X-rays & MRIs
“A thorough assessment reveals the cause of pain better than any image.”(Page 6, Low Back Disorders by Stuart Mcgill)
Did you know you can have a disc bulge with zero pain? [Source 1] It’s estimated about ⅓ of 20 year olds have a disc bulge without any pain, and that number climbs as we age. [Source 2]
X-rays and MRIs help us identify specific structures that might be creating pain, but these images alone are insufficient to diagnose the cause of chronic pain. When a radiologist sees a disc bulge on a scan, there’s no way to know if it’s a recent injury or an old scar that has healed and no longer causes pain. Scans cannot show muscle imbalances or flawed movement patterns. Pictures are not linked to pain!
Surgery Statistics
Back surgery is a pain treatment with diminishing returns. It’s estimated 30% of people make progress after a second surgery, but only 15% make progress after a third surgery [Source].
“The notion that surgery will eliminate back pain does not have statistical support. People have to manage their postsurgical backs just as much as they would their nonsurgical backs.” (Low Back Disorders, Stuart McGill, pp. 14)
If your back pain comes and goes, or if you have good and bad days, you are not a surgery candidate. You simply need to remove the cause of pain and establish pain-free habits. Surgery will not change your habits. The cause of chronic back pain is commonly not a “thing” that needs to be cut out, but a failure of function or ability. If a symptom is surgically "cured" but the cause is never addressed, the symptom will reappear.
“In many cases, had the patient subjected themselves to the rest associated with the surgery - and skipped the surgery - the results would have been just as good.” (Back Mechanic, Stuart McGill, pp. 42)
When to Have Surgery
Surgery is justifiable if you’ve had a recent trauma that needs repair or your neurological issues are substantial, such as loss of bowel and bladder control.
Before accepting your doctor’s surgery recommendation, consider the information they used to form their diagnosis. Was it based on images alone? There is no surgery without risks. Clarify what the success rate of the operation is. “Success” can mean the patient didn’t die or it can mean they had long term improvement in pain.
Get at least 3 different opinions before making any permanent surgical changes to your body. Ask the nurses and physical therapists at the hospital which surgeon has the best results. Ask the surgeon to set up a conversation with her former patients so you can be assured of their satisfaction.
If the first surgery did not work, the most common reason is that the patient did not need the surgery in the first place! The chance of a second surgery working is much lower. Always exhaust the conservative options first because surgery is irreversible.
Surgery Conclusion
It's common to pursue surgery once you feel like you've exhausted all other options, but know that surgery makes everything MORE complicated, not less.
Your body is designed to function well, but if you cut out essential parts of your body, the potential complications increases dramatically. Getting surgery often requires cutting muscle, which increases the time for recovery.
I've personally heard many surgery horror cases from back pained people, and the potential risks outweigh the benefits in most cases.
Seek out advice from a qualified clinician, get multiple opinions, and do all you can to avoid unnecessary surgery.
Hope this helps!
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