Considering Back Surgery for Chronic Pain? Discover the Risks and Benefits

Are you considering back surgery to relieve your chronic pain? It's essential to weigh up your options carefully. Pain can be debilitating, and it is understandable to want to find a solution. While surgery can help some people, it’s important to explore all options, as not everyone may find lasting pain relief. In this article, we’ll explore the risks, benefits, and types of surgeries, so you can feel ready to make an informed approach that is right for you.

Disclaimer: MoreGoodDays® does not endorse any specific back pain treatments, procedures, products or physicians referenced in this article. This information is provided for educational purposes only and is not intended to form medical advice. Anyone seeking treatment for back pain should consult their own trusted healthcare team. Our back pain program is evidence-based and relies on a multidisciplinary approach. We also wish to acknowledge that pain and the success rates of back surgery are not intended to further fuel the stigma and discrimination and invalidation that can be a part of our medical system.

Types of back surgery

There are several types that may be recommended based on your specific condition:

• Spinal fusion: This involves permanently connecting two or more vertebrae to eliminate motion between them and it’s often used for conditions like scoliosis.
• Laminectomy: This procedure removes part of the vertebrae and is typically used for spinal stenosis.
• Foraminotomy: This involves enlarging the space where nerves exit the spine and is often used when spinal discs or bones are compressing nerves.
• Discectomy: A portion of a herniated disc is removed.
• Disk replacement: In this surgery, a worn or damaged disc is replaced with an artificial one.
• Injections or implants: For some patients, pain-relieving implants or injections can offer relief without more invasive surgery​​ however a recent Cochrane review of evidence for the use of spinal cord stimulators has showed that they have no sustained clinical benefits that would outweigh the costs and risks of this surgical intervention¹.

The amount of spinal surgery is increasing internationally and in Australia, more notably in the private health sector². As some researchers have suggested, it is important to carefully consider the risk of bias in research and the role of industry and device manufacturers³.

Reasons for back surgery

There may be many reasons that spinal surgery could be suggested to you as an option to consider. These mainly fall into two categories:

Structural issues: Surgery can be necessary to address medical emergencies like spinal fractures, infections, or tumors. In these cases, surgery aims to prevent further deterioration. You might be offered surgery if you have structural issues that are causing significant nerve damage or loss of function. Other reasons include correcting spinal deformities, like severe scoliosis.

Perhaps you have a diagnosis of a disc herniations and bulges and this is the reason surgery is suggested. It is worth mentioning here that these conditions can exist within asymptomatic people and may be poorly related to experience of pain. Studies have shown that imaging evidence of degenerative spine disease is common in people who have no pain and increases with age⁴. So while such changes show up on scans, they are actually just natural changes that happen over time. You can think of them a little bit like the wrinkles we get on our faces. Pain is complex and can involve many factors that do not show up on scans such as your stress levels, your immune function, and how you think and behave in response to pain.

Pain relief: Another common reason surgery might be suggested is if you are experiencing persistent and worsening back pain. This can be complicated and very individual, however, the role of spinal surgery in the management of non‐specific low back pain remains without an evidence base⁵.

Chronic pain is complex and there will be many instances where you might have been offered surgery as a mix of both of these reasons - to address a diagnosed issue and to bring pain relief. Your experiences are valid and no one approach works for everyone.

It seems like we might need to dive a bit deeper…

Can back surgery relieve chronic back pain?

The million dollar questions of course you are all wanting to know…unfortunately the answer is unlikely to impress you because ….it depends!

Surgery is most successful when addressing significant structural damage – such as compromising nerves, neurological problems such as muscle paralysis and loss of bladder or bowel control.

It’s alarming that there isn’t a lot of data to show that surgeries actually help people who live with persistent pain. So, when it comes to surgery “fixing” back pain…things get complicated.

Let’s look at the numbers:

About 41% of people who have a spinal fusion surgery need to undergo further surgeries within 3 years, because of continued or increased pain, or other complications with the initial surgery⁶. And 80-90% still need to take strong medications for pain. This is compared to about a 0.3% rate of future surgeries for people who have a knee or hip replacement. In the UK, spinal fusions are generally not advised for low back pain. One study showed that only one in five workers who have spinal fusion return to work after two years and one in five have another spine surgery within two years⁷.

While we acknowledge that this kind of research is highly controversial, there is also evidence that spinal surgery may have a placebo effect - for example, in 50% cases people who have sham surgery improved as much as those who had real surgery⁸!

The International Association for the Study of Pain recognizes Chronic Pain After Spinal Surgery (CPSS), where pain persists post-surgery due to factors like fibrosis, scarring, inflammation, or psychological factors⁹. This affects 10-40% of people after lumbar surgery¹⁰ and can also be referred to as Failed Back Surgery Syndrome (FBSS), however this term can unfairly imply blame on the patient, despite the many contributing factors beyond structural issues​. If you’ve undergone surgery and still live with pain, we know this can be frustrating and isolating and, please know, it’s not your fault; pain is influenced by many factors beyond surgical outcomes.

For many people, chronic back pain has a multifaceted cause, including physical, emotional, and psychological factors. This complexity means that surgery may not always resolve the pain, as a surgical intervention may not always address the underlying causes of chronic pain, especially when factors like central pain processing are involved.

Back surgery risks

While surgery may offer relief for some, it comes with risks that need to be carefully weighed:

• Infection: Any surgery carries a risk of infection, particularly with major procedures like spinal surgery.
• Reaction to anesthesia: Some patients may have adverse reactions to anesthesia however the risk of this is very low¹¹.
• Long recovery times: Depending on the procedure, recovery may take months and may require extensive rehabilitation.
• Blood clots: Surgery can increase the risk of developing blood clots, particularly in the legs.
• Restrictions and function: After certain back surgeries there may be limits to your mobility and flexibility in the short term.
• Unmet expectations: many people undergoing spine surgery have high expectations for pain relief and improved function. This can influence poorer post-surgical outcome due to increased psychological distress and fear of movement that can occur as a result of unmet expectations¹². In some cases, surgery doesn’t relieve pain, and this can lead to further complications and the need for additional surgeries​

If you are weighing up back surgery another consideration is cost. Depending on your circumstances, there can be some out of pocket expenses or the procedure may be covered by workcover, income protection or private health insurance. It is estimated that average costs are in the order of $46,000 for a spinal fusion and $20,000 for a decompression¹³. According to a report from Private Healthcare Australia, on high growth items in the Prostheses List (2020-2021), items used in spinal surgery continue to show increases¹⁴.

Benefits of back surgery

For patients with clear structural problems, back surgery can offer several benefits:

• Preventing further deterioration: For conditions like spinal stenosis or scoliosis, surgery can stop or slow the progression of deformities.
• Reducing nerve damage: Surgery can relieve pressure on nerves, which can prevent permanent damage and improve mobility.
• Improvement in function and mood: For some, surgery may result in reduced pain, leading to improved mood and daily function. This can reduce dependence on pain medications and improve overall quality of life​.

The broader evidence base for spinal surgery in the management of non-specific low back pain is poor and suggests it is ineffective¹⁵.

What to consider before back surgery

Before deciding on surgery, it’s crucial to research your options, seek a second opinion, and ask your surgeon critical questions about success rates, risks, and potential complications.

If you consider surgery, always ask lots of questions about the success rate and possible complications. For example:

“What evidence exists to say that having this procedure will be better for me than not having it done?”

If your doctor can’t answer you to your satisfaction, or you feel at all unsure, seek a second opinion from a different healthcare professional. Studies have shown that agreement between diagnosis and need for surgery can be highly variable. For example, it was estimated that diagnostic agreement between first and second opinions varied from 53 to 96% and agreement for need for surgery between first and second opinions ranged from 0 to 83%¹⁶. It is important also to feel confident to advocate for yourself in the healthcare setting so you can gather all the relevant information you need.

This is a big decision, so take the time to weigh up your risks and benefits, knowing that these will be unique to you and your circumstances. Some of these may apply to you, some may not. It is okay to feel unsure and the decision might need to be mulled over for a while, researched, discussed with loved ones or your place of employment, before you commit to anything.

A quick note of caution: when researching back surgery, aim to rely on reputable sources like peer-reviewed journals or clinical guidelines to get the most accurate information. It’s essential to be cautious of websites that offer surgery services directly, as the information they provide may not always be fully impartial. Independent medical sources will provide a more balanced perspective based on evidence, rather than services they offer. This will help you make more informed and unbiased decisions about your options.

Alternatives to back surgery

Surgery is one of many treatments for back pain. The gold standard for non-specific low back pain is the biopsychosocial (BPS) model, which includes pain neuroscience education, physical therapy, and psychological support. It’s important to know that non-surgical options are often at least as effective as surgery. Recent evidence points to the effectiveness of non-invasive treatments like pain education, movement therapy, mindfulness, and emotional processing for managing chronic back pain¹⁷.​ Non-surgical treatments are mainly recommended as the first-line management because they can be beneficial and the risk of harms is generally low¹⁸.

In addition, recent multidisciplinary approaches for back pain have shown promise including RESTORE (cognitive functional therapy)¹⁹, RESOLVE (using sensorimotor retraining)²⁰ and Pain Reprocessing Therapy (PRT)²¹. All these approaches have been adapted to form important components of the new MoreGoodDays back pain management program.

Here at MoreGoodDays®, we acknowledge that everyone is different, pain is complex, so we encourage you to weigh your own options and make a decision that feels right for you and your own circumstances. 

What about me? I’ve had surgery!

Perhaps you have already had surgery to address your back pain. Perhaps you are still experiencing pain and other symptoms. The decision to have surgery is personal and can be based on a myriad of individual circumstances and medical advice. As this article aims to show, there will be times when surgery for non-specific back pain may not appropriately address the underlying causes of back pain - and these can be complex, multifactorial and may include elements that go beyond structural damage.

Perhaps it might help if I share a bit of my own journey with back surgery…

After corrective surgeries for scoliosis as a teen, I have had the experience of major spinal surgery (check out my xray below- pretty gnarly, right?). As an adult, to combat periods of debilitating chronic pain, I have considered further fusion to the sacrum. This was suggested to me as a way to alleviate pain by potentially reducing some of the loading on the vertebrae below the current fusion (L4). In the end, the long rehabilitation and the lack of a guarantee that my pain would be reduced was what kept me going, to keep using the active treatments that were helping - a holistic approach incorporating mindfulness, exercise and pacing. Also, I was grateful to have had surgeons who were honest and also complimentary in praising my efforts to manage pain in other ways. More recently, I have come to believe that due to a range of factors, my pain now has become neuroplastic. I am confident that, for me, surgery is unlikely to reduce pain as there are a complex range of biopsychosocial factors causing it. If you have had surgery but still have pain - you might like to read more and figure out if pain has become a result of an overprotective pain system. Or try our "know your pain" quiz.

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Find your own pros and cons

Back surgery is a significant decision that shouldn’t be taken lightly. While it may help some, it's essential to consider the risks, benefits, and alternatives -so we encourage you to determine your own pros and cons list.

We hope this article has provided some clarity on the complex nature of back surgery - specifically for persistent back pain where no underlying serious pathology has been identified. Before making your decision, explore all available options, and if you’re unsure, seek a second opinion.

If you’d like more information on non-surgical pain management, reach out to us and learn more about our comprehensive back pain program. We’re here to support you in finding the best path forward for your pain management.

MoreGoodDays® is a simple, science-based program that helps you manage your pain, feel better, and improve your mood—all from the comfort of your home.

We have launched our new BP program providing evidence-based pain management.

If you would like to:

• Better understand and reduce your pain, improve well-being, and regain independence.
• Learn proven non-drug tools to feel better
• Science-backed digital program
• Access clinicians that understand
  

Break the cycle and accelerate your journey to recovery by learning more about our Back Pain Program today.