Before You Go Under the Knife: A Case for Conservative Back Pain Treatment
Back surgery… How many of you either know someone who has had it or have undergone it yourself? It can be a really scary endeavor. Most often, pain is involved, which only makes solid decision-making more difficult. Now, I’m not going to be the chiropractor who shuns every invasive procedure. There is a time and place for all modalities. However, my belief has always been—and will continue to be—that one should start with the least invasive treatment and work their way up to the most invasive.
In this blog, we’ll discuss injections, discectomy, fusions, and the dreaded failed back surgery syndrome.
Epidural steroid injections are among the most common forms of treatment for low back and neck pain. These are administered by medical doctors who specialize in such procedures. It’s estimated that between 9–10 million are performed each year (1). It is thought that between 2 to 4 injections are considered safe to administer annually to the same person. However, the risks include infection at the injection site, soreness, joint degeneration, and allergic reactions.
A recent study found limited effectiveness for epidural steroid injections, and most conservative sources suggest there is only a 50-50 chance (no pun intended) that the treatment will provide pain relief (2). This leads me to caution my patients against the use of steroid injections until more conservative care has been attempted—such as chiropractic manipulation and decompression. Why risk infection when chiropractic has been proven to be more effective and significantly less invasive?
Moving on to spinal fusion—this procedure can be performed for a variety of ailments and injuries, and typically involves creating a “cage” of rods and screws around one or more joints to restrict motion. Most often, they are done to address instability in the spine. And when I say instability, I mean a truly unstable vertebra—not a muscle imbalance or flexibility issue.
Sadly, I see patients who undergo spinal fusions for pain rather than instability. Performing such an invasive surgery solely for pain is counterintuitive, as all joints in the body require a certain range of motion to function and feel their best. When we restrict that motion through fusion, pain often persists, and degeneration typically occurs in the joints above and below the fusion site—leading to more pain in the future (3).
For many surgeons, a spinal fusion is a last-ditch effort. I respect that, and I hope most surgeons would avoid recommending it as a first-line defense against musculoskeletal pain. That said, if you haven’t yet tried chiropractic care—especially Cox Flexion Distraction—I strongly encourage you to give our clinic a try.
Next on the list is discectomy, a procedure where a disc herniation or rupture is cut out and repaired. It’s often performed on an outpatient basis. On the surface, this surgery makes anatomical sense, and many people do find great success from it. However, we often look at MRIs (myself included) and see a disc herniation, then assume it’s the cause of a patient’s pain. That’s not always the case. Many people walk around with disc herniations and experience no pain at all.
A 2022 study noted that individuals who received chiropractic care were much less likely to undergo surgery (4). As with most surgical procedures, there is a time and place—but there’s also a 12% chance of needing a second surgery. It can become a slippery slope (5).
Last but not least we have what is thought of as a relatively new term: Failed Back Surgery Syndrome. This phrase is disliked by surgeons and is rarely found in medical journals. In those circles, it’s more commonly referred to as Persistent Pain Syndrome. You can see the difference in connotation between the two.
It’s a horrifying thought to go through the invasive ordeal of back surgery only to come out worse than before—but that is the case for 10–40% of those who undergo such procedures (6).
When patients ask me about back surgery, I usually explain it like this: surgery follows the rule of thirds. 33% of people get better. 33% experience no change. And 33% get worse. That means 66% of people likely should not have had the surgery they received.
As I’ve said throughout, there is absolutely a time and place for surgery—and some people simply don’t have a choice—but I always advocate for trying all conservative care options first.
In conclusion, while back surgeries like epidural injections, discectomies, and spinal fusions have their place in the medical field, they should never be the first step in addressing musculoskeletal pain. The risks, long-term consequences, and potential for persistent pain often outweigh the benefits—especially when conservative, non-invasive treatments like chiropractic care are available and proven effective. My goal is not to discredit surgical options but to encourage patients to explore every alternative before committing to a procedure that may not guarantee relief. Your health and mobility are worth a thoughtful, step-by-step approach—starting with the least invasive options and working your way forward only when necessary.
Van Boxem, K., Rijsdijk, M., Hans, G., de Jong, J., Kallewaard, J. W., Vissers, K., van Kleef, M., Rathmell, J. P., & Van Zundert, J. (2019). Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group. Pain practice : the official journal of World Institute of Pain, 19(1), 61–92. https://doi.org/10.1111/papr.12709
Armon, C., Narayanaswami, P., Potrebic, S., Gronseth, G., Bačkonja, M. M., Cai, V. L., Dorman, J., Gilligan, C., Heller, S. A., Silsbee, H. M., & Smith, D. B. (2025). Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee. Neurology, 104(5), e213361. https://doi.org/10.1212/WNL.0000000000213361
Park, P., Garton, H. J., Gala, V. C., Hoff, J. T., & McGillicuddy, J. E. (2004). Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine, 29(17), 1938–1944. https://doi.org/10.1097/01.brs.0000137069.88904.03
Trager, R. J., Daniels, C. J., Perez, J. A., Casselberry, R. M., & Dusek, J. A. (2022). Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ open, 12(12), e068262. https://doi.org/10.1136/bmjopen-2022-068262
Trager, R. J., Gliedt, J. A., Labak, C. M., Daniels, C. J., & Dusek, J. A. (2024). Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC musculoskeletal disorders, 25(1), 46. https://doi.org/10.1186/s12891-024-07166-x
Sebaaly, A., Lahoud, M. J., Rizkallah, M., Kreichati, G., & Kharrat, K. (2018). Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian spine journal, 12(3), 574–585. https://doi.org/10.4184/asj.2018.12.3.574
