You’re in severe back pain. You’ve had the MRI and X-rays, and now you’re being told surgery is the next step. But what if those scans don’t show the full story? We see it all the time. The real cause of your pain might be something your imaging missed entirely. This is why finding a real alternative to back surgery is so important. Instead of immediately considering invasive options like spinal fusion for conditions like scoliosis or spondylolisthesis, let’s first ask a critical question: What is your MRI not telling you?

  • The MRI cannot show muscle spasms from a simple back strain which can cause excruciating pain.
  • Conversely, the MRI can show a large herniated disc which may be completely asymptomatic.

Yet that large herniated disc will send the patient to surgery. As you will read in the research below, this recommendation to surgery is considered “unsupported enthusiasm for the surgical management of discogenic back pain.”

Now surgeons are publishing new data with a tempered enthusiasm about how effective spinal procedures are or are not.

Here is research reported in the European journal of orthopaedic surgery & traumatology.(1)

“(Spinal) Fusion is one of the most commonly performed spinal procedures, indicated for a wide range of spinal problems. Elimination of motion though results in accelerated degeneration of the adjacent level, known as adjacent level disease. Motion preservation surgical methods were developed in order to overcome this complication. These methods include total disc replacement, laminoplasty, interspinous implants and dynamic posterior stabilization systems. The initial enthusiasm about these methods was followed by certain concerns about their clinical usefulness and their results.”

In this study out of Greece, surgeons reassessed a few of the most commonly performed spinal fusion alternative surgical procedures. “(Motion preservation surgical methods) include total disc replacement, laminoplasty (cutting away of bone and other pressure causing material on the nerves), interspinous implants (spacers to hold nerve pathways open) and dynamic posterior stabilization systems (not a fusion but similar.).”

While they appear to be realistic surgical options for a complicated spinal problem, the initial enthusiasm about these methods was followed by certain concerns about their clinical usefulness and their results.

  • Not everyone is a good candidate for this type of spinal surgery: The main indications for total disc replacement are degenerative disc disease, but the numerous contraindications for this method make it difficult to find the right candidate.
  • Application of interspinous implants has shown good results in patients with spinal stenosis, but a more precise definition is needed regarding the severity of spinal stenosis up to which these implants can be used.
  • Laminoplasty has several advantages and less complications compared to fusion and laminectomy in patients with cervical myelopathy/radiculopathy.
  • Dynamic posterior stabilization could replace conventional fusion in certain cases, but also in this case the results are successful only in mild to moderate cases.”

One of the concerns was the need to repeat the spinal surgery, to fix something the spinal surgery made worse or did not correct the first time. Repeat spinal surgery falls under the laws of diminishing returns. This was in the Asian Spine Journal (2) :

  • “Repeat spinal surgery is a treatment option with diminishing returns. Although more than 50% of primary spinal surgeries are successful, no more than 30%, 15%, and 5% of the patients experience a successful outcome after the second, third, and fourth surgeries, respectively“
  • “The decision to perform surgery in patients with predominantly axial (mechanical low back pain) pain should be made with the understanding that many patients may not respond to the treatment.”

A study in Journal of back and musculoskeletal rehabilitation  (3) offers the same warnings:. “Four to fifty percent of patients will develop Failed Back Surgery Syndrome following lumbar spine surgery. Repeated surgeries lead to escalating costs and subsequent decreases in success rate.”

What is being said in the above research and the below research is, these surgeries may not be as helpful as doctors thought. 

In an editorial from the Department of Neurosurgery, University of Virginia, doctors found: “Without prospective trials with non-conflicted surgeons and standardized selection criteria, the true role for sacroiliac joint fusion procedures in the treatment of chronic lower back pain will remain murky. The consequences of the unsupported enthusiasm for the surgical management of discogenic back pain still negatively impacts the public perception of spinal surgeons.(4)

Understanding Your Options: A Guide to Back Surgery Alternatives

When you’re dealing with persistent back pain, the suggestion of surgery can feel both daunting and like the only path forward. But it’s important to know that a recommendation for an invasive procedure isn’t the end of the road—in fact, it’s often just the beginning of exploring a wide range of effective alternatives. Many people find lasting relief and regain their quality of life through non-surgical treatments that work with the body, not against it. These options range from simple lifestyle adjustments you can make at home to conservative therapies and cutting-edge regenerative procedures that help your body heal itself.

Thinking about alternatives isn’t about avoiding a solution; it’s about finding the right one for you. Every person’s experience with back pain is unique, and so is their journey to recovery. The goal is to address the root cause of your pain, improve your function, and get you back to doing the things you love with the least amount of risk and downtime possible. This guide will walk you through the different layers of treatment, from foundational habits to advanced medical interventions, giving you a clear picture of the possibilities that exist beyond the operating room.

The Reality of Back Pain: Some Key Statistics

If you’re struggling with back pain, you are far from alone. It’s one of the most common reasons people visit a doctor, with nearly 65 million Americans reporting a recent episode. While surgery is often presented as a definitive fix, the outcomes aren’t always what patients hope for. Research has shown that the success rates for repeat back surgeries drop significantly with each procedure. For instance, while a first surgery might have a success rate over 50%, a second one drops to 30%, a third to 15%, and a fourth to just 5%. This pattern of diminishing returns highlights why exploring less invasive options first is so critical.

Furthermore, a significant number of patients who undergo lumbar spine surgery go on to develop Failed Back Surgery Syndrome, a condition where chronic pain persists or even worsens after the procedure. This isn’t meant to scare you, but to empower you with information. Understanding that surgery isn’t a guaranteed cure opens the door to considering other highly effective treatments that can provide relief without the risks and lengthy recovery associated with invasive operations. The focus should be on finding a sustainable solution that addresses your specific condition and helps you build a stronger, more resilient back for the long term.

 

How Weight Management Reduces Strain on the Spine

Carrying extra weight, especially around your midsection, can place a significant amount of strain on the structures of your lower back. This constant pressure can contribute to a host of problems, from muscle fatigue to disc issues. The good news is that even a modest amount of weight loss can make a big difference. According to experts at UT Southwestern Medical Center, losing excess weight can dramatically reduce the load on your spine, potentially decreasing your pain to the point where medication or surgery is no longer necessary. By combining a healthy diet with regular, low-impact exercise, you can work toward a healthier weight, which not only benefits your back but also improves your overall well-being and energy levels.

Quitting Smoking for Better Healing and Blood Flow

If you’re a smoker dealing with back pain, quitting could be one of the most impactful steps you take toward healing. Smoking wreaks havoc on your circulatory system, reducing blood flow to the tissues throughout your body, including those in your spine. The discs in your spine have a very limited blood supply to begin with, and smoking constricts the small blood vessels that deliver essential nutrients and oxygen. This can accelerate degenerative disc disease and weaken the muscles and ligaments that support your back. By quitting, you allow your blood flow to improve, giving your spinal tissues a better chance to heal and stay healthy, which can lead to a significant reduction in chronic pain.

The Importance of Good Posture and Ergonomics

The way you sit, stand, and move throughout the day has a profound effect on your spinal health. Poor posture places uneven pressure on your vertebrae and discs, leading to muscle strain, nerve irritation, and chronic pain over time. Simply practicing good posture can be a game-changer. When standing, keep your shoulders back, your head level, and your core engaged. When sitting, ensure your feet are flat on the floor and your back is supported. If you work at a desk, take a look at your setup. Your monitor should be at eye level, and your keyboard should be positioned so your elbows are at a 90-degree angle. Making these small ergonomic adjustments can alleviate unnecessary stress on your back and neck.

Conservative and Complementary Therapies

When lifestyle changes alone aren’t enough to resolve your back pain, the next step is to explore conservative and complementary therapies. These professional treatments are designed to alleviate pain, restore movement, and improve function without resorting to surgery. This category of care includes a wide variety of approaches, from hands-on treatments like physical therapy and chiropractic care to mind-body techniques that change your relationship with pain. These therapies are often used in combination to create a comprehensive treatment plan that addresses your pain from multiple angles. They focus on treating the body as an interconnected system, aiming to correct underlying mechanical issues, reduce inflammation, and calm the nervous system. For many people, a well-rounded plan incorporating these therapies is the key to avoiding more invasive procedures and achieving lasting relief.

Professional Hands-On Care

Hands-on therapies provided by trained professionals can be incredibly effective for treating the mechanical causes of back pain. These treatments focus on the physical structures of your back—the muscles, joints, and soft tissues—to restore proper alignment and function. A practitioner can identify specific areas of restriction or weakness and use targeted techniques to release tension, improve mobility, and build strength. This direct approach can provide immediate relief while also addressing the root issues contributing to your pain, helping to prevent it from returning. Two of the most common and effective forms of hands-on care are physical therapy and chiropractic adjustments.

Physical Therapy

Physical therapy (PT) is a cornerstone of non-surgical back pain treatment. A physical therapist will conduct a thorough evaluation to understand the specific cause of your pain and then create a personalized program to address it. The goal of PT is to improve how your joints and soft tissues work together. This is achieved through a combination of passive treatments, like heat or ice packs and manual therapy, and active treatments, which are the exercises you do yourself. These exercises are designed to build strength, endurance, and flexibility in the muscles that support your spine, ultimately reducing pain and making you more resilient to future injury.

Chiropractic Adjustments

Chiropractic care focuses on the relationship between your spine and your nervous system. Chiropractors use hands-on spinal manipulation, also known as adjustments, to restore mobility to joints that have become restricted in their movement due to injury or repetitive stress. The idea is that by improving spinal alignment, you can reduce pressure on nerves and allow the body to heal itself more effectively. Many people find that chiropractic adjustments provide significant relief from back pain, especially when combined with other therapies like massage and corrective exercises. It’s a non-invasive approach that can be a valuable part of a comprehensive pain management plan.

Mind-Body Approaches to Pain Management

Chronic pain isn’t just a physical sensation; it has a powerful emotional and psychological component as well. Mind-body therapies acknowledge this connection and teach you how to use your mind to influence your perception of pain. These approaches can help you break the cycle of stress, anxiety, and muscle tension that often makes chronic pain worse. By learning techniques to calm your nervous system and reframe your thoughts about pain, you can reduce its intensity and its impact on your daily life. These strategies empower you to take an active role in managing your symptoms from the inside out.

Cognitive-Behavioral Therapy (CBT)

Cognitive-Behavioral Therapy (CBT) is a type of talk therapy that has been proven highly effective for people living with chronic pain. It operates on the principle that your thoughts, feelings, and behaviors are interconnected. A therapist trained in CBT can help you identify and change negative thought patterns and behaviors that may be amplifying your pain experience. For example, you might learn to challenge catastrophic thoughts about your pain (“This will never get better”) and replace them with more balanced, realistic ones. CBT also provides practical coping skills for managing flare-ups, helping you feel more in control and less distressed by your symptoms.

Mindfulness, Meditation, and Biofeedback

Mindfulness and meditation are practices that train you to pay attention to the present moment without judgment. For back pain, this can mean observing the sensation of pain without reacting to it with fear or tension, which can often make it worse. This practice can help detach you from the emotional suffering associated with pain. Biofeedback is a technique that takes this a step further. It uses electronic sensors to give you real-time information about your body’s functions, like muscle tension or heart rate. By seeing these signals, you can learn to consciously control them, for example, by relaxing tense back muscles to reduce pain.

Other Non-Invasive Treatments

Beyond hands-on and mind-body therapies, there are several other non-invasive treatments that can be valuable additions to your pain management toolkit. These options can help reduce pain and inflammation, allowing you to participate more fully in active therapies like physical therapy. From ancient practices like acupuncture to modern technology like TENS units, these treatments offer different ways to interrupt pain signals and promote healing. They are often used to manage symptoms while you work on addressing the underlying cause of your back pain through strengthening and lifestyle changes.

Acupuncture and Therapeutic Massage

Acupuncture, a key component of traditional Chinese medicine, involves inserting very thin needles into specific points on the body. It is thought to work by stimulating nerves, muscles, and connective tissue, which can trigger the release of your body’s natural painkillers and improve blood flow. Therapeutic massage focuses on manipulating the soft tissues of the back to relieve muscle tension, reduce spasms, and improve circulation. Both therapies can be incredibly effective for alleviating pain, reducing stress, and promoting a sense of overall well-being, making them excellent complementary treatments for chronic back issues.

TENS (Transcutaneous Electrical Nerve Stimulation)

A TENS unit is a small, portable, battery-operated device that offers a drug-free method for pain relief. It works by sending low-voltage electrical currents through electrodes that you place on your skin near the source of your pain. These electrical impulses are thought to work in two ways: by overwhelming the nervous system to block pain signals from reaching your brain, and by stimulating the production of endorphins, your body’s natural pain-relieving chemicals. Many people find TENS to be a useful tool for managing acute pain flare-ups at home, allowing them to remain active and reduce their reliance on medication.

Medications for Pain and Inflammation

Medications can play a role in managing back pain, particularly during acute phases. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce both pain and inflammation. For more severe pain or muscle spasms, a doctor might prescribe stronger pain relievers, muscle relaxants, or certain types of antidepressants that have been shown to help with chronic pain. While medications can provide necessary short-term relief, it’s important to view them as one part of a larger strategy. They can calm symptoms enough to allow you to engage in rehabilitative exercises, but they don’t typically address the root cause of the problem.

Minimally Invasive and Regenerative Alternatives to Back Surgery

When conservative treatments don’t provide enough relief, it’s easy to think that major surgery is the only option left. However, there is a growing field of medicine that bridges the gap between conservative care and traditional surgery. These minimally invasive and regenerative procedures are designed to treat the source of your pain with less risk, less tissue damage, and much faster recovery times than major operations like spinal fusion. Regenerative medicine, in particular, represents a paradigm shift in treatment. Instead of just managing symptoms or artificially stabilizing a joint, these therapies aim to harness your body’s own powerful healing mechanisms to repair damaged tissues and restore function from within. This approach gets to the root cause of the pain, offering the potential for long-lasting relief and true healing.

Regenerative Medicine: Healing from Within

Regenerative medicine is one of the most exciting frontiers in pain treatment. This approach uses biological materials—often from your own body—to stimulate and accelerate your natural healing processes. Instead of just masking pain, treatments like Prolotherapy, Platelet-Rich Plasma (PRP) Therapy, and Stem Cell Therapy work to repair the injured ligaments, tendons, and discs that are often the true source of chronic back pain. By targeting the underlying instability and tissue damage, regenerative medicine can provide significant, lasting relief and help you avoid the need for invasive surgery. It’s a way of working with your body to rebuild and restore function naturally.

Prolotherapy for Ligament and Tissue Repair

Prolotherapy is a non-surgical treatment that stimulates the body’s healing processes to strengthen and repair injured and weakened ligaments and tendons. These connective tissues are often the source of chronic back pain because when they become lax or damaged, they can’t properly support the spine, leading to instability and pain. The procedure involves injecting a natural solution (often a dextrose-based solution) into the affected area. This creates a mild, localized inflammation that triggers the body’s natural healing cascade, encouraging the growth of new, stronger tissue. Over a series of treatments, this helps to stabilize the spine and resolve the pain.

PRP (Platelet-Rich Plasma) Therapy

Platelet-Rich Plasma (PRP) Therapy is a regenerative treatment that uses the healing power of your own blood. The process begins with a simple blood draw, after which the blood is spun in a centrifuge to concentrate the platelets. These platelets are rich in growth factors—proteins that are critical for tissue repair. This concentrated platelet-rich plasma is then injected directly into the injured area of your back. The high concentration of growth factors supercharges the body’s natural healing response, accelerating the repair of damaged tendons, ligaments, muscles, and even discs, leading to reduced pain and improved function.

Stem Cell Therapy

Stem Cell Therapy is one of the most advanced forms of regenerative medicine available today. This procedure uses stem cells, the body’s own master cells, which have the remarkable ability to develop into many different types of cells. When injected into a damaged area of the spine, stem cells can help regenerate injured tissues like cartilage, ligaments, and discs. They also release powerful anti-inflammatory agents and growth factors that orchestrate a robust healing response. This helps to repair the structural damage causing the pain, offering a powerful, minimally invasive alternative to surgery for many degenerative spinal conditions.

At the Stem Cell Institute, Dr. Marc Darrow has over 30 Years of experience helping patients use their own body’s healing mechanisms through treatments like Prolotherapy, PRP, and Stem Cell Therapy to address the root cause of their back pain.

Other Minimally Invasive Procedures

Beyond regenerative medicine, there are several other minimally invasive procedures that can provide relief from back pain without the need for a large incision and lengthy recovery. These techniques are typically performed on an outpatient basis and are designed to target the specific source of pain with precision. From injections that calm inflammation to procedures that decompress nerves or stabilize fractures, these options offer effective solutions for a variety of spinal conditions. They serve as an important middle ground, providing more significant intervention than conservative care but with far fewer risks than traditional open surgery.

Injection-Based Therapies

Injection-based therapies are commonly used to deliver medication directly to the source of pain in the spine. The most well-known of these is the epidural steroid injection. During this procedure, a strong anti-inflammatory medication (a corticosteroid) is injected into the epidural space around your spinal nerves. This can help reduce swelling and relieve pain caused by conditions like herniated discs or spinal stenosis. While often not a permanent solution, these injections can provide enough relief to allow a patient to progress with physical therapy and other rehabilitative exercises that address the underlying mechanical problem.

Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA) is a procedure used to treat pain originating from the facet joints of the spine, a common cause of chronic back pain. RFA uses a specialized needle that delivers heat generated by radio waves to a specific nerve. This heat creates a lesion on the nerve, which disrupts its ability to send pain signals to the brain. The relief from RFA can last for several months to over a year, providing a significant window of pain reduction that allows patients to improve their strength and function. It’s a targeted, minimally invasive option for certain types of joint-related back pain.

Endoscopic Spine Procedures

Endoscopic spine procedures, such as an endoscopic discectomy, are ultra-minimally invasive surgical techniques used to treat conditions like herniated discs. A surgeon uses a very small incision (about the size of a keyhole) to insert an endoscope—a thin tube with a camera and light—to view the spine. Tiny surgical instruments are then passed through the endoscope to remove the portion of the disc that is pressing on a nerve. Because this approach spares the surrounding muscles and tissues, patients typically experience less pain, less scarring, and a much faster recovery compared to traditional open surgery.

Specialized Decompression and Stabilization Procedures

For conditions like spinal stenosis, where the spinal canal narrows and puts pressure on nerves, there are minimally invasive options that can provide relief without the need for a full fusion. Procedures like a laminoplasty (in the neck) or the insertion of interspinous implants (in the lower back) are designed to create more space for the nerves. A laminoplasty creates a hinge on the lamina (a part of the vertebra) to open up the spinal canal, while interspinous spacers are small devices placed between the vertebrae to hold them apart. These techniques decompress the nerves while preserving more natural motion than a spinal fusion.

Treatments for Spinal Fractures

For painful spinal compression fractures, which are common in people with osteoporosis, there are minimally invasive procedures called vertebroplasty and kyphoplasty. In both procedures, a needle is used to inject a special type of bone cement into the fractured vertebra. This cement hardens quickly, stabilizing the bone and often providing immediate pain relief. In kyphoplasty, a small balloon is first inserted and inflated to help restore some of the lost height to the vertebra before the cement is injected. These outpatient procedures can be highly effective for relieving the severe pain associated with these fractures.

Cervical Disc Replacement (CDR)

For chronic neck and arm pain caused by a damaged disc in the cervical spine, cervical disc replacement (CDR) is an advanced surgical alternative to traditional fusion. Instead of removing the damaged disc and fusing the two vertebrae together, the surgeon replaces the disc with an artificial one designed to mimic the natural motion of the spine. The primary advantage of CDR is that it relieves pressure on the nerves while preserving movement at that level of the neck. This can help reduce stress on the adjacent discs and may lower the risk of future problems in other parts of the spine.

Why are total disc replacement surgeries becoming much less popular?

In April 2019, a paper in the journal International orthopaedics (5) found conflicting and confusing recommendations patients and doctors were being given in the medical research concerning the aspects of fusion and total disc replacement surgery.

In this paper, 69 research studies were examined exploring the benefit or lack of benefit of total disc replacement. In 40 of the 69 papers, the general assessment was positive for a total disc replacement procedure,  five were negative towards the total disc replacement, 24 papers could not clearly  decide if the procedure was helpful or not.

The long term results of total disc replacement were examined in 11 studies. In 7 of the papers, total disc replacement was seen in a positive light. In the other four studies total disc replacement benefits were not clearly seen.

The research came to this suggestion for doctors: “It is concluded that problems with anterior surgery, imbursement (cost, reimbursement, coverage) policy, and potential problems with salvage surgery are major reasons for losing popularity of  total disc replacement policy surgery.”

What Happens When Back Surgery Fails?

This is highlighted segments from the University of  Minnesota’s Department of Orthopedic Surgery’s research in ClinicoEconomics and outcomes research:

  • “Back pain is complex to diagnose and expensive to treat . . .inaccurate diagnosis leading to treatments that do not target the underlying disease exposes patients to risk without benefit.
  • Poor outcomes after spine surgery are so common that practitioners in this area have created a unique term for this condition: failed back surgery syndrome.
  • Although the number of reported studies of lumbar fusion is large, well-controlled studies have shown that only approximately 60% of patients derive clinically important benefits from lumbar surgery.”(6)

The 60% may be considered an improvement over results found in other studies. In a heavily cited 2006 landmark study from the Schulthess Clinic in Zurich  Switzerland, doctors reported on 17 patients with chronic low back pain, with a positive response to specific diagnostic tests for sacroiliac joint dysfunction who a bilateral sacroiliac fusion procedure.

At the time of follow-up (on average 39 months after surgery),

  • Of the 17 patients: three patients reported moderate or absent pain
  • Eight had 8 marked pain and
  • 6 severe pain.
  • Eighteen percent of the patients were satisfied, but in the other 82% the results were not acceptable.
  • Reoperation was performed in 65% of the patients.
  • Our results with bilateral posterior SIJ fusion were disappointing, which may be related with difficulties in patient selection, as well as with surgical technique. Better diagnostic procedures and possibly other surgical techniques might provide more predictable results, but this remains to be demonstrated.(7)

NY Times: Surgery was no better than alternative nonsurgical treatments

In the August 3, 2016 edition of the New York Times, author Gina Kolata wrote:

  • “It looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options. Take what happened with spinal fusion, an operation that welds together adjacent vertebrae to relieve back pain from worn-out discs. Unlike most operations, it actually was tested in four clinical trials. The conclusion: Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain. In both groups, the pain usually diminished or went away.

Back to MRI assessment

Is MRI to blame? Doctors at the Leiden University Medical Center in the Netherlands questioned whether or not MRI has any value in determining sciatica treatment or diagnosis and why surgeons rely so heavily on the readings.(8) We often see patients who visited the doctor who had unsupported enthusiasm for sacroiliac joint dysfunction surgery because they had an MRI showing a herniation between the L5 and S1 vertebrae and a prognosis of impending surgery.

Complicated fusion surgery can be avoided if we look at the spinal ligaments

Many times a patient will come into our office with a nondescript diagnosis of back pain and/or accompanying hip pain. Despite numerous treatments which may include epidural steroid or cortisone injection, the patient still has pain and now has been recommended to a spinal procedure because something has shown up an an MRI. But is it in fact the disc problems on MRI causing the patient’s pain? Medical investigators are asking, “maybe we should look at the spinal ligaments?”

In a paper Japanese doctors came up with a scoring system to help clinicians determine if sacroiliac joint pain was originating from the posterior longitudinal ligament of the spine.

  • This pain manifests in not only the buttocks but also the groin and lower extremities and may be difficult to discern from pain secondary to other lumbar disorders, such as degenerative disc disease and stenosis – problems that usually mean surgery.(9)

The ligaments are important as attested to by researchers at University of Mississippi Medical Center. “As important as the vertebral ligaments are in maintaining the integrity of the spinal column and protecting the contents of the spinal canal, a single detailed review of their anatomy and function is missing in the literature.”

  •  Ligaments and tendons are weakened by age, overuse syndrome, or injury. In the sacroiliac joint, because it supports the torso and has large nerves running through it all the way to the feet, these injuries to the sacroiliac ligaments can mimic other injuries such as disc herniation and lead to an incorrect diagnosis which could lead to an unnecessary lower back surgery. For more on this subject please see my article “When a simple sprain is mistaken for degenerative disc disease“

Why not get a consultation to see if the ligaments are the cause of your back pain before your embark on surgery?

Our Published Research on Regenerative Back Pain Treatments

In a Darrow Stem Cell Institute research article published in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018. we discussed the use and outcomes of bone marrow stem cell treatment in low back pain patients.For the full article please visit this link.

These are the learning points of this research:

  • Even though the diagnosis may be a herniated disc, facet arthropathy, degenerative disc disease, spinal stenosis, scoliosis, spondylosis, spondylolisthesis, or other pathology, we have found for the past twenty years, with thousands of successfully treated patients, that the actual pain generator may not even be noted in the diagnosis.
  • With the risk of adverse complications of surgery and ineffectiveness of epidural injections, bone marrow concentrate (BMC) offers a promising treatment to treat lower back pain. BMC contains mesenchymal stem cells that have the ability to differentiate into muscle, cartilage, and bone, in addition to releasing trophic factors that enhance tissue regeneration.
  • The four patients included in this study underwent at least one treatment of BMC injection to the entheses of muscles, fascia, and ligaments surrounding the lumbar spine.
  • At one-year follow-up all four patients experienced a decrease in resting and active pain. Patients also reported a mean 80% total overall improvement and were able to perform daily activities with less difficulty.
  • These encouraging results warrant further investigation of the full potential of BMC injections for lower back pain.

We have published a study on PRP for chronic low back pain.
The study appears in the journal Cogent Medicine.

This research gives an insight into what level of treatment success we can have with certain back pain conditions and how many treatments the patient should expect towards achieving their treatment goals.Full Article: Marc Darrow, Brent Shaw, Schmidt Nicholas, Xian Li & Gabby Boeger | Tsai-Ching Hsu (Reviewing editor:) (2019) Treatment of unresolved lower back pain with platelet-rich plasma injections, Cogent Medicine, DOI: 10.1080/2331205X.2019.1581449

In our research, Treatment of Chronic Low Back Pain with Platelet-Rich Plasma Injections, we wrote:

  • Platelet-Rich Plasma (PRP) is a non-invasive modality that has been used to treat musculoskeletal conditions for the past two decades. Based on our research, there were no publications that studied the effect of PRP on unresolved lower back pain. The aim of this study was to report the clinical outcomes of patients who received PRP injections to treat unresolved lower back pain.

Methods: 

  • 67 patients underwent a series one, two, or three PRP injections into the ligaments, muscle, and fascia surrounding the lumbar spine.
  • Patients who received two treatments received injections a mean 24 days apart and patients who received three treatments received injections a mean 20.5 days apart.
  • Baseline and post-treatment outcomes of resting pain, active pain, lower functionality scale, and overall improvement percentage were compared to baseline and between groups.

Results: 

  • Patients who received one PRP injection reported 36.33% overall improvement and experienced significant improvements in active pain relief. These same patients experienced improvements in resting pain and functionality score, yet these results were not statistically significant.
  • Patients who received a series of two and three treatments experienced significant decreases in resting pain and active pain and reported 46.17% and 54.91% total overall improvement respectively. In addition, they were able to perform daily activities with less difficulty than prior to treatment.

1 Gelalis ID, Papadopoulos DV, Giannoulis DK, Tsantes AG, Korompilias AV. Spinal motion preservation surgery: indications and applications. Eur J Orthop Surg Traumatol. 2018 Apr;28(3):335-342. doi: 10.1007/s00590-017-2052-3. Epub 2017 Oct 6. Review. PubMed PMID: 28986691.
2 Daniell JR, Osti OL. Failed Back Surgery Syndrome: A Review Article. Asian Spine J. 2018;12(2):372-379.
3 Clancy C, Quinn A, Wilson F. The aetiologies of failed back surgery syndrome: a systematic review. Journal of back and musculoskeletal rehabilitation. 2017 Jan 1;30(3):395-402.
4 Shaffrey CI, Smith JS. Editorial: Stabilization of the sacroiliac joint. Neurosurg Focus. 2013 Jul;35(2 Suppl):Editorial. doi: 10.3171/2013.V2.FOCUS13273.
5 Kovač V. Failure of lumbar disc surgery: management by fusion or arthroplasty?. Int Orthop. 2019;43(4):981–986. doi:10.1007/s00264-018-4228-9
5 Polly DW, Cher D. Ignoring the sacroiliac joint in chronic low back pain is costly. ClinicoEconomics and Outcomes Research: CEOR. 2016;8:23-31. doi:10.2147/CEOR.S97345.
6 Schütz U1, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg. 2006 Jun;72(3):296-308.
7 el Barzouhi A, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Koes BW, Peul WC; Leiden-Hague Spine Intervention Prognostic Study Group. Predictive value of MRI in decision making for disc surgery for sciatica. J Neurosurg Spine. 2013 Dec;19(6):678-87. doi: 10.3171/2013.9.SPINE13349. Epub 2013 Oct 18.
8 Kurosawa D, Murakami E, Ozawa H, Koga H, Isu T, Chiba Y, Abe E, Unoki E, Musha Y, Ito K, Katoh S, Yamaguchi T. A Diagnostic Scoring System for Sacroiliac Joint Pain Originating from the Posterior Ligament.Pain Med. 2016 Jun 10. pii: pnw117..
9. Butt AM, Gill C, Demerdash A, Watanabe K, Loukas M, Rozzelle CJ, Tubbs RS. A comprehensive review of the sub-axial ligaments of the vertebral column: part I anatomy and function. Childs Nerv Syst. 2015 May 1.

Making an Informed Decision About Your Treatment

Navigating back pain treatment can feel overwhelming, especially when surgery seems like the only path. As the research shows, even common procedures can have disappointing results. The key to finding relief is becoming your own best advocate by asking questions, exploring all your options, and understanding when to seek different types of care. Making an informed choice is the most critical step you can take toward reclaiming your quality of life from chronic back pain.

When to See a Spine Specialist

If your back pain persists or you’ve been told surgery is your only option, it’s time to consult a specialist. While a primary doctor is a great start, a specialist offers a more focused diagnosis and a wider range of treatments, especially if you want to avoid surgery. Experts in pain management and regenerative medicine look at your condition differently than a surgeon might, focusing on underlying causes like ligament damage—a common but often overlooked pain generator. Seeking out a specialist with decades of experience in non-surgical solutions can reveal new pathways to healing.

Why Getting a Second Opinion Matters

Getting a second opinion isn’t a sign of distrust; it’s a sign of a smart, engaged patient. When facing a major decision like back surgery, gathering multiple expert perspectives is crucial. One study found that 88% of patients received a new or more refined diagnosis after a second opinion. A surgeon is trained to fix problems surgically, while a regenerative medicine specialist looks for ways to help the body heal itself. Consulting with different experts gives you a complete picture of your condition and all potential treatments, empowering you to choose the right path. If you’re ready to explore a non-surgical perspective, you can schedule a consultation to discuss your case.

Recognizing “Red Flag” Symptoms: When to Seek Emergency Care

While it’s important to consider your options for chronic pain, some symptoms demand immediate medical attention. These “red flags” can signal a serious condition requiring urgent care. The most critical red flag for back pain is the sudden loss of bladder or bowel control, possibly with numbness in the groin or saddle area. This could be Cauda Equina Syndrome, where compressed nerve roots can cause permanent paralysis if not treated quickly. If you experience these specific symptoms, do not wait. Go to the nearest emergency room for an immediate evaluation.

Frequently Asked Questions

My MRI shows a herniated disc. Doesn’t that mean I need surgery? This is one of the most common questions we hear, and it gets to the heart of the issue. An MRI is a static picture of your spine’s structure, but it can’t show you where your pain is coming from. Many people walk around with herniated discs and feel absolutely no pain, while others have excruciating pain with a perfectly normal-looking scan. The real source of your pain might be something an MRI can’t see, like inflammation, muscle spasms, or instability in the ligaments that support your spine. A surgical recommendation based only on an image might not address the true cause of what you’re feeling.

You talk a lot about ligaments being the problem. Why hasn’t my doctor mentioned this? It often comes down to a difference in training and focus. Traditional orthopedic and surgical training is heavily centered on bones, discs, and nerves—the structures that are clearly visible on X-rays and MRIs. Diagnosing pain that comes from ligament weakness or injury requires a different approach, one that relies more on a hands-on physical examination and an understanding of how the spine moves and stabilizes itself. Regenerative medicine specialists are specifically trained to identify and treat these connective tissue injuries, which are frequently overlooked as the root cause of chronic pain.

How do I know if I’m a good candidate for regenerative treatments like PRP or Stem Cell Therapy? You might be a great candidate if you’re dealing with chronic back pain that hasn’t improved with conservative care like physical therapy, but you want to avoid the risks and long recovery of major surgery. These treatments work best for pain caused by underlying tissue damage and instability in the ligaments, tendons, and joints of the spine. The only way to know for sure is to have a thorough evaluation with a specialist in regenerative medicine. They can determine the precise cause of your pain and assess whether helping your body repair itself is the right path for you.

With so many non-surgical options, where do I even start? It feels overwhelming. It’s completely understandable to feel that way. The best way to simplify the process is to focus on getting an accurate diagnosis first, rather than just chasing symptoms. Start with the foundational habits you can control, like posture, gentle movement, and an anti-inflammatory diet. If the pain continues, the next step isn’t to try every therapy on the list, but to get a comprehensive evaluation from a specialist who looks beyond the MRI. Once you have a clear understanding of what’s causing your pain, you and your doctor can build a logical treatment plan that targets the specific issue.

I’ve already had one back surgery that didn’t work. Is it too late for these alternatives? It is absolutely not too late. In fact, many patients we see have already been through one or more unsuccessful surgeries. This condition, often called Failed Back Surgery Syndrome, can occur when the initial procedure doesn’t address the root cause of the pain or even creates new instability in the surrounding areas. Regenerative treatments can be particularly effective in these situations by helping to strengthen the weakened ligaments and supporting tissues around the surgical site, providing the stability that the surgery may have failed to achieve.

Key Takeaways

  • Surgery Isn’t Always the Answer: Research shows that common spinal surgeries have surprisingly low success rates that decrease with each repeat procedure. It’s crucial to understand that an invasive operation is not a guaranteed fix and may lead to complications like Failed Back Surgery Syndrome.
  • Your Pain’s True Source Might Be Hidden: An MRI can be misleading, showing issues that aren’t causing pain or missing the real problem entirely. The root cause of chronic back pain is often weakened spinal ligaments, an issue that standard imaging doesn’t detect but can be treated effectively.
  • Your Body Has the Power to Heal: Regenerative treatments like PRP and Stem Cell Therapy offer a powerful alternative to surgery by addressing the underlying tissue damage. These procedures use your body’s own natural healing abilities to repair injured ligaments and discs, providing a path to lasting relief and restored function.

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