For many years, studies have shown the poor long-term outcomes of disc surgeries and spinal fusions, but many patients still believe that surgery will be a miracle cure for chronic back or neck pain. There are unfortunate side effects for patients who have had surgery for disc conditions, especially fusion-type surgeries. These surgeries have a shelf life of two-to-five years, if even that, before the patient may begin to experience failed-back surgery syndrome. Then, why is surgery so frequently recommended?

Back pain is so prevalent that most people, 8 out of 10, will suffer from it at some point in their lives, and it is one of the most common reasons people seek medical care in the United States. Back pain is annually estimated to cost between $25 billion to $50 billion US. Back pain is the most common cause of disability for people under the age of 45, and it is the most common occupational disability in the United States, and it is the second leading cause of work absenteeism.

When a doctor discusses back or neck pain, he or she is discussing back areas from your neck to your low back. There are four main spinal regions. The first region is the cervical spine, and it consists of 7 vertebrae. This begins at the base of your skull and continues to the base of your neck. The next adjoining region is your thoracic spine, consisting of 12 vertebrae, and it begins at the top of the shoulders and it continues to the bottom of the rib cage. Moving down the spine, next is the lumbar region that is made up of 5 vertebrae. Finally, we reach your tailbone, or the sacrum, and that connects to the pelvis.

Pain is assessed by utilizing several determiners which include intensity of pain (measured on a scale from 1 to 10), duration of pain, source and location of pain within the body. X-rays, blood samples, and other tests can detect problems that might cause it, but pain cannot be seen, and pain is subjective. What one patient perceives as debilitating pain, another will not. Everyone experiences pain differently. How the brain interprets pain is subjective, and it is influenced by emotional and physical factors, such as personality, underlying health conditions, physical and genetic makeup, previous episodes of pain, and preconceived ideas about pain.

Back pain is not always the result of an immediate accident or injury, but often is due to long-term repetitive actions such as poor posture, or improperly lifting, or unevenly carrying heavy things such as purses and children. Altered body mechanics will contribute to it and definitely our lack of physical fitness. It is common that some people suffering from back pain may be unaware of the escalation of their condition. Attitude and even influence of our culture may play into why people tend to ignore and or even deny they are experiencing pain. A good example of pain progression would be increased tingling and numbness in the extremities - arms or legs - and the change from intermittent pain to constant pain. By the time pain has progressed to the point of interfering with daily life and the ability to work, there can be permanent changes and nerve damage.

In my practice, I see symptoms ranging from dull and/or sharp, shooting and stabbing pain, numbness and tingling, limited flexibility and stiffness, sharp and shooting pain into the legs, and not being able to stand straight. These are commonly caused by degenerated discs and herniated discs.

Sciatica is commonly associated with degenerated or herniated discs. The sciatic nerve branches off the spine at the pelvis and continues down each leg. Sciatic pain travels along the sciatic nerve, the largest bundle of nerves of the body, and this can be accompanied by weakness in the legs. Many patients think they have leg problems, because the pain is majorly of the legs. The actual cause is a bulging disc pressing on a nerve at the base of the spine. With severe inflammation, there can be also hip and buttocks pain, and the pain can be debilitating.

Spinal stenosis can be caused because the discs in our spine degenerate over time. Spinal stenosis may occur in younger people when there has been a spinal injury or there is an abnormal narrowing of the spinal canal. A major purpose of the spine is to protect the spinal cord. It surrounds the spinal cord with vertebrae and spinal fluid. The spinal cord becomes inflamed when a disc bulges and the soft tissue around it pushes into the spinal canal, which causes a narrowing. This results in compression of the spinal cord. Diseases such as arthritis and scoliosis can cause spinal stenosis, and so can scar tissue which forms from a previous back or neck surgery. Often spinal stenosis occurs in the lumbar region of the spine with symptoms of pain in the skin, buttocks and legs, although it can occur in the cervical and thoracic regions.

When doctors talk about arthritis in your back, they may be talking about your facet joints. These joints are next to the spinous process, the bumpy part you feel when you run your hand on your spine, and this is where your ligaments and tendons are attached. They are similar to other joints, such as the knees and hips, and they are for strength and flexibility for each section of the spine. When you turn your head and feel grinding in your neck, this could be your facet joints or arthritis in the neck. This may be painful and disturbing.

Surgery is a risky proposition because there are inherent risks, and preexisting medical conditions can be complicating factors. Outcomes from back and neck surgeries are variable because of the complexity of the spine and the closeness of the discs to the spine. Scar tissue from surgery can cause pain, as a side effect, and scar tissue can cause nerve damage. I have treated many cases of failed back and neck surgeries. Some of my patients have had more than one failed surgery, and many did not have any relief from pain and symptoms. Unfortunately, the likelihood of surgical failure increases with each revision surgery. There are never any guarantees that you will be pain-free and experience long-term success, and surgery can have its own complications and consequences.

For all these reasons, you can not be guaranteed you will be free of pain or have long-term good results from back or neck surgery. Some surgeries are successful, and there are specific conditions that will require surgery. However, complications and negative consequences can happen.

It can be confusing for the patient when they hear different medical terms for the same or similar medical conditions. It can be confusing when you hear pinched nerve, bulging disc, slipped disc, prolapsed disc and ruptured disc. Patients can even be confused about what to do for treatment, and not even know what questions to ask.

You should explore every possible treatment option to avoid surgery, unless it is an emergency condition such As Cauda Equina Syndrome - where there is loss of bowel or bladder function. Surgery should be the absolute last treatment choice. Remember surgery can always be performed, but it can never be undone.