Pfusch am Rücken

Botched back - money-making with unnecessary operations  

Picture of Richard Staudner
Richard Staudner

The Optimizer

Unfortunately, some of the ways in which we deal with our health around the world are heading in completely the wrong direction. Whether it's financial resources or time, far too little is invested in prevention, i.e. protection against illness. Instead, we only take care of our health when the first problems occur, when it hurts and aches. Or even when a disease has manifested itself.

With this in mind, I'd like to take a look at one of civilization's biggest health problems with you today. Back pain!

Problems and pain with the musculoskeletal system, the musculature or the back lead almost every statistic. From the inability to work at a young age to the mobility restriction in old age, but also the economic costs.

In German-speaking countries, the annual costs to citizens and the state of back problems have broken through the billion mark.

In this article, I would like to explain why this is the case, how pointless these expenditures sometimes are, and what alternatives we have.

But before we delve deeper into this topic, I would like to thank the German weekly magazine "The Mirror" and its authors. A very well-researched article on this subject appeared in issue 51/2022. Under the title "Botched Backs," the magazine presents data and facts that scrutinize the questionable medical approach in Germany.   

The facts and figures I present here are all taken from this article. If you are interested in the sources and further information, or if you want to read the whole article, you can find the link at the bottom of this page.

When surgery becomes the first choice

An intervention in our body, be it a minimally invasive form with local anesthesia or major surgery including general anesthesia, should not be the first choice. Our body has strong natural self-healing powers and in many cases only needs support from us. Operations are a great strain on our organism, combined with an effort for regeneration and healing that should not be underestimated.

If there is a possibility to get along without surgery, this is advisable.

Unfortunately, not all people with medical-consulting functions think this way. Surgeons often see an operation, for example in the case of a slipped disc, as the ideal problem solver. Many statistics also prove that such measures are often exaggerated and that success is usually not achieved after an operation.

In fact, the opposite is true. Most operations on the spine are neither necessary nor successful.

Nevertheless, spinal surgery in Germany increased by 71% from 2006 to 2020. Pain sufferers went under the knife more than 387,000 times in 2020 in our neighbors.

Unfortunately, up to 30% of patients complain of permanent pain after disc surgery or spinal fusion surgery.

Furthermore, at any given time, 33 million Germans ask themselves the question "What can I do about my acute neck, shoulder or back pain?"

In Austria and Switzerland, this picture is probably not much different.

Economic costs

In times of crisis, where energy costs and inflation are pushing many people into economic ruin, one naturally also legitimately asks the question of what all this is costing us!

Infections and pain in the neck and lower back are the main reason for incapacity to work. The economic costs are estimated at around 50 billion euros per year. In addition, of course, there are the immense follow-up costs for citizens and the state.

Goldmine: imaging and surgery

The main reason for a true tourism in imaging and the frivolous recommendation to solve the problem with surgery is mainly the good remuneration. Imaging such as X-ray or MRI and surgery are well paid by the health insurance companies, like The mirror reports.

A radiologist in private practice is one of the top earners, with an annual turnover of around €850,000.

But patients also tend to take this route, usually due to a lack of information about alternatives. The problem needs to be solved quickly and the desire for an image that clearly identifies the problem is great. No matter whether MRI or X-ray.

Germany is at the forefront here when it comes to imaging. In 2017, there were 143 MRIs per 1000 inhabitants. In Finland, by comparison, there were only 43 in the same period.

Patients and insurers are then asked to pay for the operation. An intervertebral disc operation costs 3900€, a spinal fusion, for example, 9000€. Plus additional costs.

In comparison, the health insurance company reimburses a medical consultation with about 15€.

It is immediately clear that a problem is being created here. On the one hand, it creates a gold-rush atmosphere, and on the other, conversations between doctors and patients take on a completely different qualitative level. Namely, that of an assembly line operation.

When citizens become patients

The big question is whether people only become patients as a result of this questionable style of treatment. If, in view of the financial earning potential of operations, less drastic measures, such as physiotherapy, are not even a choice.

According to statistics, 85% of back pain have no organic cause. Often no clear defect is detectable.

Preventive researcher Dr. Michael Überall has analyzed the data of 7500 people to whom back surgery was suggested. In less than 5% of these cases, surgery was justified. However, patients and doctors are rarely influenced by such statistics and still choose the risky surgery.

Of course, there are problems in the musculoskeletal system where a quick intervention is necessary. For example, in the case of paralysis symptoms.

Back surgery and its consequences

Unfortunately, it often does not remain with an operation on the spine. Further interventions are often the consequence if the pain remains or the problem shifts.

Surgery after a herniated disc, where material is removed, often results in instability of the vertebral bodies.

Stiffening of vertebral bodies often results in a never-ending disaster. The more often we go under the knife, the lower the chances of success according to statistics. The success rate of a second operation is 30%. The success rate of a third operation is only 15%. 

The (almost) sad truth is, however, that bulging intervertebral discs usually disappear by themselves. Often, the person affected does not even notice this. Neither the protrusion nor the regression. Our body can also often resolve a herniated disc very well on its own. Especially if we help it along with physiotherapy, for example.

The actual status of our spine

What is really the state of health of our spine? Do only people in pain have signs of wear and tear? Or is degeneration of the spine part of the natural course of life, like wrinkles on the face?

Researchers at the Mayo Clinic in the USA have tried to answer this question.

One study compared data from 3110 individuals (not patients).

The team concluded that around 37% of the 20-year-olds already had signs of wear and tear on their intervertebral discs or vertebral bodies. That's surprising at such a young age, one would think. It's probably less surprising that, according to the researchers, 96% of 80-year-olds showed similar degeneration.

What is exciting, however, is that both groups were unaware of this and even lived symptom- and pain-free.

Many of us already have signs of wear in our spine, but of course also in joints such as knees or hips. And we are not aware of it! Wear and tear on the musculoskeletal system is part of aging, you can say that of course. A problem is so considered often only created when you look for it.

The German research duo Julia Truthmann and Richard Kasch came to a similar conclusion. They analyzed the data of 2400 people. Some of them already suffered from back pain, while others did not.

The amazing thing, however, was that according to their analysis, among the group with back pain, 77.8% showed wear and tear, and in the comparison group, also an impressive 74.4%. Participants without pain actually showed almost the same high rate of degeneration. But symptom and pain free!

An example from my past professional career

Around 2010, I had the privilege of caring for an Olympic weightlifting athlete who complained of back pain in the lumbar region after intensive preparation. An X-ray and later an MRI were to provide information about the problem.

The doctor on duty at the time made the findings and unfortunately also had the first conversation with the athlete. She came to the conclusion that the athlete should stop sport in order not to damage her musculoskeletal system in the long term. The individual shape of the lumbar spine and a degeneration brought her to this opinion.

The athlete was disintegrated and mentally damaged for weeks.

A specialist's second opinion was, " Now if I take 100 people off the street and do an X-ray, 80% will have those results too!"

Strengthened with this opinion and 6 weeks of physiotherapy, the athlete solved the problem permanently.

But what actually leads to back problems?

Maybe it's not the spine that's the problem, because it's actually very sophisticated for human construction. It gives us an upright gait and yet a high degree of flexibility and mobility. It is probably the question of how we deal with it!

Statistically, people are particularly prone to back problems when they are exposed to stress, they are plagued by anxiety disorder, they are dissatisfied with their work or they suffer from depression. Who would have associated mental problems with pain in the back?

Are there alternatives to back surgery?

First and foremost, we should take responsibility again and take preventive care of our health. Unfortunately, a certain medical culture has developed among us humans. 

Dr. Michael Überall put it this way, "When I get sick, someone helps me, I'm not responsible for myself!"

That's why people like to be injected once when they're in pain, and if the pain disappears as a result, they do nothing else. Until the pain comes again.

The consequences are that we become more and more inactive, dragging out the problems and even making the situation worse.

Everywhere recommends that we move a lot even when we are in pain. Going for a walk, for example, as far as the individual situation allows.

Everywhere has also developed a program that can be seen as an alternative to surgery.

It combines the knowledge and treatment of doctors, physical therapists, and psychologists in a 3-week therapy to address back problems.

91.5% of the 4400 patients who have already completed the program felt better afterwards.

How to get a healthy and fit spine!

There are several ways to preventively strengthen and protect your spine. All of these interventions also support your overall health and help you live healthier for longer.

  • Reduce stress and lower tension

Stress increases our muscle tone and affects various hormonal processes in our body. Both can lead to back pain.

Try to find a healthy way to deal with stress. Stress is not unhealthy per se; as we know, the amount makes the poison. We need a healthy portion of stress to be motivated and productive. However, stress should not overwhelm us or become chronic. Reflect regularly and evaluate your stress level. Try to find balance with mindfulness exercises, meditation or breathing exercises. Forest bathing or listening to music are also great ways to relax. You can read more about the power of the forest and its effect on your stress system here:

  • Our body needs movement

Evolutionarily speaking, we are used to regular and intense exercise. Our body needs a certain amount of movement to stay healthy. Of course, this is especially true for our spine. Get off the couch and into your running shoes or weight room. Our spine needs stress to stay healthy. Intervertebral discs, for example, are squeezed out by jumping, running and exercising with weight and then recover. In this process, they soak up important nutrients. An important and natural process, which is not possible without movement.

Strength training does double duty. By building muscle mass, we create a protective armor around our spine. This reduces the risk of injury and degeneration of vertebrae and intervertebral discs.

Too much body weight can be stressful for our spine. Also from this point of view, the exchange of body fat for muscle mass is a very effective measure in the fight against back problems.

  • A sedentary lifestyle atrophies the back

Whether in the office, in the car, at the dinner table, and even then when we're taking a well-deserved rest. Our bodies spend too much time in a sedentary position in our daily lives. As a result, our muscles atrophy. In particular, the back thighs, our buttock muscles and the back suffer. The result is often knee and back pain. This "sedentary lifestyle," as they say in America, is of course strongly influenced by the changes in our working world. Industrialization and now digitalization have significantly changed the way we work. Unfortunately at the expense of our musculature and our health. Physical inactivity and the loss of musculature are among the biggest triggers for musculoskeletal pain.

  • Poor sleep hygiene puts a strain on our back

A good mattress and head cushion are important elements in keeping our sleep healthy and can prevent us from waking up in the morning with tension in our back or neck. A mattress should be replaced at least every 10 years, because the material sags and loses its support function.

But sleep itself also deserves more attention. During sleep, our body regenerates and gets ready for the stress of the next day. Every night, our body and brain are serviced and made fit again. Intervertebral discs recover and refuel with nutrients, which is why we are a little taller in the morning than in the evening. Our muscles also relax and repair minor damage caused by strength training, for example.

To pay attention to a healthy sleep of 7-8 hours is very essential from many points of view. And our back will definitely thank us.

  • Smoking blocks the transport of nutrients

Even though smoking cigarettes relaxes many people, giving them a balance at work, for example, this habit has major drawbacks for our back health. 

Smoking has a negative effect on our blood vessels and blood circulation. The oxygen content in the blood decreases due to the consumption of cigarettes and thus reduces the supply of organs. Our back also suffers from these effects and is supplied less with important nutrients.

A conclusion for our back

Our back is an exciting construction of nature and manages to make us one of the few species on earth to walk upright. If we treat it well, it will carry us throughout our lives and not cause us any worries. When the back pinches and hurts, it often leads to secondary problems such as migraines, depression, digestive disorders, inability to work and much more.

"Use it or lose it", a phrase that many athletes know well. Loosely translated it means: "Use your muscles (in this case on your back) or you will lose them".

Maintaining muscle into old age is our greatest opportunity to keep our backs fit and pain-free.

Think about tomorrow today and strengthen the musculoskeletal system today for tomorrow!

Thanks to the magazine "The Mirror", its editorial staff and the authors of the original article, who meticulously researched facts and figures on the subject.

Link to said article:

Have an energetic time and a strong back!

Your optimizer
Richard Staudner


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