Almost everybody knows someone who seems to have back problems. How many of
those go wrong?
Dr. Light: There are about 250,000 laminectomies done every year and it's said
in 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 fixed
and 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 categorize
them as the natural history of the problem that results in a less than optimal
result. A mistake would be that the doctor operates on the wrong disc or the
wrong level. Fortunately, that does not happen that often, but I would say it
probably 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, meaning
the cause of the pain isn't obvious and the doctor thinks the cause of the
pain is one disc when in essence it might be a combination of discs. So, only a
part of the problem is corrected. Then, there's the type of problem that
happens where the doctor does the proper operation, but by virtue of the way
that the operation is completed the problem returns. So, the most obvious and
common situation is somebody that has a herniated disc in the lumbar spine. One
of 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 belief
that if you just go in and take out one tiny little piece of the disc that the
problem is solved and because you've done so little that, that cures the
problem. When in essence that isn't quite how it happens. It happens like that
for maybe 60 or 70 percent of people. There's another 30 percent of patients
where the little piece of the disc that herniates and is removed is just the
tip of the iceberg. Just under the surface there's a large fragment of disc
material that the next time the patient coughs or increases their
intraabdominal pressure it's pushed out again in to the spinal cannel and
compresses the nerve. That happens approximately one out of five cases. One out
of five people who have microdiscectomy have recurrent herniation of the disc
and that's an ongoing problem. There's another issue that comes out that
happens, when you remove the disc the disc is part of the natural shock
absorber of the spine. So, when you remove part of the disc you remove some of
the shock absorbing qualities of the spine. There are a group of people maybe
again one out of five that once the disc is removed they develop a condition
called mechanical back pain or arthritic back pain because they've lost the
normal cartilage in the spine. The disc space narrows the spine starts to shift
in 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 back
pain as a result of it. So, those are two very common causes of failure in
Would you say that most of your patients who come here after having surgery and
it did not work for one reason or another, do they come back within five years
of that surgery or within five months?
Dr. Light: I would say that most people, if they know that they're going to
have a failed operation usually it occurs sometime in the first year or two
following the operation. There is another group of patients, another possible
cause of failure and in this case we're going to discuss this is the cause of
the problem in spinal surgery. One of the most common operations we do is a
spinal fusion. What a spinal fusion really is, is the doctor takes a piece of
bone and places it between the two vertebral bodies and the two vertebrae wind
up fusing together or joining together as one vertebrae. So, what that really
does is it solves the problem of the disc in that area. In other words, there's
no 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 nerve
irritation. So, what it does is it solves that problem. But what it does is
first of all it makes the spine very straight and the spine is meant to have a
curve in it.
Would you say to stay away from spinal fusions?
Dr. Light: If you can. There are certain problems where spinal fusions are
absolutely necessary. If you have a condition known as spondylolisthesis where
one vertebrae has slipped in relationship to the next that slippage or a
malposition of the vertebrae pinches the nerves, in that situation the doctor
has to put the vertebrae back and has to fuse it. Otherwise there's no way of
holding it. If you have a condition such as scoliosis or curvature of the spine
the only way to straighten the spine and keep it straight really is to fuse
it. So, if you have one of those two things you have to have it fused. There
are specific situations where it's unavoidable, but nowadays we have better
things than spinal fusions. We have these things called disc replacements and
they are clearly superior to spinal fusions. Hopefully everybody will be able
to keep the movement in their spine with a disc replacement and avoid having a
Have you ever done what you did with Sharion before and did you come up with
Dr. Light: I've done it one other time. I did it at the time that I did her
operation. So, her story is very simple. She fell and hit her head and injured
the C 5-6 disc. She went on and was treated conservatively and then eventually
underwent spinal fusion. Then, gradually over the years the discs on either
side of the spinal fusion disintegrated so to speak. She was left with terrible
pain that originated on both sides of the fusion. In addition, the fusion
itself was fused in an awkward position and what it did is it made the discs
above have to work twice as hard when the patient looked straight ahead because
the 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 put
stress on the disc above. So, she had a fusion that was not fused in an
appropriate position and she had degeneration of either discs, discs on either
Is it painful?
Dr. Light: It was painful. She was miserable. She had to take pain medication
on a regular basis; she had to stop performing her normal activities. She'd get
numbness in her hands, weakness in her hands. She wasn't able to work, she was
not very happy.
This information is intended for additional research purposes only. It is not
to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any
medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no
responsibility for the depth or accuracy of physician statements. Procedures or
medicines apply to different people and medical factors; always consult your
physician on medical matters.