CF 370: Unnecessary Surgery & Gabapentin Linked To Dementia Today we’re going to talk about Unnecessary Surgery & Gabapentin Linked To Dementia But first, here’s that sweet sweet bumper music  

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #370 Now if you missed last week’s episode, we talked about Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

What a crazy as hell Summer, folks. Europe, two trips to Dallas, and one to Boston the weekend before last…..then Dallas at the end of August and then Key largo at the very tail end of August.  I love travel. Please don’t get me wrong. But it plays hell on your clinic when you’re the only chiro in it. Most of you know exactly what I’m saying.

So, I’m looking forward to the kids getting back to school and everyone getting back on a schedule. The kids can’t be traveling which means my travel is dramatically reduced. Which means my patient numbers go back up! Traditionally, our slow times of the year are back to school and dead in the middle of the holidays. So, that used to start first week in August and now the kids are goign to school starting August 13th believe it or not. So now the slow down starts at the end of July. Like right now.  We’re not going to fuss though.

My travel schedule has brought on some of it so don’t sit around and piss and moan about things you brought on yourself.  Looking forward, we have a Parker intern coming in to work with us very soon and we’re always looking forward to that. She’ll be in at the end of the month or the very beginning of September. I’m not exactly sure just yet. Up here in Amarillo, about 5.5 hours NW of Dallas, we only see interns about once per year. Sometimes less. We always enjoy it though and we’re looking forward to this one too.

She seems to be a go getter and it’s always fun to watch a go getter grow.  Who knows….maybe she’ll wanna stick around with us after she graduates. Then I can quit telling all of you how we need an associate!!. I cna’t believe y’all haven’t taken me up on that yet. We have a staff change comign up in the clinic and this girl means a lot to me. I hate to see her go but with every departure comes an opportunity to have a new special person come on board and bring them in to the family and get ‘em up and running.  In the last month or so, I made one of our rock stars the manager and she is a rock start folks. This girl runs the front desk and just never seems to drop the ball about anyhting. I’ve had 20 or so front desk staff over the years. Give or take.

And this girl is heads and tails above them all. Kudos to my wife for hiring such a stud.  So I made her the manager and this is her first hire. We shall see how good she is at hiring. If she’s as good at hiring as she is at everything else, then she’ll have knocked it out of the park and settled in on the perfect staffer. I’m looking forward to it and…..I didn’t have to do all of the hiring so that’s a big plus!

Item #1

Our first one today is an oldie but a goodie. It’s called, ““Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience” by Epstein et al and no, it’s not THAT Epstein. It’s Nancy Epstein and it was published in Surgical Neurology in 2011.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg Neurol Int. 2011;2:83. doi: 10.4103/2152-7806.82249. Epub 2011 Jun 21. PMID: 21776403; PMCID: PMC3130462.

Why They Did It There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.

How They Did It During a one-year period, the senior author, who is a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations.  A patient was assigned to the “unnecessary surgery” group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans]. Here’s a tip from your Ol’ Uncle Jeffro that’s in line with this, pain is not a reason to have surgery. Now I feel pretty good today so that’s easy for me to say, right? But in general, pain is not a reason for surgery. The reason for surgery should be progressive neurological deficits. Cauda equina, DTRs, motor strength, dermatomes and sensory….you get the point.  OK, let’s proceed…

What They Found Of the 274 consults, 45 patients were told they needed surgery by outside surgeons, although their neurological and radiographic findings were not abnormal.  An additional 2 patients were told they needed lumbar operations, when in fact the findings indicated a cervical operation was necessary.  In 29 patients there were one or more overlapping comorbidities.

Wrap It Up During a one-year period, 47 [17.2%] of 274 spinal consultations seen by a single neurosurgeon were scheduled for “unnecessary surgery”. The author went on to offer this in the summary of the body of the paper, “This is an underestimate of the percentage of unnecessary surgeries as the 274 patients include those coming for first opinions. If we only considered the patients coming for second opinions, then the percentage of unnecessary operations would have been considerably larger.” I have seen estimates suggesting that only 5% of spinal surgeries actually taking place day-to-day are actually necessary.

I will try to track down the source for the stat and share in a future episode for you.  To be fully honest, this is one of the things that keeps me up at night. All of the people getting unnecessary spinal surgeries because a surgeon is just way behind on their research, too arrogant to think they could be wrong, or worst….doing surgeries based purely on financial gain. 

Item #2 Our second one today is called “Risk of dementia following gabapentin prescription in chronic low back pain patients” by Eghrari et al and publisehd in Regional Anesthesia & Ain Medicine in July 2025 and that’s hotter than a Texas tin roof in August. If you know, you know…that’s pretty hot. 

Eghrari NB, Yazji IH, Yavari B, Van Acker GM, Kim CH. Risk of dementia following gabapentin prescription in chronic low back pain patients. Reg Anesth Pain Med. 2025 Jul 10:rapm-2025-106577. doi: 10.1136/rapm-2025-106577. Epub ahead of print. PMID: 40639955.

Why They Did It Gabapentin is widely used to treat chronic pain, but its association with cognitive decline and dementia remains unclear. This study examined whether gabapentin prescription is associated with dementia in adults with chronic low back pain.

How They Did It We conducted a retrospective cohort study using the TriNetX national database of de-identified patient records from 2004 to 2024.  Adults diagnosed with chronic low back pain were included; those with prior gabapentin use, dementia, epilepsy, stroke, or cancer were excluded.  Propensity score matching controlled for demographics, comorbidities, and pain medications.  Patients were stratified by age and gabapentin prescription frequency.  Primary outcomes were dementia and mild cognitive impairment.

What They Found 26,416 adults we analyzed following propensity-score matching.  Patients with six or more gabapentin prescriptions had an increased incidence of dementia and mild cognitive impairment   When stratified by age, non-elderly adults prescribed gabapentin had over twice the risk of dementia and mild cognitive impairment compared to those not prescribed gabapentin.  Risk increased further with prescription frequency: patients with 12 or more prescriptions had a higher incidence of dementia and mild cognitive impairment than those prescribed gabapentin 3-11 times.

Wrap It Up Gabapentin prescription in adults with chronic low back pain is associated with increased risk of dementia and cognitive impairment, particularly in non-elderly adults.  Physicians should monitor cognitive outcomes in patients prescribed gabapentin. Alright, that’s it.

Keep on keepin’ on.

Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Diplomate of the International Academy of Neuromusculoskeletal Medicine (DIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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