“Do I need surgery?” It’s a question many ask when faced with a diagnosis of chronic back pain. When your pain becomes chronic, you may feel like surgery is your only option. But spinal surgery is having a moment right now, and not a happy one. NBA coach Steve Kerr has famously battled back pain for years and underwent two back surgeries as a result. He is now suffering from the serious postoperative complication of a spinal cord fluid leak which gives him severe pain and headaches. Surgery is a quick fix with a long and often incomplete recovery. The research shows us that, broadly speaking, back surgery does not fix persistent back pain [1].
Yet hundreds of thousands of people go under the knife every year seeking to alleviate their back pain. We spend over $1.65 billion a year on spinal surgeries [2]. But there is not safety in numbers. Success rates for spinal surgery vary widely depending on the surgery type and how you define success. You would likely define success as living without chronic pain. A recent study of subjects who underwent disc arthroplasty found that 64% still took opioid pain medication post-op [1]. Doesn’t sound like a life without chronic pain to me. Another study reported that patient satisfaction post-op was as low as 15% [3].
We spend over $1.65 billion a year on spinal surgeries Share on X
Are you comfortable with those odds? I wouldn’t be. If you are living with chronic back pain, take assurance in the knowledge that surgery is not your only option. You likely have more power over your pain than a surgeon’s knife. I’ll explain why.
The Damage Dilemma
Spinal surgery is a contradictory method of treatment for most cases of chronic low back pain. Surgery is extremely disruptive to our tissue. Procedures such as spine fusion and interspinous spacers require the introduction of metal screws and implants directly into the bones of the spine. Laminectomies consist of the removal of entire pieces of bone, exposing the sensitive spinal cord. All procedures require that surgeons cut through the muscles of the back to even reach the bones of the spine.
These procedures all assume that the source of chronic back pain exists in the structures of the spine we can visualize on imaging. But we know that many pain-free adults are walking around with bulging discs, spinal degeneration, and shrinking joint spaces. Imaging abnormalities don’t correlate well with pain. You can learn more about the potentially harmful effects of imaging on chronic low back pain here. Chronic pain does not occur as a result of structural changes, but rather a highly sensitized nervous system and a body in a constant state of persistent inflammation from various lifestyle factors.
Why should we invade an already inflamed area in an attempt to stop the pain? Consider the case of a child with a skinned knee. We tell the child not to pick at the scab, but rather to leave it alone and let the scab heal. Even minimally invasive procedures that claim to remove “painful” portions of the spine create new areas of damage and new sources of pain. If you had a headache, you wouldn’t want to have your brain removed! Surgery is a traumatic experience for the body. You must decide if surgery is worth the damage it introduces to the body and the potential complications that can occur.
Common Complications of Spinal Surgery
All surgeries have an inherent amount of risk, no matter where they occur in the body. These include stroke, cardiac arrest, hematoma, pulmonary embolism, infection at the incision site, and pneumonia just to name a few [4, 5]. While complications can occur for any patient, the risk increases with age and with the presence of other medical issues [5]. Risk factors such as heart disease, diabetes, obesity, depression or anxiety all complicate the outcome of spinal surgery.
There are additional, more specific, complications for each surgical procedure in the spine. Procedures that fix two or more bones of the spine together, as in a spinal fusion, create increased instability in the spine directly above and below the surgical site [6, 7]. This is a particularly ironic side effect of a surgery that is advertised to increase spinal stability. Additionally, screw insertion into the bones of the spine can permanently damage the nerves that travel along the spine, leading to a weakening of the muscles which provide stability to the back [8]. Lumbar laminectomies commonly performed in those with degenerative spinal disease carry the risk of muscle weakness, sensory loss, and cerebrospinal fluid loss (the same as Coach Steve Kerr) [9].
We also can’t forget the only guaranteed complication of spinal surgery- the bill. Hospital stays for lumbar decompressions begin at the low price of ~$23,000 and end at ~$80,000 when a more complex spinal fusion is also performed [4]. The total cost of spinal surgery rises when reoperative rates are considered. Upwards of 14% of patients who undergo lumbar laminectomies must go back under the knife within the next 3 years [9].
5 Ways to Heal Without Surgery
Surgery is expensive, carries significant medical risks, and often doesn’t treat the source of chronic back pain. You can begin decreasing your pain today by following these steps to heal the true sources of your chronic pain.
1. Revisit your diet
The elevated levels of inflammation that occur in chronic pain conditions can be reduced with an anti-inflammatory diet. A pain-free diet includes food which helps reduce inflammation while avoiding food that can increase inflammation. Eating 6 to 9 servings of whole fruits and vegetables a day provides sufficient vitamins, minerals, and antioxidants to gradually reduce destructive systemic inflammation and quiet pain-transmitting neurons [10]. Part ways with the artificial sweeteners. These hide under various names- aspartame, sucralose, saccharin, cyclamate, neotame, and alitame. Found in many beverages and food products, these chemicals increase the amount of inflammatory mediators in our body after consumption [11]. If you have a bad sweet tooth, give organic stevia a try instead. It a natural and safe sweetener option. Finally, consider whether a gluten insensitivity is over-activating your immune system and leading to an over-abundance of inflammation that is attacking your joints. Even those that don’t have Celiac disease may find that their body feels better without gluten. This is referred to as non-celiac gluten sensitivity [12]. Trial a gluten-free diet now!
2. Decrease stress and negativity
Believe it or not, but our emotional state affects the physical state of our body. Have you ever how tense your body feels after a long day at work or before a big presentation? Negative emotions such as fear, anger, or distress amplify our body’s ‘flight or fight’ system, increasing muscle contraction and enhancing pain sensation. When this system is on for long periods of time, our muscles fatigue and ache with a pain that is amplified by our heightened sensory awareness [13]. Even typically non-painful touch and movement can feel painful to a nerve living on high alert.
Negative emotions such as fear, anger, or distress amplify our body’s ‘flight or fight’ system! Share on X
Learn to recognize when your emotional state is impacting your body. Practice stress management techniques such as meditation, relaxation, yoga, or simply listening to calming music. These techniques calm the ‘fight or flight’ system, reduce inflammation and decrease pain [13].
3. Move, then move some more!
Arguably the most important step in reducing chronic back pain is exercise. Moving may seem scary if you have lived with an achy back for years. Perhaps someone told you that you have a ‘bad back’. Remember that chronic back pain is correlated with an angry nervous system, not an injury to the spine. Your spine is strong and meant to withstand great forces. Movement is necessary to lubricate the joints of the back and keep them healthy. Research has consistently shown that movement helps to calm a sensitized nervous system [14]. Begin with small, manageable goals like walking 10 minutes every day and progress to more challenging goals as you grow more confident in your body. Find an activity that you enjoy and implement it into your life. Perhaps that’s yoga, dancing, hiking, swimming, or all of the above. Lifestyle changes are a more a permanent method of reducing pain than surgery.
Signs You May Need Surgery
Surgery is not indicated for most people with chronic back pain, but you may be an exception if you have any of the following symptoms:
** Any Red Flag such as:
- Fever and unexplained weight loss.
- Bladder or bowel dysfunction.
- History of cancer.
- Presence of severe medical illness.
- Progressive neurological deficit.
- Disturbed gait, saddle anesthesia.
These indicate potentially serious neurological changes that require an immediate visit to the doctor.
If you do not have any neurological signs, you likely do not need spinal surgery to begin living without back pain. As Steve Kerr has wisely said, “Stay away from back surgery.”
