Trying to convince my 74-year-old father-in-law to avoid back surgery...

I wasn't sure where to put this post, so apologies if this isn't the right forum.

My father-in-law has been diagnosed with spinal stenosis (I think L4 or L5 region).  He is in serious pain and cannot walk upright or sleep in a bed.  He had a steroid injection but it did not help.  His doctor is now recommending lumbar laminectomy, and my father-in-law wants to do this ASAP.

My gut tells me that his decision is a mistake, and that he should continue pursuing physical therapy.  He was doing PT, but some exercise that he was doing actually triggered more pain and disability, and now he distrusts PT.

My father-in-law is a reasonable, rational man.  I was hoping that someone here in the forums with some expertise could provide a brief, science-based, and logical argument against surgery -- if, in fact, the experts here on the forum believe that surgery should be avoided.  If surgery is his best option, then OK.

Thanks for your consideration and any help or guidance you can give me,

Craig

There is so much history missing here it's impossible to give an opinion, even if anyone was qualified (there are a few osteopaths on this forum). And no professional would give advice on this.

Is the stenosis from trauma or degeneration? What did your FIL do for work? Is/was he active. Does he want to be active? Is he aware that post surgery, he will have to be diligent with mobility and certain types of exercise?

How long has it been a problem?

What PT is he doing? What caused the problem?

What does the PT think about surgery?

Has the surgeon/his GP outlined the likelihood of the surgery being successful, given his symptoms? (HIS symptoms, not someone else's).

Has the surgeon (or any other surgeons s/he knows) performed this operation and had no improvement in symptoms?

It is often possible to manage some orthopaedic conditions conservatively (without surgery; I've written about this some of my previous posts: one shoulder probably needed surgery, the other probably didn't). In a lot of cases, conservative treatment and surgery have the same outcome at 6 months, 1 year, two years and so on. But it's the here and now that's important. If your FIL has had PT for a "while" and it hasn't helped, then surgery can - usually, USUALLY - help, and then you spend the same time rehabbing yourself that conservative treatment takes anyway.

So I'm not advising you one way or another. You and your FIL should talk to people who have had the procedure done, and ask about its success, the rehab/post-op exercise, and anything that went wrong.

One observation: with either PT or rehab, impress upon your FIL that "more is not better". A lot of old blokes I know will blast away at rehab like a bull at a gate, then wonder why they're sore. My father is no exception, when I was a massage therapist I treated my parents occasionally and Dad would do things until he could barely move, then complain he was hurting.

The topic of the relationship between pain and injury is complex, and this is also something you can investigate. In short, pain doesn't always involve injury, and vice versa (for example, stretching your hamstrings can hurt. Does it mean you're injured? No.) It can make some difference in how you approach rehab pain though.

One observation: you mention your FIL is a reasonable, rational man, and you're asking about treatment based on a "gut" decision. Perhaps you and FIL think about things in different ways and gather information differently in order to arrive at a conclusion, so gather a LOT of information from different people.

Please keep us informed as to the outcome.

 

 

Nick: thank you.  You've given me much to consider. I'm going to ask my father-in-law to consider all of these questions, and also implore him to discuss all this with his doctors.

 

I know nothing about the condition you're describing, but know some about how to think about figuring out your medical state and what to do about it.

Anyone who gives you a diagnosis and \ or treatment suggestions based on a description on an internet forum is unprofessional and shouldn't be trusted. In most places that's also illegal. Any material claim would be considered medical advice, create liability, and it would be crazy to give it without examining the patient and looking into whatever information the practitioner deemed relevant, rather than just what occurred to you to write.

Practical advice, if you're uncomfortable with the currently recommended treatment: seek a second opinion, from another physician, based on a face to face medical consultation. Or third, for that matter. Preferably from a physician who has as much specific expertise as possible. Good luck.

Hi Craig, I should point out I have expertise in this apart from having my own back problems over the last few years. I recently stumbled across a few podcasts with Dr Stuart McGill a world renown bio mechanic that specialises with the spine. You can find him on the align podcast, movement fix podcast & squat university podcast. Definitely worth a listen. Good luck