I spend a lot of time with patients helping them to understand the benefits and risks associated with lumbar disc replacement surgery. They’re usually very knowledgeable, since they’ve generally had years to perform internet searches and other research to learn from others’ experiences. But one key question they often ask me is: “At what point do I give up on non-surgical options for my pain?”

Please note that I’m writing this blog specific to lumbar disc replacement surgery; other procedures will have different recovery/recuperation processes, and the risks associated with other procedures may be different. Make sure you are considering this question with respect to the specific procedure you’re potentially undertaking, as well as the risks associated with that procedure. For example, I counsel my spinal fusion patients to understand that this is a procedure that may need to be repeated in the future, as fusing one level may cause adjacent levels to degenerate. Disc replacement surgery has been shown to have a much lower propensity for adjacent level degeneration—however, no one has been able to determine whether this propensity is greater or less than the natural aging process.

Everyone’s patient journey is unique. However, after having answered this question for many years, the below points may help.

There are a limited number of non-surgical treatments. Most patients I work with try a non- surgical treatment and many of those patients find this successful and do not need additional therapy. A smaller number of patients will go on to a second, third, or fourth option. As treatments fail to provide relief, we begin discussing surgical options.

Many patients limit their activities in response to pain episodes. This often leads them to narrow their ‘fun’ and not live a full life (see the above chart for the degenerative cascade I often see patients move through).

Back pain can affect many aspects of your life. It has been increasingly linked to major mental conditions, and can affect one’s career, relationships, your ability to get a good night’s rest, as well as your mental health. Chronic pain has also been shown to affect your abilty to effectively use time, energy and attention.

Patients often delay surgery until they can’t stand it anymore—if they can ‘manage’ then they don’t choose to take a risk on surgery. There is usually some trigger or ‘breaking point’ beyond which people recognize that they’re missing out on life by living in pain.

Most of my patients find relief after lumbar disc replacement surgery—however, there are complications associated with any surgical procedure. These include, but are not limited to, the below. Please discuss all other potential risks and complications with your surgeon.
- Anesthesia risks, such as allergic reactions
- Bleeding risks, such as blood clots
- Infection

Lumbar disc replacement surgery can potentially require a lengthy physical therapy process to fully recover.
- Nearly all of my patients take months to fully recover, but this generally varies depending on the health/fitness of the patient prior to the procedure. Have they had back pain that prevented them from pursuing most physical activity for years, or did they have a boating accident that led to an abrupt disc herniation? Have their back muscles atrophied over the years due to their lack of activity? What is their willingness/ability to commit to working to regain core fitness?
- Typically, my patients experience a 75% pain reduction at 6 weeks, and 95% at 3 months.
- Typical patients are on their feet the same day (but have incision pain), are back to work within a few weeks, and can have a full range of activities within three months.

Post-operative recovery often requires some advanced planning.
- You will need to provide normal care for your belly incision for up to two weeks.
- You won’t be able to drive, lift small children, or vacuum (among other things) until cleared by your surgeon to ensure your incision and muscles have a chance to heal and recover.
- I usually see patients 2 weeks after the procedure, 3 months afterwards, 6 months afterwards, and then at 12 months.

Your doctor can help you determine whether you’ve exhausted your non- surgical treatment options. Only you can decide that you’re done living with painful conditions and are ready to undertake a surgical solution. In my hands, lumbar disc replacement surgery has been highly effective, but should only be undertaken when you’ve reached that point where you’ve run out of useful non-surgical solutions and are ready to undertake the work needed to rehab after surgery.

About the Author:

Dr. William D. Bradley specializes in both minimally-invasive and complex spinal procedures. He has extensive experience in conservative treatment of neck and back pain, degenerative spinal conditions, artificial disc replacement, reconstructive spine surgery and offers the most modern advancements in spine care.

Opinions expressed herein are those of Dr. Bradley based upon his qualifications as a surgeon.

Important Note: The patient information presented is for general education purposes only. As with any spine surgery, there are potential benefits, complications, and risks associated with disc replacement and spinal fusion procedures. Individual results may vary. It is important that you discuss the possible risks and potential benefits of various procedures with your doctor prior to receiving treatment, and that you rely on your physician’s best judgment. Only your doctor can determine whether you are a suitable candidate for a specific surgical procedure.

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