Years ago a neurosurgeon friend of mine said jokingly, “surgery is the only answer.” But over the years I’ve come to realize that surgery for back and neck pain is in fact hardly ever the answer.
Most of the time lower back pain can be treated through noninvasive, nonsurgical methods.
For example, physical therapy, if it’s done correctly, can correct the abnormal movement patterns that put extra stress on our low back and neck. Newer physical therapy techniques, with “dry needle” techniques with or without electrical stimulation, can reset muscles in spasm that are too deep to reach with manual therapy.
Additionally, adjusting your sleep position can often also help ease your back pain. During sleep your tissues and skeleton restore themselves, if you give them a chance. Give your back a break at night by sleeping “supine”, or on your back, with a pillow under your knees. Sometimes, a thin pillow is necessary to support your head, so you don’t hyperextend your neck. Sleeping in this way removes strain from your neck and lower back, and keeps your entire spine in proper, natural alignment. Just a simple switch to the correct sleeping position can relieve low back and neck pain. If you can’t sleep that way because you snore or stop breathing on your back, then you may have sleep apnea and need to be seen by a sleep specialist.
Unfortunately, what I see too many times is patients who want someone to give them a “final cure” for their back or neck pain, and a surgeon sometimes offers them that “magical cure.” Physical Therapy is given a lick and a promise, epidural steroid injections into their back are given (we know they don’t do any good for the long run), and ultimately they’re whisked away to surgery, never to be the same again.
So, why can “surgery first” be a bad idea?
First off, it is very expensive and puts you out of commission for a long time. But worse, we have found that one surgery often leads to more surgeries. If back and leg pain is caused by a disk herniation, and the surgeon has to enter the disk itself, then the chance of recurrence of that herniation can be as high as 30%. During surgery, the surgeon’s knife pierces the outer capsule and removes part of it, exposing the softer inner material to the space where the nerve runs. With the capsule weakened, the same incorrect movement patterns which caused the original bulge or herniation, if they continue, are almost certain to cause a re-herniation. The nerve will get pinched again, likely requiring another surgery and more invasive procedures, and on and on. Even though this doesn’t happen to everyone, it happens enough to make you think – is surgery really the best way to cure your neck or back pain?
Don’t get me wrong. A really good surgeon is essential if you need one. But most people don’t really need them for neck or back pain. Every back pain and neck pain patient is unique, with different degrees of problems associated with bone or disc abnormalities. But back and neck pain can be associated with many other abnormalities, such as sleep disorders (like sleep apnea) and repetitive motions carried out incorrectly at work, and even plain old bad posture, which leads to weakened muscles supporting the back and neck.
The multiple factors that are associated with back pain, however, means there are multiple opportunities that can be corrected to help someone with their back or neck pain. Though surgery can be a valuable treatment tool under the right circumstances that make it necessary, according to a white paper from Johns Hopkins on lower back pain and osteoporosis less than 5% of people are actual candidates for it. Which means, for 95% of back pain patients, opting for surgery is probably going to be a bad, ineffective, and very expensive idea.
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But, what if surgery is necessary? The pain, expense, slow recovery, and increased risk of re-injury that comes with spinal surgery could be worth it if it were actually going to solve the problem. So, how do you know if it will? The key is to get an opinion from a non-surgical specialist outside the hospital system where your surgery may be carried out BEFORE having surgery. Surgeons are usually very good at what they do, but what they do is surgery. That’s what they’re trained to do. So if the first specialist you consult is a surgeon, they will likely recommend a surgical procedure, because that’s what they’re trained to do. Instead, you need a truly independent neurologist to evaluate your case and get you a precise diagnosis.
Once you have a precise diagnosis, your specialist can recommend the best treatment. If you need surgery, after a proper diagnosis is made, at least you will have the peace of mind that you tried every best alternative, and surgery is actually your best option. Your neurologist can recommend a good surgeon or if you know someone who works in a hospital or outpatient surgical center, they can often tell you who the good surgeons are.
Have a surgeon you’re considering? Try using the Surgeon Scorecard by ProPublica. They have over 16,000 surgeons in their database. ProPublica calculated death and complication rates for surgeons performing one of eight elective procedures in Medicare, carefully adjusting for differences in patient health, age and hospital quality. Use this database to know more about a surgeon before your operation.
Experiencing chronic back pain? Getting evaluated by a specialist is a smart idea. But, there are things to consider before you do. Read my article on the 5 facts you should know BEFORE you see someone.
