Considering Back Surgery? Why More Patients Are Trying Chiropractic Care First

If a doctor has mentioned back surgery as an option for you, I want you to know something before you go any further: surgery is rarely the only option, and in most cases, it shouldn't be the first one.

I've spent nearly 50 years treating back pain in Sioux Falls, and I've also spent a significant part of my career helping patients who had surgery and were still in pain afterward. That experience has given me a clear view of both sides of this decision. So I want to walk you through what the research actually says, what your options look like, and why trying conservative care first is worth taking seriously before you commit to an operation.

Most Back Pain Doesn't Require Surgery

This might surprise you, but the majority of back pain cases are mechanical in nature, not surgical emergencies. Low back pain is one of the leading causes of disability worldwide, yet the majority of cases are mechanical rather than surgical emergencies, and most patients do not need surgery, opioids, or extensive imaging during the early stages of care.

That doesn't mean your pain isn't real or serious. It means that the structures in your spine causing your pain often respond well to non-surgical treatment that restores movement and function, without the risks that come with going under the knife.

What the Clinical Guidelines Actually Recommend

This isn't just a chiropractor's opinion. Major medical guidelines now point in this direction.

Clinical guidelines from multiple healthcare organizations now recommend conservative treatment first, including spinal manipulation, movement-based therapies, and exercise. The American College of Physicians guidelines specifically recommend non-drug treatments like exercise, spinal manipulation, or yoga as first-line therapies, and orthopedic guidelines generally recommend conservative care for six to twelve weeks unless there are severe neurological deficits.

Some insurance plans have built this expectation directly into their coverage requirements. One major health plan mandated that candidates for spine surgery must prove they have tried and failed a three-month conservative treatment plan that includes chiropractic care and physical therapy before surgery will be authorized. That policy shift reflects a broader recognition in healthcare that surgery should be a later step, not a first response.

What the Research Says About Outcomes

The numbers on back surgery outcomes are worth understanding before you make this decision.

The American Society of Anesthesiologists estimates that 20 to 40 percent of back surgeries fail to resolve the patient's symptoms. This is the condition I see most often in my own practice — patients who had surgery, did everything they were told, and are still dealing with pain months or years later. It's called Failed Back Surgery Syndrome, and it's far more common than most patients realize going in.

Repeat surgeries carry even steeper odds. One study found that only 30 percent of second back surgeries are successful, and the chance of success continues to drop with each additional procedure. Even among patients who try conservative treatment first and still ultimately need surgery, one study found that 94 percent of patients who underwent back surgery after first trying medications and physical therapy still reported low back pain afterward, with the majority also reporting dull aches or numbness.

I'm not sharing these numbers to scare you away from a surgery you may genuinely need. I'm sharing them because informed decisions are better decisions, and too many patients aren't given this context before they consent to an operation.

Chiropractic Care Can Help You Avoid Surgery Entirely

For many patients, conservative chiropractic care resolves the problem before surgery ever becomes necessary.

Research published in JAMA Network Open found that spinal manipulation provides improvements in pain and function for non-specific low back pain compared to usual care, and a randomized trial in a U.S. military population found that adding chiropractic care to usual medical care improved outcomes within six weeks.

Sciatica is one of the more striking examples. A randomized trial found that 60 percent of patients with sciatica who were already considered surgical candidates improved with chiropractic spinal manipulation and avoided surgery entirely, with outcomes similar to those who underwent microdiscectomy.

That's a meaningful number. Six out of ten patients who were told they likely needed surgery improved with conservative care alone.

If You Do Need Surgery, Chiropractic Care Still Has a Role

I want to be honest with you: chiropractic isn't a replacement for every surgery. Chiropractors cannot set broken bones or correct structural scoliosis, and severe neurological deficits sometimes do require surgical intervention. If your situation falls into that category, I will tell you directly and help you find the right specialist.

But even when surgery is the right path, conservative care still plays an important role on both sides of the procedure.

Before surgery. Pre-surgical chiropractic care, sometimes called prehab, focuses on improving strength, mobility, and joint mechanics before an operation, and patients who complete it often begin the surgical process in a stronger, more stable condition, which can contribute to better overall outcomes.

After surgery. Once you've fully healed from the procedure and your surgeon has cleared you, gentle chiropractic care can support your recovery. At Back Specialists, this is exactly the population we treat through our Failed Back Surgery Syndrome program — patients whose surgery didn't fully resolve their pain, and who are looking for a path forward that doesn't involve another operation.

Why the Activator Method Is a Good Fit for This Decision

If you're weighing surgery against conservative care, the technique matters. At Back Specialists, Dr. Bruce Jon Hagen and Dr. Sean Hagen practice exclusively with the Activator Method — a gentle, instrument-assisted technique that delivers precise, low-force adjustments without any twisting, cracking, or high-velocity manipulation.

This matters for two reasons if you're considering this path. First, it's an appropriate, low-risk option for patients who are in significant pain and may be apprehensive about more forceful manual techniques. Second, if you've already had spinal surgery and are exploring whether chiropractic can help your remaining symptoms, the Activator's precision and gentleness make it a safe option for a surgically altered spine, when appropriate and cleared by your surgeon.

What to Do If You've Been Told You Need Surgery

If a doctor has recommended back surgery, here's what I'd suggest before you move forward:

Ask whether conservative care has truly been tried. If you haven't completed a real course of chiropractic care, physical therapy, and structured exercise, you haven't exhausted your non-surgical options yet.

Get a second opinion specifically on the conservative path. A surgeon's job is to evaluate whether surgery can help. A chiropractor with deep experience in complex spinal cases can evaluate whether it's necessary in the first place.

Understand your specific diagnosis. Not all back pain is the same, and not all causes respond equally well to conservative care. A thorough evaluation, including a review of any imaging you've had, will give you a clearer picture of what's actually driving your pain.

Don't wait too long to start care either way. Whether you ultimately pursue surgery or conservative treatment, delaying any treatment allows symptoms to become more entrenched and harder to resolve.

At Back Specialists, we offer thorough evaluations for exactly this situation. If conservative care can help you avoid surgery, we want to give you that chance. If it can't, we'll tell you honestly and help you find the right next step.

Make This Decision With Full Information

Surgery is sometimes the right answer. But it should never be the first answer without a real conservative effort first, and it should never be a decision made without understanding the actual success rates and risks involved.

If you're weighing back surgery and want an honest, experienced evaluation of whether chiropractic care could help you avoid it, I'd like to talk with you.

Call or text 605-361-1700 or schedule online to set up your evaluation.

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