Sciatica and low back pain misdiagnoses lead to mistreatment
July 18, 2013
Mark L. Friedman, MD, FACEP, FACP
I can't tell you how many times patients have come to me with a condition known as "failed back syndrome" or "failed back surgery syndrome." Essentially, the patient complains of lower back and/or leg pain for which they underwent major back surgery. The surgeries have run the gamut from partial disc removals, to laminectomies, to fusions using bone, rods, or even metal cages to stabilize the back. This, supposedly, would stop the pain. In some cases such surgeries work; in many cases, however, they don't. And in a great many of these latter cases the reason for failure is simple: misdiagnosis.
Even conservative surgeons can be fooled by X-rays or MRIs that show arthritic or degenerative changes in the spine. If a person comes into the office complaining of back or leg pain that seems to follow certain patterns "“ such as sciatica (pain in the leg which follows the distribution of the sciatic nerve) "“ and gets an X-ray or MRI showing disc problems or arthritic changes in an area of the spine which coincide with that nerve and might explain the pain, it would be easy to conclude that surgery to the region will likely fix the pain.
However, because there are several other potential causes for the pain, doctors should do further physical examination to rule out other causes.
Even after surgery has failed to relieve back pain, physical examination often reveals the real cause. Piriformis Syndrome (spasm of a muscle in the buttocks region) often causes sciatica-type symptoms. Quadratus Lumborum muscle contraction (a large muscle that reaches from the lower two ribs to the pelvis) often causes back pain. Sacroiliac (SI) joint dysfunction or injured ligaments in the lumbar spine or SI joint can mimic hip pain, back pain, and sciatica.
A well-trained physician, such as one trained in osteopathic hands-on diagnosis and manipulative medicine techniques and prolotherapy, can often fix the problems left behind after failed back surgery. Perhaps more importantly, such a physician might have been able to sort through all the data, including the abnormal X-rays that showed coinciding spine problems to determine the actual cause of the ongoing pain.
Interestingly, many of the causes are not in the spine or cannot be resolved by chiropractic treatment alone. Many of the patients I have seen have been to chiropractors for years who have missed QL spasms. Chiropractors also often cannot adequately treat many ligament injuries as they cannot do prolotherapy.
A visit to a well-trained osteopathic physician, however, might have saved many of these people from unnecessary and useless surgery and rehabilitation "“ as well as the complications of back surgery, which we will cover in a future blog.
If you have back or leg pain or sciatica that won't resolve, you might want to consider visiting your local osteopathic manipulative medicine doctor before undergoing surgery.