Back pain has a way of wearing us down.

We try medication. Physical therapy. Injections. Massage. Chiropractic. Maybe each one helps for a while, but eventually the back pain comes back.

After enough rounds of that cycle, someone may suggest the option we hoped we would never need to consider: surgery.

In my experience, most people don’t reach that point excited about having back surgery. They reach it exhausted. They’ve hurt long enough, tried enough things, and changed enough of their lives around the pain that surgery begins to feel less like a choice and more like the only option left.

Sometimes surgery is absolutely necessary. Certain conditions require surgical evaluation, particularly when there are serious or progressive neurological problems or other significant pathology. When surgery is the right treatment for the right problem, it can provide meaningful improvement.

But recurring back pain doesn’t automatically mean surgery is next.

What Does the MRI Actually Tell Us?

By the time surgery enters the conversation, most people have had imaging. An MRI may show disc degeneration, bulging discs, arthritis, narrowing or other structural changes.

Those findings can be important, but they don’t always explain why we hurt.

Research and clinical guidelines recognize that abnormalities on spinal imaging are also commonly found in people without back pain. That’s one reason routine imaging isn’t recommended for every episode of uncomplicated low back pain. Imaging becomes much more useful when the findings correlate with our symptoms and examination or when the results are likely to change treatment decisions.

So the important question isn’t simply, “What does my MRI show?”

It’s whether what we see on the MRI actually explains what we’re experiencing.

“I’ve Tried Everything”

I hear this from people with chronic back pain all the time.

And usually, they really have tried a lot.

But when we look more closely, what we’ve often tried is a long series of different ways to make the pain stop.

That’s understandable. When our back hurts, relief is exactly what we want.

The problem is that relief and recovery aren’t necessarily the same thing.

If medication helps for a while, an injection helps for a while, massage helps for a while, or an adjustment helps for a while, we’ve learned that something can change our symptoms.

We haven’t necessarily answered why they keep coming back.

That’s a different question.

Before Surgery Feels Like the Only Choice

Before we conclude that we’ve exhausted every option, I think we deserve a closer look at function.

How is our body moving? What can we do comfortably now compared with before? Are there measurable problems with mobility, strength, balance or movement that can be improved? And when we change something, does our function actually improve?

That doesn’t mean surgery should be avoided at all costs.

It means there is a meaningful difference between choosing surgery because we’ve identified a problem that surgery is well suited to address and choosing surgery because we simply don’t know what else to do.

Back surgery also isn’t a guarantee that back pain will never return. Outcomes vary substantially depending on the condition and procedure, and recurrent problems can occur after surgery.

So, if surgery truly is our best option, we should be able to make that decision with as much confidence and information as possible.

But if we’re considering surgery primarily because the pain keeps coming back and everything we’ve tried has only helped temporarily, there may still be one important question left unanswered:

Why does this keep coming back?

Sometimes surgery is the answer.

But it shouldn’t have to become the answer simply because we feel like we’ve run out of questions.

Until easy is normal.

About Dr. Thomas Polucki

Dr. Thomas Polucki is a Santa Clarita chiropractor with more than 35 years of clinical experience. His Newhall practice focuses on Upper Cervical Chiropractic, functional rehabilitation and objective measurement to help people with recurring pain improve how they move and function.

Medical Disclaimer

This article is for educational purposes only and is not intended to diagnose or treat any condition or replace individualized medical advice. New or worsening weakness, loss of bowel or bladder control, saddle numbness, significant trauma, fever or other concerning symptoms associated with back pain warrant prompt medical evaluation.

References

American College of Radiology. Appropriateness Criteria: Low Back Pain. Imaging is generally reserved for specific clinical indications, including persistent or progressive symptoms in potential surgical or interventional candidates.

American Academy of Family Physicians. Chronic Low Back Pain in Adults: Evaluation and Management. Routine imaging is not recommended without clinical indications; nonpharmacologic approaches are generally first-line when specific medical or surgical pathology is absent.

World Federation of Neurosurgical Societies Spine Committee. Lumbar Disc Herniation: Prevention and Treatment of Recurrence. The committee reports that recurrent disc herniation and reoperation can occur after lumbar disc surgery and that outcomes following surgery for recurrent herniation are generally inferior to those following initial surgery.

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