Myths about Back Surgery

Myth No. 1: A spine specialist will always recommend surgery

In reality, the opposite is true. The number of cases where surgery is the only treatment option is quite limited. In most cases, there are multiple ways to treat back pain, herniated discs, spinal stenosis, or instability without surgery. These individually tailored treatments may include modifying daily activities, physical therapy, medication, injections (nerve blockades), orthoses, etc. The goal of both the patient and surgeon is to solve the existing health issue with the least possible intervention. Surgery is typically reserved as a last resort. However, it is important for patients to be aware that some mild spinal conditions may predispose them to surgical spinal diseases in the future. With or without surgery, there are always ways to help you return to your daily activities and leave back pain in the past.

Myth No. 2: All spinal surgeries are major procedures with large incisions and extensive tissue trauma

In most cases, the opposite is true. While the spine is a large structure, it does not mean that every spinal surgery must be a major operation. Thanks to modern diagnostic and surgical equipment, most spinal surgical interventions today can be performed using minimally invasive techniques.

This means that surgeries are carefully planned to achieve their goals with the least possible intervention. Imaging technology during surgery, small incisions, microsurgical methods, and micro-instruments help reduce the impact of the procedure. As a result, these surgeries minimize tissue damage, require less recovery time, cause less pain, and carry a lower risk of infection compared to major operations.

If you have a herniated disc, a compressed spinal nerve, a spinal synovial cyst, spinal stenosis, degenerative disc disease, vertebral compression fractures, spinal instability, or another surgical spinal condition, you are likely a good candidate for minimally invasive spinal surgery.

Myth No. 3: Recovery after spinal surgery is always extremely painful and prolonged

This is not necessarily true—if the surgery is performed using minimally invasive methods, post-operative pain is typically mild and can be managed with over-the-counter painkillers for a short period. Hospitalization is often only one night.

Pain is usually most intense in the first three days, after which it gradually decreases.

In contrast, standard, large-scale surgical interventions can lead to stronger and prolonged pain, require longer hospitalization, and impose greater mobility restrictions.

Recovery time depends on many factors, including age, type of surgery, overall health, and physical condition. However, the general principle holds: greater intervention leads to a longer recovery, while smaller interventions result in shorter recovery times. For example, recovering from a microdiscectomy or minimally invasive spinal stenosis surgery may take just a few weeks at home, whereas recovery from traditional spinal fusion surgery can last three to six months.

Myth No. 4: After spinal surgery, you will never walk again / you will be confined to a wheelchair

In reality, the opposite is true—spinal surgeries are usually performed to prevent the loss of mobility due to spinal conditions. When a surgeon discusses the possibility of surgery, it typically means the risks of the operation are significantly lower than the risks of not having it (in terms of long-term health consequences).

While every spinal surgery carries some risk, including potential damage to the spinal cord, all possible precautions are taken before and during surgery to avoid complications. Spinal surgeries are considered very safe overall.

Additionally, most spinal surgeries are performed in the lower back (lumbar spine), where the spinal cord has already ended. In adults, the spinal cord terminates between the first and second lumbar vertebrae, meaning the risk of spinal cord injury is low or nonexistent. In these cases, only individual spinal nerves might be affected, significantly reducing the risk of severe disability.

Serious post-surgical mobility loss is extremely rare, and using minimally invasive techniques further reduces both short-term and long-term disability risks.

Myth No. 5: If surgery is not performed urgently, you will soon be in a wheelchair

The short answer is that paralysis due to spinal disease is extremely rare. Most spinal diseases are degenerative, meaning they progress slowly over years and almost never cause sudden paralysis (exceptions noted below).

"If surgery isn't done soon—you will be in a wheelchair!" is a common myth, often resulting from misinterpretation of a patient's actual condition or as an overly aggressive recommendation from a surgeon.

Sir William Osler, one of the founders of modern medicine, once said: "Listen to your patient, they are telling you the diagnosis." Be cautious of a very busy surgeon who does not take the time for a thorough discussion and only offers an urgent surgery as the single option. The decision for surgery should always be based on a full analysis of spinal images and medical history.

Remember—you always have the right to seek a second opinion and decline any treatment that does not feel right for you.

Exceptions: Only a few spinal conditions can cause sudden paralysis and may require urgent surgery to prevent severe disability, including spinal fractures (due to trauma) with spinal cord / Cauda Equina compression, metastatic spinal cord compression, spinal tumors, spontaneous epidural hematoma, spinal infections (epidural abscess), or large lumbar disc herniations causing Cauda Equina syndrome. Please note—none of these diseases are degenerative spinal conditions (except Cauda Equina syndrome)!

Myth No. 6: I am too old / too young for spinal surgery

Regardless of a patient's age, treatment decisions should be based on careful evaluation of the spinal problem and any co-existing conditions.

Processes that cause spinal degeneration (natural aging), leading to conditions like spinal stenosis, typically develop later in life and are rare in younger patients. Conversely, some spinal conditions, such as herniated discs or protrusions causing nerve compression, are more common in younger individuals.

Thus, there is no "right" or "wrong" age for spinal surgery—different age groups tend to experience different spinal issues.

Not all patients of the same age have equal surgical risks, meaning age alone is not an adequate indicator of a patient's health status. Many conditions that increase surgical risks, such as diabetes, obesity, cardiovascular disease, and atherosclerosis, can be present in both older and younger patients.

Treating the patient as a whole, rather than just addressing individual diseases, is the right approach to achieving the best results and avoiding foreseeable complications.