-990-9660.
