What Spine Surgery Can and Cannot Fix

There is as much art as there is science to it and no 100% guarantees

I’ve read multiple articles recently about notable world figures past and present, who have suffered from significant bouts of back pain and tried a plethora of spine treatment options during their lifetimes and illustrious careers. Iconic former President John F. Kennedy had chronic back pain throughout much of his life, sources say. It was reportedly so debilitating that some historians believe the back brace he wore daily to combat it may have contributed to his death by allowing his body to spring back to an upward position after he was struck with the first bullet by Lee Harvey Oswald, which is when the second fatal shot was fired.

Former President John F. Kennedy and daughter, Caroline

These theories aside, a compilation of medical reports for Kennedy show a pattern of treatment that may not look that different from the one many chronic back pain sufferers experience today, though the methods might be slightly different. Kennedy underwent a variety of treatments—from non-surgical options like massage and injection therapy to four spine surgeries—all to relieve the spinal pain likely associated with sports injuries in his younger years and military combat-related traumatic injuries later on.

This account of JFK’s health history fascinates me for many reasons—not the least of which is the notion that, sometimes, spine surgery cannot eliminate pain. It remains true today. And while there are copious well-studied procedures that are clinically proven to help many patients with structural issues related to the spine, thereby subsequently reducing or eliminating the associated pain—none of them are accompanied by a 100 percent guarantee that this will be the case for every patient.

When it comes to back pain specifically, there is nothing a spine surgeon can do to “cure back pain.” Pain is a symptom. Depending on where it is located and how it is felt, there may be structural issues involved with the spine that are related to the pain, but the pain itself isn’t the fixable problem. What a skilled surgeon must do is thoroughly evaluate a patient, including an extensive physical examination and imaging tests if necessary, a detailed overview of their medical history and importantly, carefully listening to the description of the pain and the patient’s thoughts on it. Only then can we get to the bottom of back pain and develop an accurate plan for treating it with the goal of restoring our patients to healthy, active living.

As I discuss at length with my patients in the exam room and readers here on this blog, spine surgery is not ‘magic’ and it shouldn’t be considered with the expectation that it will return anyone to a state of youthful existence before time, lifestyle and circumstances got involved. As with any type of surgery, there is risk involved. We don’t recommend surgical spine procedures to people who haven’t already tried other ways to relieve the back pain or people who are medically unfit to undergo surgery without significantly increased risks of more serious complications.

Here’s the good news. For those who are appropriate candidates for spine surgery, it can be lifechanging, for the better. I have operated on patients who thought they were headed for a wheelchair-bound life, yet returned to normal, active pain-free living because we were able to help surgically correct the spine issues that left them disabled. Those are cases a spine surgeon never forgets and certainly doesn’t take for granted.

Though significant and notable strides continue to be made in spine surgery and its associated outcomes, our field of medicine remains a challenging one that involves an art to surgery as much as science.

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