Invariably, the conversation goes something like this. You’ve had low back pain or neck pain for months, maybe even years. You’ve taken pain pills, used heating pads, hoping it just resolves on its own. You receive an MRI and then see a surgeon who says, “Well, we could operate.” Operating suddenly sounds expensive, scary, daunting, and a decision that someone doesn’t want to make.
Little do most people realize that when they avoid asking the right questions about conservative care, they may just be getting the first part of the answer. This isn’t to say that surgery is never appropriate.
Spinal surgery is an excellent option with certain conditions after all. Severe nerve compression that results in weakness or loss of function? That’s something different. Structural instability that’s worsening by the day? You may need surgical intervention.
What’s Misconstrued About Surgery
But surgery is recommended for far too many conditions. An MRI reads bulging disc: Let’s talk fusion surgery. Chronic low back pain? Let me implant some hardware.
This is not to say that certain patients won’t benefit from surgery. But most disc-related issues, stenosis or even osteoarthritis along the spine isn’t due to some cataclysmic structural compromise.
It’s due to mechanical malfunction, muscles not firing when they should, joints not tracking when necessary, tissues that have gained poor compensatory mechanics due to stress or injury. There is no way to cut away a problem and somehow make mechanics improve.
Why Conservative Care Makes Sense
When spinal dysfunction exists, as opposed to a collapsing structure, there are manual therapeutic approaches that can treat what’s actually wrong. A Chiropractor specializing in spinal conditions and sports-related injuries understand movement dysfunctions not visible on imaging. They’ve trained to recognize compensatory movements versus primary restrictions, allowing for treatment at the joint and soft tissue levels.
Joint restriction means aberrant tissue can be addressed. Muscle imbalances that contribute to chronic pain cycles can be calmed without painful injections.
The difference when it comes to surgery vs conservative care is what each approach is trying to alleviate. Surgical methods change structure, removing tissue here, fusing segments there, changing anatomic arrangements. Conservative care improves function, makes things function better, reduces inflammation by promoting better mechanics and better learned norms.
When Patients Realize This
Most patients are baffled to find that years of distress can be resolved with targeted manual therapy but in a world when body workers are reduced to masseuses unless they’re orthopedic or sports chiropractors, people assume it’s going to take something bigger and more intrusive.
Overwhelmingly, their bodies do heal remarkably well once mechanical barriers are removed.
The Evidence Overwhelmingly Has Supported This
Such conclusions are not relegated to small studies in obscure journals; instead, numerous large studies attempt to compare surgical and non-surgical intervention for common spinal complaints. Most populations find equivalent if not better long-term outcomes with conservative care.
One such study took herniated disc patients and divided them into two groups – those who received surgery and those who avoided. Over a four-year span, the surgical group reported an uptick in improvements sooner than those who avoided it. But by year two, there were no significant differences in pain or function between groups.
By year four, outcomes were relatively the same.
This isn’t to say that surgery is wrong or fails at times, but it does mean that for our most common complaints, going under the knife right away is at best, avoiding something that works just as well without risk and time away from work and considerable expenses.
Where the Risks Aren’t Worth the Rewards
Spine surgery costs money, which is obvious, but even with insurance covering a good amount, we’re still talking about thousands of dollars.
But secondary to financial consequences include loss of time of work associated with spine recovery protocols post-surgery (weeks off for placement of hardware requires no lifting or reasonable movement; months off means avoiding certain triggers to give the hardware time to stabilize). And when fusion occurs, it can lead to accelerated degeneration of adjacent spinal segments as they now take on more stress because one segment doesn’t move anymore.
Where risks for infection aren’t common but neither are blood clots, nerve damage and failed back surgeries, every patient who receives any sort of surgical intervention must sign consent acknowledging these possibilities.
Effective approaches that avoid conservatively have virtually none of the above risks. Recovery from manual therapy isn’t a timeline of months; there’s no no-anesthesia approach (or anesthesia, in some cases).
For someone with mechanical problems or injuries throughout their spine, this risk-benefit assessment often favors conservative care first.
When Willingness Matters
Time also isn’t of the essence when it comes to spinal concerns, surgeons instill fear that if something catastrophic is developing, it will get worse over time so get in while you can, true.
Cauda equina syndrome needs emergency attention and may require surgical intervention; rapid progression of weakness, severely unstable spine from trauma similarly needs immediate attention.
However, chronic back pain from herniated discs over months or years doesn’t foster the same urgency. A herniated disc that’s bulging into other segments causing radicular pain but no change in function? That will get worse; however, it’s mostly symptomatically better over time with appropriate conservative efforts.
Degenerative changes seen on imaging, especially the cervical spine, have developed over decades, making them neither emergent nor problematic in need of attention tenfold over when symptoms on par with such changes occur elsewhere in the body.
Therefore, taking months to explore conservative avenues doesn’t foreclose surgical options. Should a patient attempt manual therapy interventions combined with rehabilitation efforts and deliberate movement patterns with minimal progress for daily improvement up to a year or two in effort? Surgery is still on the table.
But overwhelmingly people find that when they’ve taken the time, and this includes almost daily strengthening elements, they no longer need surgical input.
Expectations from Both Sides
But the caveat is that patients can’t expect surgery doesn’t fail when they don’t do anything differently. If they’ve been moving passively for most of their lives creating this problem without any change, where’s the incentive for anyone else to help?
A patient needs to relearn how to sit at work or how they pick things up from a trunk; a patient needs to gain strength where stability no longer exists and improve lumbopelvic mobility where areas have tightened.
They must learn how to appreciate simple things like the temperature in their homes (spouses don’t keep rooms too cold if one has spondylosis). Strengthening different areas help promotes improved patterns so long as they’re willing to consistent rehabilitate even if they’re boring movements without any loaded effort.
Bodies can adapt, with sustainable changes implemented over time. Bodies are incredibly apt with adjustment when they receive appropriate stimuli.
Making A Personal Choice
At the end of the day, nobody will make this decision for anyone else. Spine pain is personal; how it’s controlled also needs a personal element before anyone makes advice about how best to proceed.
But before rushing someone into an operating room, perhaps ask the tough questions? Have you genuinely tried conservative care? What mechanical facets have maybe been genuinely overlooked?
What does research say about surgical intervention options for this diagnosis?
Ultimately people find an understanding of their symptoms aside from making do goes a long way during conservative endeavors: Some people get so much better surgery is never even considered; some people find their symptoms improve so much they can tolerate whatever is left after as long as it’s not catastrophic.
Some still find themselves interested in surgery, but at least from an educated perspective having exhausted all options first.
The spine is incredibly sensitive, and sometimes structural solutions are needed for structural catastrophes, but in reality, where mechanical dysfunction predominates quality-of-life situations preventing appropriate function level improvements through mechanical approaches produce relief without excess fragmentation via operating rooms and recovery complications otherwise.