Most patients understand that back surgery is bad news. This is because most know someone first or second hand that has had their back ruined by surgery. However, as a physician, I still get asked the question, “Should I get back surgery?” For those that still think this could be a good option, a picture is worth a thousand words. In this case a low back MRI showing the low back stabilizing muscles completely destroyed by surgery.
Most patients don’t know that one of the reasons their spine doesn’t fly apart when they move is due to tight and precise muscular control stabilizing one back bone on the other. The muscles that accomplish this are called multifidus and they can be easily seen on a low back MRI but are often ignored by radiologists and surgeons. This is despite more than a hundred research studies showing that they are critical for a healthy and pain free spine.
This patient’s MRI is similar to thousands I have reviewed over the last 25 years, but it’s dramatic enough so that even someone who doesn’t look at MRIs all day will see what’s going on. Notice that in the dashed lines on the right, is the dark muscle of someone with low back pain. It’s smaller than someone who doesn’t have back pain, but it’s still hanging in there. On the left is the MRI of the patient I just evaluated this week who had low back surgery. Note that in the dashed lines is mostly white, which means mostly dead muscle. What happened? The surgery killed off the stabilizing muscles which means his low back is permanently unstable at this level.
The upshot? Low back surgery is usually bad news. While there are a few people who couldn’t get better without it, the vast majority of low back surgeries done in the U.S. and elsewhere are unnecessary. In addition, now you can visually see the havoc they wreck on the body by seeing what a dead low back stabilizing muscle looks like on MRI!