Three Reasons Back Surgery May Not Be The Answer

When back pain interferes with your daily life, it’s reasonable to think surgery may be the answer. For severe knee arthritis, a knee replacement gives people their mobility back. The results of knee replacements are consistently positive with a low rate of complications. Surgery for back pain or back arthritis is an entirely different situation.


1. Back Surgery is Unpredictable

The results of back surgery are unpredictable and it often doesn’t work. A significant portion of people have worse pain and disability after back surgery. As a disability doctor, these people filled my clinic. For many, the pain was worse after surgery. For others, unexpected nerve damage and paralysis occurred, leaving them with bladder problems or difficulty walking in addition to unchanged back pain.

My greatest precaution is for those with non-specific low back pain or pain from widespread back arthritis (degenerative disk disease). Non-specific low back pain is when there’s no clear structural reason for the pain. Back pain arises from many pain generators: the disks, bones, muscles, nerves, and even the brain (see nociplastic pain below) can produce pain. A surgeon can only fix a known target.

In the absence of compressed nerves causing leg weakness or bladder problems, back surgery may not be in your best interest. Even in properly selected patients for back surgery, almost 40% of people reported chronic pain and moderate disability in daily activities 5 years after surgery.I recall one patient, a police officer, who met all the indicators for benefitting from spine surgery. He had unrelenting nerve pain down his leg from a pinched nerve. His MRI showed a structural problem that a surgeon could target. His exam was clean; he had symptoms in the nerve distribution showing compression on his MRI. I referred him to a neurosurgeon feeling confident he would have a great outcome. After the operation, his leg pain was no better. Worse, during the operation, he wasn’t positioned properly and the nerve in his hand was permanently damaged. He lost the strength and dexterity in his right hand. He could no longer work as a police officer. He continued to have leg pain and lost his career. Back surgery is unpredictable.


2. A Significant Percentage of People Are Worse After Surgery

A 20-year-old was having low back pain. No injury or trauma preceded the pain. His doctor sent him to a local surgeon. After the operation, his back pain was worse. He was sent to another surgeon and had a second surgery. Worse again. Finally, he sought an opinion at a well-regarded academic medical center where surgery number three was performed. It didn’t help. They told him the pain was likely “in his head.”

This young man spent the next few years on his couch. His mental health deteriorated. He struggled to pass his classes in college. In despair, he talked with a friend who also struggled with chronic pain and had learned how to live a great life despite his pain.

His friend’s words changed his mindset. He got off his couch and started moving every day. He resumed his hobbies of swimming and snowboarding. He’s now on the dean’s list for college and is near graduation. He still reports some back pain but not nearly as much. No more back surgeries for him.


3. The Back Pain is From Nociplastic Pain

Nociplastic pain arises from abnormalities in how pain signals are processed and perceived in the brain, spinal cord, and nerves. This pain type arises from sensitization of the nerves, which makes them more sensitive and reactive to stimuli.

Chronic low back pain often involves nociplastic pain. Surgery doesn’t help this pain type because the abnormality is in the brain. The treatment approach is also different. You can learn more about nociplastic pain in my book, Sunbreak: Healing the Pain No One Can Explain.

In summary, back surgery is unpredictable. Performed on the wrong person, surgery can leave you in more pain and more disability. Remember, surgeons have varying thresholds of when to operate. Proceed with caution and understand the risks.