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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The FDA Just Redefined “Healthy”—But How?
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In the ongoing war of labelling regulations (usually with advertisers on one side and regulators on the other), the FDA has updated what’s required in order to label a food as “healthy”.
Here’s what they’re now* requiring:
To bear the “healthy” claim, a food product needs to:
- Contain a certain amount of food (food group equivalent) from at least one of the food groups or subgroups (such as fruits, vegetables, fat-free and low-fat dairy etc.) recommended by the Dietary Guidelines.
- Adhere to specified limits for the following nutrients: saturated fat, sodium, and added sugars.
Source: FDA | Press Releases | FDA Finalizes Updated “Healthy” Nutrient Content Claim
*however, manufacturers have 3 years to conform, which if we’re being cynical about it, looks suspiciously like just short of a US presidential election cycle so that actual enforcement will be someone else’s problem.
Will it help?
Maybe! It’s not too dissimilar to the “traffic light system” already in use in Europe, although that currently emphasizes the absence/presence of “bad things” e.g. saturated fat, sodium, and added sugars.
It has its faults, because for example…
- not all saturated fat is bad, and a jar of coconut oil is now definitely going to get labelled as very unhealthy
- low-sodium salt is, ironically, going to to get flagged as being very high in sodium and therefore unhealthy
This latter is because on a g/100g basis, a product that’s ⅓ sodium chloride is going to have a lot of sodium, even if it’s approaching ⅔ less sodium than the product it’s (healthily!) replacing.
However, on a large scale, these kinds of problems are surely going to be small next to (hopefully) manufacturers scrambling to find ways to cut down on the saturated fats, sodium, and added sugars.
You may be wondering…
What will they replace them with?
Sometimes, companies trying to make something healthier will mess up, like when the health risks of smoking hit public consciousness, one cigarette company had the bright idea of putting asbestos in their filter tips, to market them as healthier. So, could something similar happen here?
- Saturated fat: definitely could; because the health benefits/risks of different kinds of fats and their constituent fatty acids are a lot more nuanced than just “saturated” vs “mono-/polyunsaturated”, it is definitely possible that companies may replace healthier saturated-heavy fats with less healthy unsaturated fats, depending on what is cheaper.
- See also: Can Saturated Fats Be Healthy?
- Sodium: probably not; likely go-to replacements for sodium chloride will be potassium chloride (healthier than sodium chloride) and MSG (has an unearned bad reputation in the US, but is healthier than sodium chloride).
- Added sugars: probably—things get very complicated very quickly when it comes to artificial sweeteners, and also the crux will definitely lie in what gets defined as an “added sugar”; watch out for a rise in the use of things that slide by the definition of added sugar while still being chemically (and, which is important, metabolically) the same thing.
Well that doesn’t sound great
It doesn’t, but on the flipside, the positive inclusions will probably be mostly good.
For example, the only way to get a “healthy” labelling in including fiber is to include more fiber, same with vitamins and minerals.
The low-fat dairy thing could possibly get abused (much like with the general “low-fat” trend of the 80s).
The “portion of fruit” thing will need to be carefully defined to avoid running straight back into the “this is just added sugar by another name” problem; mostly that it’ll need to still include the same amount of fiber as was in the whole fruit, gram for gram.
See also: What Matters Most For Your Heart? ← it’s about fiber, not salt or saturated fats!
Take care!
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Scattered Minds – by Dr. Gabor Maté
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This was not the first book that Dr. Maté sat down to write, by far. But it was the first that he actually completed. Guess why.
Writing from a position of both personal and professional experience and understanding, Dr. Maté explores the inaptly-named Attention Deficit Disorder (if anything, there’s often a surplus of attention, just, to anything and everything rather than necessarily what would be most productive in the moment), its etiology, its presentation, and its management.
This is a more enjoyable book than some others by the same author, as while this condition certainly isn’t without its share of woes (often, for example, a cycle of frustration and shame re “why can’t I just do the things; this is ruining my life and it would be so easy if I could just do the things!”), it’s not nearly so bleak as entire books about trauma, addiction, and so forth (worthy as those books also are).
Dr. Maté frames it specifically as a development disorder, and one whereby with work, we can do the development later that (story of an ADHDer’s life) we should have done earlier but didn’t. In terms of practical advice, he includes a program for effecting this change, including as an adult.
The style is easy-reading, in small chapters, with ADHD’d-up readers in mind, giving a strong sense of speeding pleasantly through the book.
Bottom line: when it’s a book by Dr. Gabor Maté, you know it’s going to be good, and this is no exception. Certainly read it if you, anyone you care about, or even anyone you just spend a lot of time around, has ADHD or similar.
Click here to check out Scattered Minds, and unscatter yours!
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Power Plates – by Gena Hamshaw
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Superfoods are all well and good, but there are only so many ways one can reasonably include watercress before it starts becoming a chore.
Happily, Gena Hamshaw is here with a hundred single-dish vegan meals, that are not only nutritionally balanced as the subtitle promises, but also, as the title suggests, are nutritional powerhouses too.
In the category of criticism, some ingredients are not so universally available as others. For example, depending on where you live, your local supermarket might not have freekeh, gochujang, or pomegranate molasses.
However, most of the recipes have ingredients that are easy enough to source in any medium-sized supermarket, and for the ones that aren’t, we do recommend ordering the ingredient online and trying something you might not otherwise have experienced—that’s an important thing in life, after all!
Bottom line: if you’d like plant-based meals that are packed full of nutrients and are delicious too, this is a top-tier recipe book.
Click here to check out Power Plates, and enjoy a wide variety of plant-based cuisine!
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The Sugar Alcohol That Reduces BMI!
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Inositol Does-It-Ol’!
First things first, a quick clarification up-front:
Myo-inositol or D-chiro-inositol?
We’re going to be talking about inositol today, which comes in numerous forms, but most importantly:
- Myo-inositol (myo-Ins)
- D-chiro-inositol (D-chiro-Ins)
These are both inositol, (a sugar alcohol!) and for our purposes today, the most relevant form is myo-inositol.
The studies we’ll look at today are either:
- just about myo-inositol, or
- about myo-inositol in the presence of d-chiro-inositol at a 40:1 ratio.
You have both in your body naturally; wherever supplementation is mentioned, it means supplementing with either:
- extra myo-inositol (because that’s the one the body more often needs more of), or
- both, at the 40:1 ratio that we mentioned above (because that’s one way to help balance an imbalanced ratio)
With that in mind…
Inositol against diabetes?
Inositol is known to:
- decrease insulin resistance
- increase insulin sensitivity
- have an important role in cell signaling
- have an important role in metabolism
The first two things there both mean that inositol is good against diabetes. It’s not “take this and you’re cured”, but:
- if you’re pre-diabetic it may help you avoid type 2 diabetes
- if you are diabetic (either type) it can help in the management of your diabetes.
It does this by allowing your body to make better use of insulin (regardless of whether that insulin is from your pancreas or from the pharmacy).
How does it do that? Research is still underway and there’s a lot we don’t know yet, but here’s one way, for example:
❝Evidence showed that inositol phosphates might enhance the browning of white adipocytes and directly improve insulin sensitivity through adipocytes❞
Read: Role of Inositols and Inositol Phosphates in Energy Metabolism
We mentioned its role in metabolism in a bullet-point above, and we didn’t just mean insulin sensitivity! There’s also…
Inositol for thyroid function?
The thyroid is one of the largest endocrine glands in the body, and it controls how quickly the body burns energy, makes proteins, and how sensitive the body should be to other hormones. So, it working correctly or not can have a big impact on everything from your mood to your weight to your energy levels.
How does inositol affect thyroid function?
- Inositol has an important role in thyroid function and dealing with autoimmune diseases.
- Inositol is essential to produce H2O2 (yes, really) required for the synthesis of thyroid hormones.
- Depletion of inositol may lead to the development of some thyroid diseases, such as hypothyroidism.
- Inositol supplementation seems to help in the management of thyroid diseases.
Read: The Role of Inositol in Thyroid Physiology and in Subclinical Hypothyroidism Management
Inositol for PCOS?
A systematic review published in the Journal of Gynecological Endocrinology noted:
- Inositol can restore spontaneous ovarian activity (and consequently fertility) in most patients with PCOS.
- Myo-inositol is a safe and effective treatment to improve:
- ovarian function
- healthy metabolism
- healthy hormonal balance
While very comprehensive (which is why we included it here), that review’s a little old, so…
Check out this cutting edge (Jan 2023) study whose title says it all:
Inositol for fertility?
Just last year, Mendoza et al published that inositol supplementation, together with antioxidants, vitamins, and minerals, could be an optimal strategy to improve female fertility.
This built from Gambiole and Forte’s work, which laid out how inositol is a safe compound for many issues related to fertility and pregnancy. In particular, several clinical trials demonstrated that:
- inositol can have therapeutic effects in infertile women
- inositol can also be useful as a preventive treatment during pregnancy
- inositol could prevent the onset of neural tube defects
- inositol also reduces the occurrence of gestational diabetes
Due to the safety and efficiency of inositol, it can take the place of many drugs that are contraindicated in pregnancy. Basically: take this, and you’ll need fewer other drugs. Always a win!
Read: Myo-Inositol as a Key Supporter of Fertility and Physiological Gestation
Inositol For Weight Loss
We promised you “this alcohol sugar can reduce your BMI”, and we weren’t making it up!
Zarezadeh et al conducited a very extensive systematic review, and found:
- Oral inositol supplementation has positive effect on BMI reduction.
- Inositol in the form of myo-inositol had the strongest effect on BMI reduction.
- Participants with PCOS and/or who were overweight, experienced the most significant improvement of all.
Want some inositol?
As ever, we don’t sell it (or anything else), but for your convenience, here’s myo-inositol and d-chiro-inositol at a 40:1 ratio, available on Amazon!
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To Err Is Human; To Forgive, Healthy
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How To Forgive (And Why)
There’s an old saying that holding onto a grudge is like drinking poison and expecting the other person to die. If only it were so simple and easy as just choosing to let go!
But it’s not, is it?
When people have wronged us and/or wronged our loved ones, it’s hard to forgive, especially if they have not changed. For that matter, it can be hard to forgive ourselves for mistakes that we made, too.
Either way, “drinking that poison” can be close to literal, in terms of what harboring such anger and resentment can do for our cortisol levels.
So, what to do about it?
If you have a dialogue with the person, our previous article on communication may help a lot.
If you don’t, there are various other angles that can be taken:
The Unsent Letter
You can even send it, if you like, but it’s not the point here. The idea is to write to the person, expressing your grievances. But, (as per the above-linked article on communication) try to focus at least as much on your feelings as their actions. “When you did/said x, I felt y”, etc.
This is important for helping you process your feelings. If you send the letter, it’s also important for the other person to be able to understand your feelings.
Sometimes, we feel the things we do so strongly because we don’t have an outlet for them. Pouring out our emotions in such a fashion, on the other hand, means (to labor the metaphor) they’re no longer bottled up. Even just in and of itself, that can provide us a lot of relief.
And when we the negative emotions are no longer such high pressure, it can be easier to let go of them.
Mindfulness
Following on from the above idea, a good strategy can be simply sitting and feeling everything you need to feel, noticing it without judgement, like a curious observer.
Sometimes what we need is just to be heard, and that starts with hearing ourselves.
Compassion
There’s a Buddhist exercise that involves actively feeling compassion for three people: a loved one, a stranger, and an enemy. Many people report that it’s actually harder to feel compassion for a random stranger, than an enemy. Why? Because we don’t know them; we don’t know what’s good and bad about them in our estimation.
If you’re reading this because you want to be able to gain the peace of being able to forgive someone (even if that someone is yourself), then in at least some respect right now, that person is in the “enemy” category. So how do we unpack that?
To err is human. Everybody screws up sometimes. And also, everyone has a reason (or a complex of reasons) for acting the way they do. This does not mean that those reasons excuse the behavior, but it can explain it.
You don’t get angry at a storm for soaking you through. Even if you might not understand the physics of it in the way a meteorologist might, you understand that there were things that led to that, and you were just in the wrong place at the wrong time.
So why do we get angry at someone else for wronging us? Even if we might not understand the personal background of it in the way their psychologist or therapist might, we (hopefully) understand that there were things that caused them to be the way they were, and we were just in the wrong place at the wrong time.
And ourselves? We probably know, when we made a mistake, why we made it. Maybe we were afraid, insecure, reactive, forgetful, or too focused on some other thing. Whatever it was, we did our best at the time and, apparently, our best wasn’t as good as we’d like.
If we didn’t deserve forgiveness, we wouldn’t be critical of our past selves in the first place.
And, the science is very clear that it’s important for our health for other reasons besides cortisol management, too.
And as for others? They did the best they knew how. Maybe they were afraid, insecure, reactive, forgetful, or too focused on some other thing. Same story, different character.
Remembering that can be key to “accepting the apology we never received”.
Forgiving without forgetting
Developing the ability to forgive is a useful tool for our own mental health. It doesn’t mean we must or even should make ourselves a doormat.
“I forgive you” does not have to mean a clean slate; it means remembering that the thing happened, and just not holding on to the anger/resentment associated with it.
It may be water under the bridge now, but it might have been a devastatingly destructive wave at the time, and continuing to acknowledge truth that is sensible. Just, from a position of peace now, hopefully.
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Tips for Avoiding PFAs
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝Hi, do you have anything helpful on avoiding PFAs?❞
PFAS, or perfluoroalkyl and polyfluoroalkyl substances, are “forever chemicals” made specifically to avoid degradation of industrial and chemical products. Which is great for providing stain and water resistance, but not so great for our bodies or the environment.
To go into all the harms they cause would take a main feature (maybe we will, one of these days), but suffice it to say, they’re not good, and range from cancer and insulin resistance to hypertension and reduced immune response.
To answer your question in a nutshell, avoiding them completely would be almost impossible, but we can reduce our exposure a lot by avoiding single-use food/drink products that have been waterproofed, e.g. paper/bamboo straws, utensils, cups, dishes, take-out containers, etc.
Also, anything advertised as “stain-resistant” that you suspect should be quite stainable by nature, is probably good to avoid too.
For more detailed information than we have room for here today, here’s a helpful overview:
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