Is Surgery For You?

The essential checklist for deciding whether surgery is necessary — and what to do instead.

95% Don't Need Surgery

Ninety-five percent of the challenging patients seen at the University of Waterloo spine clinic do NOT need surgery, even though many were told it was their only cure. This is based on three decades of experience working with patients who have been successful with surgical avoidance.

Here's a critical insight: after surgery, the patient is forced to rest. In many cases, had the patient subjected themselves to the rest associated with surgery — and skipped the surgery — the results would have been just as good.

Important

Surgery constitutes "rolling the dice." There is no "undo" button. Essential nerve and muscle tissue is cut. The scarring process sometimes grabs onto nerves, resulting in potentially chronic pain. Essential bone is removed and does not grow back.

Try "Virtual Surgery" First

Before any actual surgery, play the "virtual surgery" game. Pretend you just had surgery today. This means:

  • No gym or stretching tomorrow
  • Rest properly
  • Very slowly and methodically build a progressive rehabilitation program

The program follows these principles:

  1. Erasing the cause of pain
  2. Establishing pain-free movement patterns
  3. Walking
  4. Specific exercises

Many patients have done better than the statistical outcome for surgery by employing these techniques alone.

When Surgery SHOULD Be Considered

  • When neurological issues are substantial (loss of bowel or bladder control)
  • In cases of trauma where broken bone and torn tissues need stabilizing
  • When pain is unrelenting and severe for a substantial period of time
  • When all conservative options have truly been exhausted

When Surgery Should NOT Be Considered

  • If you have good and bad days — you are NOT a surgery candidate. You need to identify the cause of the changing pain
  • If you've only tried one form of physical therapy
  • If no one has assessed your pain triggers
  • If your pain is episodic — the fact that you have pain-free days means you simply need to identify and eliminate the triggers
Key Insight

Studies show that initial progress may be made with surgery, but after a few years the surgical patient's status is comparable to those who chose the non-surgical option. The major reason: the original flawed mechanics that led to tissue breakdown were never addressed.

Selecting a Surgeon (If You Must)

  • Ask nurses and physical therapists at the hospital which surgeon has the best results
  • Find a surgeon who has performed the procedure hundreds of times
  • A good surgeon always discusses options, alternatives, and risk/reward
  • If the surgeon becomes perturbed by questions, find another surgeon
  • If the first surgery didn't work, be very skeptical of a second — the most common reason surgery fails is that the patient didn't need it in the first place
  • Avoid surgeons who propose multi-level fusion for "degenerative disc disease"
  • Avoid "institutes" that offer to view your scans and advise surgery without assessing YOU
Virtual Surgery Protocol
Virtual Surgery Protocol

The Typical Failed Story

  1. Person goes to family doctor with back pain
  2. Doctor prescribes pain medication
  3. If pain persists, surgical consultation or physical therapy referral
  4. Surgeon says "I can fix it with surgery"
  5. During the waiting time, patient often gets better on their own
  6. But pain reoccurs — because no one addressed the CAUSE
  7. Patient gets five minutes of surgeon's time
  8. Surgery proceeds, addressing the symptom but not the mechanism

The fundamental flaw: an episodically pained patient is not a surgical case. The fact that they have pain-free days shows they simply need to identify the triggers that cause a painful day and eliminate them.

Your Strategy

Arm yourself with information. Ask tough questions. Hold your health practitioners to a higher standard. Focus on proper identification of your unique back issues. Take an active role on the path to achieving back health. In other words — become your own back mechanic.