Almost everybody knows someone who seems to have back problems. How many ofthose go wrong?Dr. Light: There are about 250,000 laminectomies done every year and it's saidin this country that of 1/3 of all spinal operations result in failure. So,that would be about a hundred thousand failures a year.So, every day you're seeing someone who went to a doctor to get something fixedand now you have to fix that, correct?Dr. Light: Pretty much.What are the most common procedures that have the most mistakes?Dr. Light: You can categorize them as mistakes and then you can categorizethem as the natural history of the problem that results in a less than optimalresult. A mistake would be that the doctor operates on the wrong disc or thewrong level. Fortunately, that does not happen that often, but I would say itprobably happens about one out of every 1,000 cases, maybe a little bit less.Then, there's a type of problem where the cause of the pain is obscure, meaningthe cause of the pain isn't obvious and the doctor thinks the cause of thepain is one disc when in essence it might be a combination of discs. So, only apart of the problem is corrected. Then, there's the type of problem thathappens where the doctor does the proper operation, but by virtue of the waythat the operation is completed the problem returns. So, the most obvious andcommon situation is somebody that has a herniated disc in the lumbar spine. Oneof the most popular operations for that is called microdiscectomy.Microdiscectomy means that the doctor makes a very tiny opening in the back,the smallest possible opening that he can make. Then, there's a common beliefthat if you just go in and take out one tiny little piece of the disc that theproblem is solved and because you've done so little that, that cures theproblem. When in essence that isn't quite how it happens. It happens like thatfor maybe 60 or 70 percent of people. There's another 30 percent of patientswhere the little piece of the disc that herniates and is removed is just thetip of the iceberg. Just under the surface there's a large fragment of discmaterial that the next time the patient coughs or increases theirintraabdominal pressure it's pushed out again in to the spinal cannel andcompresses the nerve. That happens approximately one out of five cases. One outof five people who have microdiscectomy have recurrent herniation of the discand that's an ongoing problem. There's another issue that comes out thathappens, when you remove the disc the disc is part of the natural shockabsorber of the spine. So, when you remove part of the disc you remove some ofthe shock absorbing qualities of the spine. There are a group of people maybeagain one out of five that once the disc is removed they develop a conditioncalled mechanical back pain or arthritic back pain because they've lost thenormal cartilage in the spine. The disc space narrows the spine starts to shiftin an irregular fashion and that in and of itself is a cause of back pain. So,another 1/5 of the patients who have microdiscectomies develop arthritic backpain as a result of it. So, those are two very common causes of failure inthat situation.Would you say that most of your patients who come here after having surgery andit did not work for one reason or another, do they come back within five yearsof that surgery or within five months?Dr. Light: I would say that most people, if they know that they're going tohave a failed operation usually it occurs sometime in the first year or twofollowing the operation. There is another group of patients, another possiblecause of failure and in this case we're going to discuss this is the cause ofthe problem in spinal surgery. One of the most common operations we do is aspinal fusion. What a spinal fusion really is, is the doctor takes a piece ofbone and places it between the two vertebral bodies and the two vertebrae windup fusing together or joining together as one vertebrae. So, what that reallydoes is it solves the problem of the disc in that area. In other words, there'sno more disc. If there's no more disc there's no more pinching of the nerve.If there's no movement of that disc space, then there's no more nerveirritation. So, what it does is it solves that problem. But what it does isfirst of all it makes the spine very straight and the spine is meant to have acurve in it.Would you say to stay away from spinal fusions?Dr. Light: If you can. There are certain problems where spinal fusions areabsolutely necessary. If you have a condition known as spondylolisthesis whereone vertebrae has slipped in relationship to the next that slippage or amalposition of the vertebrae pinches the nerves, in that situation the doctorhas to put the vertebrae back and has to fuse it. Otherwise there's no way ofholding it. If you have a condition such as scoliosis or curvature of the spinethe only way to straighten the spine and keep it straight really is to fuseit. So, if you have one of those two things you have to have it fused. Thereare specific situations where it's unavoidable, but nowadays we have betterthings than spinal fusions. We have these things called disc replacements andthey are clearly superior to spinal fusions. Hopefully everybody will be ableto keep the movement in their spine with a disc replacement and avoid having aspinal fusion.Have you ever done what you did with Sharion before and did you come up withthis?Dr. Light: I've done it one other time. I did it at the time that I did heroperation. So, her story is very simple. She fell and hit her head and injuredthe C 5-6 disc. She went on and was treated conservatively and then eventuallyunderwent spinal fusion. Then, gradually over the years the discs on eitherside of the spinal fusion disintegrated so to speak. She was left with terriblepain that originated on both sides of the fusion. In addition, the fusionitself was fused in an awkward position and what it did is it made the discsabove have to work twice as hard when the patient looked straight ahead becausethe disc below, the C 5-6 disc, was fused in a flexed or kyphotic posture. So,every time she looked straight ahead she had to tip her head back and putstress on the disc above. So, she had a fusion that was not fused in anappropriate position and she had degeneration of either discs, discs on eitherside.Is it painful?Dr. Light: It was painful. She was miserable. She had to take pain medicationon a regular basis; she had to stop performing her normal activities. She'd getnumbness in her hands, weakness in her hands. She wasn't able to work, she wasnot very happy.This information is intended for additional research purposes only. It is notto be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or anymedical professional interviewed. Ivanhoe Broadcast News, Inc. assumes noresponsibility for the depth or accuracy of physician statements. Procedures ormedicines apply to different people and medical factors; always consult yourphysician on medical matters.