A Spine Surgeon Says Not to Rush to Surgery
If you suffer from low back pain, you know how debilitating it can be. When your back hurts, your life hurts. You’ll do anything to stop the pain, and often surgery is billed as the go-to solution. It’s no mystery why surgeons as a group want to cut (when you have a hammer, everything looks like a nail!), and it’s hard for patients to resist the lure of a “quick fix.” Plus, everywhere you look these days, you see ads touting the life-changing benefits of “one-inch incisions” and “minimally invasive” laser surgeries.
That’s why it tends to surprise people when a spine surgeon (of all people) cautions against spine surgery.
Surgery is risky, it has a long recovery period, and often it just doesn’t work for chronic low back pain. It might even make the problem worse. My advice: exhaust every possible option first.
The good news is there are better options. The system is slowly shifting toward prevention and natural healing methods for spine conditions, and for good reason. Not only are these options a fraction of the cost of surgery, for many patients these methods simply work better.
I advocate for a holistic treatment centered on medically supervised exercise that takes into account the patient’s perceptions, habits, psychology, physical condition, lifestyle, and goals. When a patient fully commits to this more natural treatment regimen, surgery can usually be avoided.
If you’re thinking of pursuing back surgery, here are some reasons to reconsider.
“Minimally invasive” laser surgery is a marketing gimmick. You’ve probably seen ads for spinal laser surgery clinics encouraging you to mail in your MRI results for a “free consultation.” Don’t be fooled. First, an MRI alone cannot determine whether you need surgery. Second, lasers are minimally useful in back surgeries—mechanical grabbers and electrocautery are far more effective—and are primarily used because the notion of laser surgery appeals to consumers. Third, such procedures are still very invasive.
Despite the smaller incision, these laser-performed surgeries often remove bones and ligaments vital to the structural integrity of the spine, still cause scarring around the nerves, and often do not alleviate pain in the long run. And I have seen many patients who have undergone so-called ‘laser surgeries’ where it was clear that standard surgical tools like high-speed burrs were used and whose surgery had the same risks as traditional spine surgeries.
There is no widely agreed-upon surgical treatment for lower back pain. Based on a recent study in Spine, surgeons significantly disagree on methods for treating low back pain. In fact, there was 75 percent disagreement in how to treat back pain sufferers.
It is very telling that surgeons can’t agree on how to best approach a solution for back pain. This lack of consensus should warn patients to proceed with caution and to avoid surgery until they have exhausted all less-invasive treatment options.
Bad MRI findings are NOT a valid reason to have surgery. Simply having a disc abnormality or even a disc herniation on an MRI is not a good enough reason to undergo a spinal procedure. Unfortunately, when patients can see a dark spot, they jump to the conclusion that they need surgery to “fix it.”
It is very common for adults to have abnormal MRI readings—even those who don’t have low back pain or sciatica. It does not usually justify a surgery that will require weeks of recuperation and time out of work and could be ineffective at curing the pain in the first place.
Very often, surgery won’t cure back pain anyway. Spine surgery is best for relieving nerve compression, but it does not alleviate all back pain. Without an evident reason for pain, like instability, nerve compression, or a fracture, surgery has an inconsistent record of success and shouldn’t be rushed.
Most back pain will resolve itself when you take a “wait-and-see” approach. Your body has an impressive capacity to heal itself. Over my 20 years of surgical practice, I have been amazed at how many conditions, which I was taught were surgical, were in fact improved and in many cases resolved by maximizing the body’s own recuperative capacity. Many people have been conditioned to believe that surgery is the only answer for low back pain, and often, people don’t give themselves sufficient time and resources to allow natural healing to occur before going under the knife.
Give yourself plenty of time to heal and reassess your level of function after some time has passed. You can always opt for surgery later, but if you rush to cut, you can’t un-cut it later.
Conservative self-help programs combined with lifestyle changes often work better than surgery. My own integrated medical fitness program, SpineZone, located in San Diego, California has helped close to 7,000 patients recover from spinal injury or back pain without surgery. Not only do patients perform medically supervised exercises to strengthen the spine, they’re also schooled in lifestyle changes aimed at holistically reducing pain and improving their overall health—all under the care of a team of surgeons and specialists.
We’ve had countless patients tell us that our approach either eliminated their pain or lessened it dramatically. Most find that they not only were able to avoid surgery, they decreased or eliminated the need for injections and addictive opioids.
The bottom line? Surgery should always be a last resort for back pain.
A ‘wait-and-see’ approach, combined with taking proactive steps to becoming healthier, works far better than surgery. It gives your body the chance to accomplish what it already knows how to do: recover on its own. By taking control of your health instead of seeking out a ‘quick fix,’ you have a better chance of healing your pain and changing your life for the better.
Kamshad Raiszadeh, MD, is the author of Take Back Control: A Surgeon’s Guide to Healing Your Spine Without Medications or Surgery. He has an unusual perspective for a spine surgeon. Early in his career, he realized that for most chronic back and neck pain patients, surgery is not the best solution. He and his team set about designing, developing, and perfecting a program to prevent unnecessary procedures and medications. Infused with an emphasis on strengthening, education, and self-empowerment, SpineZone has helped close to 7,000 patients enjoy full and lasting recoveries. For more information, visit www.takebackcontrol.com,