Surgery should always be considered the last option. Surgery is by far the most dangerous of all available treatment options AND is associated with the lowest success rates AND has the longest recovery time AND is the most expensive AND is the most painful. In very rare circumstances, surgery cannot be avoided. Patients that may have no other option than to forego conservative treatment and receive surgery include those with progressive neurological deficit (motor weakness, loss of reflexes, etc.) or cauda equina syndrome (bilateral sciatica, saddle dysesthesia, motor weakness in the lower extremities and/or loss of bowel and bladder control). Nearly all other cases should consider less dangerous, non-invasive interventions first.

Surgery is not without its risks. According to a study published in the respected medical journal, Spine (1991; 16[1]), 1 out of every 575 lumbar discectomy surgeries (one of the most commonly performed low back spinal surgeries) will involve severe vascular complications. Of these complications 37-61% will result in the death of the patient. In other words, approximately 1 out of every 1000 lumbar discectomy patients will die as a direct result of the surgery.

The risk associated with surgery is not always the procedure itself, but the general anesthesia necessary to perform the operation. A small percentage of patients die every year or are permanently disabled as a direct result of both properly and improperly applied anesthesia. Some surgeons are incorporating epidural anesthesia into their less-invasive surgical protocols in an attempt to reduce some of these risks.

The failure rate of surgery for back pain and neck pain is very high. Some 200,000 patients undergo lumbar spine surgery every year. On average, approximately 53 percent of all lumbar spine disc surgeries fail to relieve symptoms according to a study published in International Orthopedics (1987; 11:255-259). The results from another study published in Spine (2004; 29[17]:1931-7) showed that 20-40 percent of patients will fail to gain the desired outcome and 10 percent of patients will be worse after the initial surgery. The same study followed the progress of 3,362 patients that received spinal surgery. The results of a SF-36 Health Survey showed that patients with a history of spine surgery fared significantly worse on areas such as physical functioning, general health and mental health compared to those patients with no prior history of spine surgery. The researchers went on to say that “[p]revious back surgery is associated with significantly worse general health status than those without surgery...”