The Spinal Surgeries That Didn’t Need to Happen: Rethinking the Back Pain Fix

The Story Behind the Scalpel

In her thought-provoking piece, “The Spinal Surgeries That Didn’t Need to Happen” (New York Magazine, 2025), journalist Paula Aceves highlights a growing and uncomfortable truth in musculoskeletal medicine: thousands of Americans undergo spinal fusion surgeries that may never have been necessary.

Through the story of Tiffany Bruce, who endured six spinal fusions over two decades for chronic back pain, the article unveils a recurring pattern — escalating surgical intervention met with diminishing returns. Each procedure promised relief; instead, she found herself trapped in the cycle known as Failed Back Surgery Syndrome (FBSS) — persistent or worsening pain after structurally successful surgery.

Her case is not an anomaly; it’s a mirror held up to a healthcare system too quick to cut and too slow to question.

The Rise of Spinal Fusion: When “Doing Something” Becomes the Norm

Since the 1990s, spinal fusion procedures have skyrocketed in the U.S. In many hospital systems, they now rival joint replacements in frequency — despite far murkier evidence for long-term benefit.

What began as a life-saving technique for trauma, tumors, or gross instability has become a default response for degenerative disc disease, spinal stenosis, and “chronic low back pain.”

The problem? Back pain is not a structural defect — it’s a multifactorial, biopsychosocial experience. MRIs reveal degeneration in most adults over 40, yet the majority are asymptomatic. As Aceves notes, imaging doesn’t equal illness.

Still, surgical rates keep climbing — fueled by patient expectations, institutional incentives, and sometimes, the illusion that mechanical pain must have a mechanical fix.

What the Experts Are Saying — A Growing Skepticism

Across orthopedics and neurosurgery, dissenting voices are growing louder:

• Dr. Eugene Carragee (Stanford), one of the field’s leading skeptics, has long warned that “the evidence supporting lumbar fusion for degenerative back pain is weak at best.”

• A 2023 systematic review (ES Bada et al.) concluded there is no consistent proof that spinal fusion outperforms conservative care in chronic low back pain.

• AlAli et al. (2023) found that as many as 60% of patients recommended for spine surgery didn’t actually need it, based on second opinions and imaging review.

• Others, like Miękisiak et al., emphasize the role of psychosocial factors — fear, depression, and catastrophization — in perpetuating post-surgical pain, a perspective that aligns with modern pain neuroscience.

Even within surgical circles, frustration brews. Surgeons admit that predicting who will benefit is elusive. Some candidly note that even “technically perfect” operations often fail to deliver meaningful relief.

Why Fusions Fail — and What We Miss

Spinal fusion alters biomechanics by permanently joining two or more vertebrae. The price of stabilizing one segment is often accelerated wear on its neighbors — a phenomenon known as adjacent segment disease.

In time, patients return with new pain, new degeneration, and new imaging “findings” that justify the next fusion.

It’s not malice — it’s momentum.

Layer in financial incentives (surgeon compensation, hospital revenue, device industry ties), and a system emerges where more surgery often seems like the logical next step — even when outcomes suggest otherwise.

Pain: The System, Not the Structure

Here’s where modern pain science reframes the conversation. Pain is not simply the product of damaged tissue — it is an output of the brain, influenced by biological, psychological, and social inputs.

When we fixate on spinal structures alone, we risk missing the central mechanisms of chronic pain:

• Sensitization of the nervous system

• Altered movement and motor patterns

• Neuroimmune and hormonal dysregulation

• Fear, catastrophization, and loss of agency

These mechanisms cannot be cut out. They must be retrained, not removed — through education, graded activity, and movement exposure, not through fusion hardware.

The Physical Therapy Perspective: Building Resilience, Not Dependence

From a clinical rehabilitation lens, the solution lies not in eliminating pain but in restoring adaptability.

Effective interventions — when grounded in evidence — include:

• Pain neuroscience education (to reduce threat perception)

• Graded motor control and loading (to restore movement confidence)

• Cognitive-behavioral integration (to reframe pain as manageable, not monstrous)

• Lifestyle and systemic factors (sleep, stress, inflammation, and conditioning)

The patient’s narrative shifts from “my back is broken” to “my system is capable of change.”

The Call for Change

The issue isn’t that spinal surgery has no place — it’s that its use has outpaced its proof.

To reform this culture, three shifts are necessary:

1. Evidence-based restraint — Reserve fusion for clear, structural pathology (trauma, instability, deformity).

2. Patient education before intervention — No one should undergo fusion without understanding the limited evidence for chronic pain relief.

3. Systemic accountability — Reimbursement and performance metrics should reward outcomes, not volume.

Closing Reflection: Pain as a Signal for Change

Tiffany Bruce’s story, like thousands of others, reminds us that the pursuit of a “fix” can sometimes deepen the wound.

If pain is the body’s alarm system, perhaps the real message isn’t to fuse it silent — but to listen differently.

Understanding pain as a dynamic, adaptive, and reversible process gives patients hope beyond the operating table — hope grounded in biology, not hardware.

References

• Aceves, P. (2025). The Spinal Surgeries That Didn’t Need to Happen. New York Magazine.

• Miękisiak, G., et al. (2023). Failed Back Surgery Syndrome. Medicina, 59(7):1255.

• AlAli, K.F., et al. (2023). Unnecessary Spine Surgery: Can We Solve This Ongoing Problem? Journal of Spine Surgery.

• Bada, E.S., et al. (2024). Lumbar Spine Fusion vs Conservative Care: Systematic Review. BMJ Open.

• Carragee, E. (Stanford University). Spine outcome research commentaries, 2019–2024.