Elon Musk says ‘disc replacement’ worked for him. But evidence this surgery helps chronic pain is lacking
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Last week in a post on X, owner of the platform Elon Musk recommended people look into disc replacement if they’re experiencing severe neck or back pain.
According to a biography of the billionaire, he’s had chronic back and neck pain since he tried to “judo throw” a 350-pound sumo wrestler in 2013 at a Japanese-themed party for his 42nd birthday, and blew out a disc at the base of his neck.
In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.
Musk’s original post has so far had more than 50 million views and generated controversy. So what is disc replacement surgery and what does the evidence tells us about its benefits and harms?
What’s involved in a disc replacement?
Disc replacement is a type of surgery in which one or more spinal discs (a cushion between the spine bones, also known as vertebrae) are removed and replaced with an artificial disc to retain movement between the vertebrae. Artificial discs are made of metal or a combination of metal and plastic.
Disc replacement may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.
Disc replacement is major surgery. It requires general anaesthesia and the operation usually takes 2–4 hours. Most people stay in hospital for 2–7 days. After surgery patients can walk but need to avoid things like strenuous exercise and driving for 3–6 weeks. People may be required to wear a neck collar (following neck surgery) or a back brace (following back surgery) for about 6 weeks.
Costs vary depending on whether you have surgery in the public or private health system, if you have private health insurance, and your level of coverage if you do. In Australia, even if you have health insurance, a disc replacement surgery may leave you more than A$12,000 out of pocket.
Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion) but its use is increasing.
In New South Wales for example, rates of privately-funded disc replacement increased six-fold from 6.2 per million people in 2010–11 to 38.4 per million in 2019–20.
What are the benefits and harms?
People considering surgery will typically weigh that option against not having surgery. But there has been very little research comparing disc replacement surgery with non-surgical treatments.
Clinical trials are the best way to determine if a treatment is effective. You first want to show that a new treatment is better than doing nothing before you start comparisons with other treatments. For surgical procedures, the next step might be to compare the procedure to non-surgical alternatives.
Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain. As a result, there’s a great deal of uncertainty about the treatment.
There are no clinical trials we know of investigating whether disc replacement is effective for neck pain compared to nothing or compared to non-surgical treatments.
For low back pain, the only clinical trial that has been conducted to our knowledge comparing disc replacement to a non-surgical alternative found disc replacement surgery was slightly more effective than an intensive rehabilitation program after two years and eight years.
Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.
In the clinical trial mentioned above, 26 of the 77 surgical patients had a complication within two years of follow up, including one person who underwent revision surgery that damaged an artery leading to a leg needing to be amputated. Revision surgery means a re-do to the primary surgery if something needs fixing.
Are there effective alternatives?
The first thing to consider is whether you need surgery. Seeking a second opinion may help you feel more informed about your options.
Many surgeons see disc replacement as an alternative to spinal fusion, and this choice is often presented to patients. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement to spinal fusion. These studies show people with neck pain may recover and return to work faster after disc replacement compared to spinal fusion and that people with back pain may get slightly better pain relief with disc replacement than with spinal fusion.
However, spinal fusion is similarly not well supported by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm.
Fortunately for patients, there are new, non-surgical treatments for neck and back pain that evidence is showing are effective – and are far cheaper than surgery. These include treatments that address both physical and psychological factors that contribute to a person’s pain, such as cognitive functional therapy.
While Musk reported a good immediate outcome with disc replacement surgery, given the evidence – or lack thereof – we advise caution when considering this surgery. And if you’re presented with the choice between disc replacement and spinal fusion, you might want to consider a third alternative: not having surgery at all.
Giovanni E Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Reduce Your Skin Tag Risk
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝As I get older, I seem to be increasingly prone to skin tags, which appear, seemingly out of nowhere, on my face, chest and back. My dermatologist happily burns them off – but is there anything I can do to prevent them?!❞
Not a lot! But, potentially something.
The main risk factor for skin tags is genetic, and you can’t change that in any easy way.
The other main risk factors are connected to each other:
Skin folds, and chafing
Skin tags mostly appear where chafing happens. This can be, for example:
- Inside joint articulations (especially groin and armpits)
- Between fat rolls (if you have them)
So, if you have fat rolls, then losing weight will also reduce the risk of skin tags.
Additionally, obesity and some often-related problems such as diabetes, hypertension, and an atherogenic lipid profile also increase the risk of skin tags (amongst other more serious things):
See: Association of Skin Tag with Metabolic Syndrome and its Components
As for the chafing, this can be reduced in various ways, including:
- losing weight if (and only if) you are carrying excess weight
- dressing against chafing (consider your underwear choices, for example)
- keeping hair in the armpits and groin (it’s part of what it’s there for)
See also: Simply The Pits: These Underarm Myths!
Take care!
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Nutrivore – by Dr. Sarah Ballantyne
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The core idea of this book is that foods can be assigned a numerical value according to their total nutritional value, and that this number can be used to guide a person’s diet such that we will eat, in aggregate, a diet that is more nutritious. So far, so simple.
What Dr. Ballantyne also does, besides explaining and illustrating this system (there are chapters explaining the calculation system, and appendices with values), is also going over what to consider important and what we can let slide, and what things we might need more of to address a wide assortment of potential health concerns. And yes, this is definitely a “positive diet” approach, i.e. it focuses on what to add in, not what to cut out.
The premise of the “positive diet” approach is simple, by the way: if we get a full set of good nutrients, we will be satisfied and not crave unhealthy food.
She also offers a lot of helpful “rules of thumb”, and provides a variety of cheat-sheets and suchlike to make things as easy as possible.
There’s also a recipes section! Though, it’s not huge and it’s probably not necessary, but it’s just one more “she’s thinking of everything” element.
Bottom line: if you’d like a single-volume “Bible of” nutrition-made-easy, this is a very usable tome.
Click here to check out Nutrivore, and start filling up your diet!
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Intermittent Fasting, Intermittently?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Have you come across any research on alternate-day intermittent fasting—specifically switching between one day of 16:8 fasting and the next day of regular eating patterns? I’m curious if there are any benefits or drawbacks to this alternating approach, or if the benefits mainly come from consistent intermittent fasting?❞
Short and unhelpful answer: no
Longer and hopefully more helpful answer:
As you probably know, usually people going for approaches based on the above terms either
- practise 16:8 fasting (fast for 16 hours each day, eat during an 8-hour window) or
- practise alternate-day fasting (fast for 24 hours, eat whenever for 24 hours, repeat)
…which latter scored the best results in this large meta-analysis of studies:
There is also the (popular) less extreme version of alternate-day fasting, sometimes called “eat stop eat”, which is not a very helpful description because that describes almost any kind of eating/fasting, but it usually refers to “once per week, take a day off from eating”.
You can read more about each of these (and some other variants), here:
Intermittent Fasting: What’s The Truth?
What you are describing (doing 16:8 fasting on alternate days, eating whenever on the other days) is essentially: intermittent fasting, just with one 16-hour fast per 48 hours instead of per the usual 24 hours.
See also: International consensus on fasting terminology ← the section on the terms “STF & PF” covers why this gets nudged back under the regular IF umbrella
Good news: this means there is a lot of literature into the acute (i.e., occurring the same day, not long-term)* benefits of 16:8 IF, and that means that you will be getting those benefits, every second day.
You remember that meta-analysis we posted above? While it isn’t mentioned in the conclusion (which only praised complete alternate-day fasting producing the best outcomes overall), sifting through the results data discovers that time-restricted eating (which is what you are doing, by these classifications) was the only fasting method to significantly reduce fasting blood glucose levels.
(However, no significant differences were observed between any IF form and the reference (continuous energy restriction, CER, i.e. calorie-controlled) diets in fasting insulin and HbA1c levels)
*This is still good news in the long-term though, because getting those benefits every second day is better than getting those benefits on no days, and this will have a long-term impact on your healthy longevity, just like how it is better to exercise every second day than it is to exercise no days, or better to abstain from alcohol every second day than it is to abstain on no days, etc.
In short, by doing IF every second day, you are still giving your organs a break sometimes, and that’s good.
All the same, if it would be convenient and practical for you, we would encourage you to consider either the complete alternate-day fasting (which, according to a lot of data, gives the best results overall),or time-restricted eating (TRE) every day (which, according to a lot of data, gives the best fasting blood sugar levels).
You could also improve the TRE days by shifting to 20:4 (i.e., 20 hours fasting and 4 hours eating), this giving your organs a longer break on those days.
Want to learn more?
For a much more comprehensive discussion of the strengths and weaknesses of different approaches to intermitted fasting, check out:
Enjoy!
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Galveston Diet Cookbook for Beginners – by Martha McGrew
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We recently reviewed “The Galveston Diet”, and here’s a cookbook (by a nutritionist) to support that.
For the most part, it’s essentially keto-leaning, with an emphasis on protein and fats, but without quite the carb-cut that keto tends to have. It’s also quite plant-centric, but it’s not by default vegan or even vegetarian; you will find meat and fish in here. As you might expect from an anti-inflammatory cookbook, it’s light on the dairy too, though fermented dairy products such as yogurt do feature as well.
The recipes are quite simple and easy to follow, with suggestions of alternative ingredients along the way, making for extra variety as well as convenience.
If you are going to buy this book, you might want to take a look at the buying options, to ensure you get a full-color version, as recent reprints have photos in black and white, whereas older runs have color throughout.
Bottom line: if you’d like to cook the Galveston Diet way, this is as good a way to start as any.
Click here to check out the Galveston Diet Cookbook for Beginners, and get cooking!
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Why You Can’t Just “Get Over” Trauma
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Time does not, in fact, heal all wounds. Sometimes they even compound themselves over time. Dr. Tracey Marks explains the damage that trauma does—the physiological presentation of “the axe forgets but the tree remembers”—and how to heal from that actual damage.
The science of healing
Trauma affects the mind and body (largely because the brain is, of course, both—and affects pretty much everything else), which can ripple out into all areas of life.
On the physical level, brain areas affected by trauma include:
- Amygdalae: becomes hyperactive, keeping a person in a heightened state of vigilance.
- Hippocampi: can shrink, causing fragmented or missing memories.
- Prefrontal cortex: reduces in activity, impairing decision-making and emotional regulation.
Trauma also activates the body’s fight or flight response, releasing stress hormones like cortisol and adrenaline. These are great things to have a pinch, but having them elevated all the time is equivalent to only ever driving your car at top speed—the only question becomes whether you’ll crash and burn before you break down.
However, there is hope! Neuroplasticity (the brain’s ability to rewire itself) can make trauma recovery possible through various interventions.
Evidence-based therapies for trauma include:
- Eye Movement Desensitization and Reprocessing (EMDR): this can help reprocess traumatic memories and reduce emotional intensity.
- Trauma-focused Cognitive Behavioral Therapy (CBT): this can help change unhelpful thought patterns and includes exposure therapy.
- Somatic therapies: these focus on the body and nervous system to release stored tension.
In this latter category, embodiment is key to trauma recovery—this may sound “wishy-washy”, but the evidence shows that reconnecting with the body does help manage emotional stress responses. Mind-body practices like mindfulness, yoga, and breathwork help cultivate embodiment and reduce trauma-related stress.
In short: you can’t just “get over” it, but with the right support and interventions, it’s possible to rewire the brain and body toward resilience and healing.
For more on all of this from Dr. Marks, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- PTSD, But, Well…. Complex.
- Undoing The Damage Of Life’s Hard Knocks
- A Surprisingly Powerful Tool: Eye Movement Desensitization & Reprocessing
Take care!
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How To Make Drinking Less Harmful
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Making Drinking Less Harmful
We often talk of the many ways alcohol harms our health, and we advocate for reducing (or eliminating) its consumption. However, it’s not necessarily as easy as all that, and it might not even be a goal that everyone has. So, if you’re going to imbibe, what can you do to mitigate the harmful effects of alcohol?
There is no magical solution
Sadly. If you drink alcohol, there will be some harmful effects, and nothing will completely undo that. But there are some things that can at least help—read on to learn more!
Coffee
It’s not the magical sober-upperer that some would like it to be, but it is good against the symptoms of alcohol intoxication, and slightly reduces the harm to your body, because it is:
- Hydrating (whereas alcohol is dehydrating)
- A source of antioxidants (whereas alcohol causes oxidative stress, which has nothing to do with psychological stress, and is a kind of cellular damage)
- A stimulant, assuming it is not decaffeinated (it’s worth noting that its stimulant effects work partly by triggering vasoconstriction, which is the opposite of the vasodilation caused by alcohol)
To this end, the best coffee for anti-alcohol effects should be:
- Caffeinated, and strong
- Long (we love espresso, but we need hydration here and that comes from volume!)
- Without sugar (you don’t want to create an adverse osmotic gradient to leech water from your body)
As for milk/cream/whatever, have it or don’t, per your usual preference. It won’t make any difference to the alcohol in your system.
Antioxidants, polyphenols, flavonoids, and things with similar mechanisms
We mentioned that coffee contains antioxidants, but if you want to really bring out the heavy guns, taking more powerful antioxidants can help a lot. If you don’t have the luxury of enjoying berries and cacao nibs by the handful, supplements that have some similar benefits are a perfectly respectable choice.
For example, you might want to consider green tea extract:
L-theanine 200mg (available on Amazon)
Specialist anti-alcohol drugs
These are somewhat new and the research is still ongoing, but for example:
Dihydromyricetin (DHM) as a novel anti-alcohol intoxication medication
In short, DHM is a flavonoid (protects against the oxidative stress caused by alcohol, and has been found to reduce liver damage—see the above link) and also works on GABA-receptors (reduces alcohol withdrawal symptoms after cessation of drinking, and thus also reduces hangovers).
Once again: the marketing claims of such drugs may be bold, but there’s a lot that’s not known and they’re not a magic pill. They do NOT mean you can take them alongside drinking and drink what you like with impunity. However, they may help mitigate some of the harmful effects of alcohol. If you wish to try them, these can be purchased at pharmacies or online, for example:
Alcohol Defense Capsules (available on Amazon)
Bottom line
Alcohol is bad for your health and none of the above will eliminate the health risks. But, if you’re going to have alcohol, then having the above things as well may at least somewhat reduce the harm done.
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