The Truth About Back Surgery
Surgery: Just Say "Not So Fast"
Here's the crux of the problem: We tend to think of back surgery as the Big
Fix — the treatment that will, if other approaches aren't successful, work.
Sometimes, in our desperation to get our lives back, it may seem like a good
idea to jump over those less invasive procedures and go right to the big one.
That's a good call in a few cases — where there's a risk of paralysis, for
example — but those types of emergencies are rare. Otherwise, "surgery offers
specific therapy for specific conditions," says Dr. Deyo. It should never be
seen as "worth trying" for pain. Such hope on the part of patients — too often
reinforced by surgeons — leads to operations that offer no relief.
Discectomies (removal of the herniated part of the disc) are the most common
back surgery. But spinal fusions (operations that involve joining the
surrounding vertebrae) have been rising — from just over 150,000 in 1993 to
350,754 in 2007. And so has the controversy over their use. Fusions that are
done for certain very specific conditions, such as spondylolisthesis (in which
one vertebra has slipped forward over the one below), can have success rates of
more than 80 percent. But that's not the usual case. When the surgery's done
for a "simple" degenerated disc, the results are far less happy. Fewer than
half of fusions are appropriate, experts estimate, and fewer than half are
successful, research confirms. And surgical fusions don't come cheap: The
average cost is about $75,000, not to mention months of rehab and weeks lost
The takeaway: If a doctor recommends an operation, get a second opinion —
always. A good surgeon will understand that you need to be comfortable
with any decision, and should provide your tests and records, says Alex
Ghanayem, M.D., professor of orthopaedic surgery at Loyola University Medical
Center in Maywood, IL. For a truly useful second look, and to find out if you
would benefit from surgery, go outside your doctor's practice or center and
consult with different types of specialists. Specifically: