Do I Need Low Back Surgery?

Are you considering surgery as a treatment for your low back pain? With such a potentially life altering decision on the table it’s important to separate fact from fiction. There’s a myth in the general population that if your back pain hasn’t resolved after a few weeks of treatment, then surgery is the only remaining option.  

And while in some cases it may be necessary, it’s important to think long and hard before going under the knife. Surgery is rolling the dice. There’s no going back from surgery. Some things to consider before going under the knife:

  • Findings on imaging (X-Ray or MRI) should not be the sole determining factor for whether or not to get surgery. Studies have shown that spinal degeneration shown on imaging has no correlation to pain levels experienced by patients (many individuals have degeneration with no low back pain; many individuals with low back pain have no degeneration or disc bulging). Surgeons are often quick to recommend surgery after looking at imaging  and without any exam of the individual.
  •  In an effort to ‘cut out’ the pain, the surgeon must inevitably cut through healthy tissue (muscles, nerves, ligaments, etc) to reach the spine. This can create problems after the surgery that weren’t there to begin with.
  •  Surgery does nothing to address the cause of low back pain. Without the cause of low back pain being addressed, pain often returns months to years later (usually above or below the surgical site).

With that in mind, there are some generally accepted rules for when surgery is indicated.

1. Major Trauma. An obvious indication would be any trauma that is life threatening or puts an individual at risk for further complications.

2. Worsening neurological functioning. Progressive weakness, numbness, changes in bowel or bladder habits indicate a neurological issue that needs to be addressed ASAP.

3. Loss of Function. If pain is so severe and unrelenting that it limits patients ability to function in daily life.

4. Unresponsive to conservative care. General consensus says that failure of conservative care after 3 months can indicate a surgical approach. A few things to keep in mind here:

  •  First – the three month time span was determined by muscular studies in rats. It can sometimes take years for lumbar disc tissues to fully heal. Moral: There’s no set timeline – but their should be some functional improvement with a structured rehab protocol.
  • Not all conservative care is created equal. Three months of passive therapies (chiropractic, massage, acupuncture, etc) without any sort of exercise prescription leads o short term relief without providing the long term results that patients need. Conservative care must include active care to improve movement and strength or core and low back stabilizers.

If you don't fit into any of the previous four categories, surgery may not be your best option. Surgery is highly invasive and can come with some serious complications. Don't be afraid to get a second opinion. We'll leave you with the following rule that spine and low back pain expert Dr. Stuart McGill leaves with his patients:

If your surgeon can’t provide a guarantee that surgery will get rid of your pain for good, a conservative approach is the best way to manage your back pain.


Evolve Performance Healthcare specializes in providing long term relief. We're not into quick fixes, but creating chiropractic and fitness plans to help you take care of back pain for good.

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