Surgery Is Damage to Accomplish a Goal

by Chris Centeno, MD /

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Most of my patients view surgery as like getting a part fixed in their car. A part wears out, so you replace it or “fix it” with a new one. As I spoke to a patient this week about pursuing back surgery or continuing to try to avoid it with orthobiologics, I was struck how he didn’t understand that back surgery would damage his spine. He didn’t get that the procedure would only be worth it if we had no other option and if the damage from the surgery was less than the good we thought it might do. At that moment, sitting there, struggling to get him to understand, I coined a phrase: “Surgery is damage to accomplish a goal.”

Surgical Damage

Let’s say that you have a nerve that’s being compressed by a disc bulge. If a surgeon goes into “fix” that problem, he or she must first cut through the muscles that stabilize the back. The act of just placing a retractor tightly against those muscles to allow the surgeon to visualize the area will also damage them in direct proportion to the pressure and the amount of time that the device is in place. If the surgeon removes the part of the disc pressing on the nerve, the structure of that disc will be forever compromised as it won’t grow back. If the surgeon must remove part of the local bone to open up the area, then the whole vertebra will be less stable.

Let’s take this surgical damage concept to the knee, shoulder, and ankle. A torn piece of a knee meniscus can’t be removed without also increasing the forces on the cartilage. When a surgeon removes the biceps tendon because where it attaches is torn, it will negatively change the way that biceps muscle and the shoulder work. And so the examples continue from the ankle ligaments replaced with tendons to an ACL replaced with a hamstrings or patellar graft. There is no surgery-free lunch, meaning it’s all controlled damage to accomplish a goal.

Is the Damage Less Disabling Than the Goal?

This, of course, is the billion-dollar question. First, the answer is very easy when research shows that the surgery doesn’t produce positive results better than physical therapy or a placebo. So for these surgeries, unless it’s a unique scenario, no amount of damage is acceptable:

Reducing the Damage

One way to move the balance of damage and outcome into your favor is to reduce the damage. So for the spine patient above, we discussed getting a true muscle-sparing, minimally invasive surgery where they would remove the least amount of disc and bone feasible. This is why we practice interventional orthopedics, allowing us to get stem cells and platelets to the right spot using an injection that does no or little damage. This is also why we’re working on the next generation of injection-based tools that will replace surgery, allowing us to do things through needles that used to only be possible with surgery.

The upshot? Surgery is damage to accomplish a goal. There’s just no way around it; modern orthopedic surgery is often like a bull in the china shop. None of these procedures are like replacing a worn-out part with a new one. In fact, they all involve damaging the musculoskeletal system to some degree. So the million-dollar questions is always, is the amount of damage this surgery will cause worth the end game?

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14 thoughts on “Surgery Is Damage to Accomplish a Goal

  1. Serafin Padron

    This article is very interesting, I never saw surgery from this prospective

  2. Michael

    Thanks for giving us the inside scoop

  3. Cheryl Starsong

    But how to know in case of hips with little cartledge if stem cell can help enough to walk comfortably?

    1. Regenexx Team Post author

      Cheryl,
      Establishing whether or not you’d be a good Candidate for a Regenexx Hip procedure and which type of procedure (same day or cultured) would give you a good idea of what to expect. Generally, the Cultured procedure is needed for Severe Hip arthritis. To see wether we can help, you can either submit the Candidate form, or if you’re local to one of our Physicians, you can begin that process with the exam. Please see: https://regenexx.com/the-regenexx-procedures/hip-surgery/ and here is thelist of Regenexx physicians:https://regenexx.com/find-a-physician/

  4. MIMI LEVINE

    Good way to put it !

  5. mark pringle

    hi, i agree with that statement. i would rather try to fix it than cut it out. i am an ironworker, 33 years in the trade. having a double hip replacement in a few months. i have no cartilage left at all or i would consider flying to the USA for some stemcell treatment. i also have osteoarthritis in my left shoulder, degenerative wear in L3, L4, and L5 with nerve root compression at L3. having lots of pain in my right knee as well. i know it is too late for my hips but i would definitely like to try some stemcell treatment on my other issues. let me know if you need any volunteers for your research.

  6. Mary Reustle

    when do you think that medicare will recognize the procedure for the knee? Instead of replacement surgery that regenerating is the way to go .Are you all making it known to them that it works ? Is the success rate reported to them ?

    I am waiting to have them cover expenses so I can get my procedure . Also does the cost cover a second round if the first does not have a success..?

    1. Regenexx Team Post author

      Mary,
      While it would be significantly better for the patient, and definitely cost saving for Medicare, it doesn’t appear likely that Medicare will be covering stem cell procedures in the near future. Small encouraging steps are taking place, but given the way that Healthcare is set up – it’s a big mountain to climb. Our outcome Data is available on our website.

  7. Tim

    What about a case of shoulder impingement syndrome in which bone spurs have developed? Since it is a mechanical issue to address, wouldn’t surgery be the first step necessary to remove the spurs to stop continuation of chronic tendon degeneration?

    1. Regenexx Team Post author

      Tim,
      Generally, not. Bone spurs are your body’s way of “shoring up” an unstable joint, so it’s the instability that needs to be treated. Because bone is alive and responds to the pressures, forces and chemical signals of it’s environment, when those abnormal forces are resolved they are no longer needed. If necessary, they can be broken up with a procedure done through a needle.

      1. Tim

        Would the procedure to break up the spurs via a needle have to be done by an ortho surgeon or is this something your facility offers? I’m assuming it would need to be done prior to any other regenerative procedures, correct?

        1. Regenexx Team Post author

          Tim,
          This is a nonsurgical procedure we offer when needed. In order to get more specific information on what would be needed in your particular case, you’d need to submit the Candidate form for one of our Physicians to review your specific case with you, determine if you’d be a good, fair or poor Candidate, and what type of procedure/procedures, would likely be needed. Please see: https://regenexx.com/blog/shoulder-mri-results/

  8. Peg gertz

    What about spondylothesis. A 3mm plus of instability

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
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Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

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Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

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