Surgery: To Be or Not To Be?Apr 11, 2020
Written by Dr. Ryan Peebles, DPT
If you have non-specific back pain and surgery is something you are considering, there is something very crucial you should know. Ready? Here goes… Whether you get surgery or not, you will still have to undergo a lengthy rehabilitation program. That’s because back surgery doesn’t get to the root of the problem. It addresses the symptoms, or results of the problem. Either way, you must put in the hard work of addressing the underlying factors that caused problem in the first place. Otherwise the downward spiral continues. So why not commit to a solid rehab program before surrendering to the knife.
When making a decision, it’s really about how much the pain is a limiting factor. If it’s manageable, I would try an honest attempt at getting your core back into balance which can actually encourage healing of the disc. If it’s intractable back pain then surgical intervention might be necessary to allow for rehab (note: if you can lie on your back or stomach, then you can complete the first 2 phases of Core Balance Training). My suggestion is always to choose the most conservative option, which is therapeutic exercise. If surgery is absolutely necessary, then choose the most conservative surgical option.
Microdiscectomy surgery is a minimally invasive option that can reduce neurological symptoms such as burning, shooting and other nerve type pains. If it’s just back pain you’re having and no nerve symptoms, there’s no benefit. If you are having nerve pain, and it’s preventing you from participating in rehab, then this surgery should be used as a tool to allow for better participation in a solid rehab program.
Again, this surgery is not a long term solution alone. Lots of people get a microdiscectomy and feel better thinking the problem is solved. However, because the true cause of the problem was not addressed (core muscle imbalances), the dysfunction continues and the pain eventually comes back. Then, they get the surgery again and the spiral continues often leading to spinal fusion. I never recommend spinal fusion surgery unless there is profound structural damage due to trauma. For non-specific back pain, studies show fusion is less effective than therapeutic exercise. Again, a solid core balancing program is incredibly important no matter which option you choose.