Back and shoulder surgery is often worse than useless

There's a huge amount of confirmation bias in the process of diagnosing musculoskeletal conditions based on imaging studies. When a patient presents with a complaint about pain or lack of mobility then the care team will order imaging, and when they see some anatomic abnormality they'll assume it's causing the symptoms and needs to be surgically repaired. But studies have shown that if we perform the same imaging studies on a random population of subjects we'll find a lot of abnormalities and yet most of those subjects are asymptomatic.

This is a huge problem in US health care financing: we have a fee-for-service model, no price transparency, and a consumer base (insulated from a lot of the costs of procedures by indirect payment through employer-provided insurance) conditioned to think procedures are inherently good. We waste billions annually on procedures that shouldn't be delivered at all.

I'm fond of pointing out the stat (true as of a year ago) that Massachusetts (I think it's MA?) has more MRI machines than the entire country of Canada.

As someone who's going to the doctor next week to discuss potential shoulder surgery, this is timely.

I really need to figure out whether it's going to make things better or worse, but unfortunately, that feels like something a doctor can't guarantee one way or the other.

Any anecdotes or other experiences/thoughts are appreciated.

Here’s the accompanying article from the Science & Tech section.

https://www.economist.com/science-and-technology/2026/09/23/...

Gift link: https://www.economist.com/science-and-technology/2026/09/23/...

For those interested in pricing transparency, check out https://www.dolthub.com/repositories/dolthub/standard-charge...

and the Dartmouth Atlas of Health Care - https://www.dartmouthatlas.org/

Well, sample size of 1 but a family member was in debilitating pain all the time until they had a couple vertebrae fused. They can walk and life is mostly normal for them now.

As someone with herniated discs, spinal stenosis, degenerative disc disease and scoliosis for decades, who's already had surgery but still got worse... what else even is there besides more surgery?

I can't wave a magic wand and just put more space between my discs... that's the only thing that's going to ease off my pain as far as I'm aware.

Strengthening my posterior chain solved my back pain from desk based living. I didn't realize how weak it actually was. It is almost like strong muscle structure helps brace and hold the bones in better position.

I've had a searing rotator cuff for over 2 years. Someone recommended peptides called Wolverine Blend. It is now healed after 3 weeks of injections.

The thing is, this seems to be rather common.

I wasn't able to read the full article because of the paywall, but as someone who had back surgery and live with complications from it (mainly from spending a decade postponing going to a competent doctor to have a diagnosis and a healthy fear of hospitals - don't be me, if you feel regular back pain or if you sometimes feel back pain that is incapacitating, seek proper medical care - things tend to degrade, and I'm actually quite lucky I'm not in a wheelchair, not kidding) I think I'm entitled to say a thing or two:

We have a statistics problem. Thing is, the way successful surgeries vs botched procedures are measured isn't transparent; as an example, my mother died 2 years ago victim to a routine procedure; It was a combination of both "bad luck" (something went wrong with the procedure) with laxity (prolonged weekend, nobody cared about complaints). Because she didn't died on the table, instead from "complications in recovery" (fyi they accidentally perfurated the intestine during the procedure), its "natural causes".

Many years ago, my dad died from meningitis, 8-10 months after a surgery and a very long recovery. I'd bet a couple of fingers it was a hospital-contracted infection during either the surgery or the recovery. Again, a routine surgery took 8h instead of the expected 2.5-3h. Shit happens, we know - surgery is extremely dangerous, and there is a shit ton of stuff that can go wrong.

Thing is, none of this get into the statistics; There are no reliable survival metrics; The papers you sign are riddled with medical terms to isolate you from the consequences (would you do a non-critical surgery if you could end up shitting on a stomach bag for the rest of your life?), and many many doctors are quite happy into "selling you" their trade option. To be clear, the number any doctor presents you is *wrong*; it has no connection with reality; failure rates measure deaths on the table (the best kind of death, btw), and studies extrapolate from badly measured (per-hospital metrics) or non-existing data.

Tl,DR: avoid surgery if you can; If you really need it (after asking for at least 2 more opinions), your health (and often life choices) matter - bad kidneys, weak liver, etc may be the difference between someone rushing it up or giving an extra 20 min to ensure everything is kosher.

Surgeons often jump too quickly to the knife. Effective physical therapy or lifestyle adjustments frequently offer superior, less invasive outcomes.

(Below has nothing to do with people who need surgery due to catastrophic injury or congenital defect.)

Most surgeries are followed by more surgeries.

And the hard truth is that most surgeries happen because most people do not have the discipline to do what's needed over many months to solve the problems they are having with the chronic pain they are in. They want a faster solution and are never really told by anyone that the only real permanent solution is one that will be difficult and take months.

Rather than change their habits and their environments and their bodies, people opt to do things that have surprisingly low rates of success and more often than not result in a state than can never be fixed.

Some people get past the point of no return. For those people, surgery may be the only option. But for most people the only real option is a change in lifestyle that is more or less like deciding you are going to get very fit. It takes months and in the mean time, theres a lot of effort and discomfort.

In addition, most people don't really get how much of their back pain and ailment is due to ergonomics. That their bed is wrong. That they are sitting in a bad office chair or couch.

But more than that, most people don't get how central exercise and core strength are for maintaining the health of your back.

So before you get back surgery, consider getting a new office chair, exercising more, and facing that pain for a few more months. Work toward a real solution.

The same could be said about economist articles behind paywalls; worse than useless as it prevents linking to an article covering it at a different source. Perhaps https://www.unsw.edu.au/newsroom/news/2022/03/three-orthopae... or https://www.thetimes.com/life-style/health-fitness/article/h... instead