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.

A medical practitioner examines a patient's lower back.
Many people experience chronic pain. Yan Krukau/Pexels

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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  • Want the health benefits of strength training but not keen on the gym? Try ‘exercise snacking’

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    The science is clear: resistance training is crucial to ageing well. Lifting weights (or doing bodyweight exercises like lunges, squats or push-ups) can help you live independently for longer, make your bones stronger, reduce your risk of diseases such as diabetes, and may even improve your sleep and mental health.

    But not everyone loves the gym. Perhaps you feel you’re not a “gym person” and never will be, or you’re too old to start. Being a gym-goer can be expensive and time-consuming, and some people report feeling unwelcome or awkward at the gym.

    The good news is you don’t need the gym, or lots of free time, to get the health benefits resistance training can offer.

    You can try “exercise snacking” instead.

    Pressmaster/Shutterstock

    What is exercise snacking?

    Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day – often with minimal or no equipment. It’s OK to have several hours of rest between.

    You could do simple bodyweight exercises such as:

    • chair sit-to-stand (squats)
    • lunges
    • box step-ups
    • calf raises
    • push-ups.

    Exercise snacking like this can help improve muscle mass, strength and physical function.

    It’s OK to hold onto a nearby object for balance, if you need. And doing these exercises regularly will also improve your balance. That, in turn, reduces your risk of falls and fractures.

    OK I have done all those, now what?

    Great! You can also try using resistance bands or dumbbells to do the previously mentioned five exercises as well as some of the following exercises:

    When using resistance bands, make sure you hold them tightly and that they’re securely attached to an immovable object.

    Exercise snacking works well when you pair it with an activity you do often throughout the day. Perhaps you could:

    • do a few extra squats every time you get up from a bed or chair
    • do some lunges during a TV ad break
    • chuck in a few half squats while you’re waiting for your kettle to boil
    • do a couple of elevated push-ups (where you support your body with your hands on a chair or a bench while doing the push-up) before tucking into lunch
    • sneak in a couple of calf raises while you’re brushing your teeth.
    A man does weighted lunges in his lounge room.
    Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day. Cavan-Images/Shutterstock

    What does the evidence say about exercise snacking?

    One study had older adults without a history of resistance training do exercise snacks at home twice per day for four weeks.

    Each session involved five simple bodyweight exercises (chair sit-to-stand, seated knee extension, standing knee bends, marching on the spot, and standing calf raises). The participants did each exercise continuously for one minute, with a one-minute break between exercises.

    These short and simple exercise sessions, which lasted just nine minutes, were enough to improve a person’s ability to stand up from a chair by 31% after four weeks (compared to a control group who didn’t exercise). Leg power and thigh muscle size improved, too.

    Research involving one of us (Jackson Fyfe) has also shown older adults found “exercise snacking” feasible and enjoyable when done at home either once, twice, or three times per day for four weeks.

    Exercise snacking may be a more sustainable approach to improve muscle health in those who don’t want to – or can’t – lift heavier weights in a gym.

    A little can yield a lot

    We know from other research that the more you exercise, the more likely it is you will keep exercising in future.

    Very brief resistance training, albeit with heavier weights, may be more enjoyable than traditional approaches where people aim to do many, many sets.

    We also know brief-and-frequent exercise sessions can break up periods of sedentary behaviour (which usually means sitting too much). Too much sitting increases your risk of chronic diseases such as diabetes, whereas exercise snacking can help keep your blood sugar levels steady.

    Of course, longer-term studies are needed. But the evidence we do have suggests exercise snacking really helps.

    An older Asian man lifts weights at home.
    Just a few short exercise sessions can do you a world of good. eggeegg/Shutterstock

    Why does any of this matter?

    As you age, you lose strength and mass in the muscles you use to walk, or stand up. Everyday tasks can become a struggle.

    All this contributes to disability, hospitalisation, chronic disease, and reliance on community and residential aged care support.

    By preserving your muscle mass and strength, you can:

    • reduce joint pain
    • get on with activities you enjoy
    • live independently in your own home
    • delay or even eliminate the need for expensive health care or residential aged care.

    What if I walk a lot – is that enough?

    Walking may maintain some level of lower body muscle mass, but it won’t preserve your upper body muscles.

    If you find it difficult to get out of a chair, or can only walk short distances without getting out of breath, resistance training is the best way to regain some of the independence and function you’ve lost.

    It’s even more important for women, as muscle mass and strength are typically lower in older women than men. And if you’ve been diagnosed with osteoporosis, which is more common in older women than men, resistance exercise snacking at home can improve your balance, strength, and bone mineral density. All of this reduces the risk of falls and fractures.

    You don’t need heavy weights or fancy equipment to benefit from resistance training.

    So, will you start exercise snacking today?

    Justin Keogh, Associate Dean of Research, Faculty of Health Sciences and Medicine, Bond University and Jackson Fyfe, Senior Lecturer, Strength and Conditioning Sciences, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Hazelnuts vs Pistachios – Which is Healthier?

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    Our Verdict

    When comparing hazelnuts to pistachios, we picked the hazelnuts.

    Why?

    An argument could be made for either, depending on what we prioritize! So there was really no wrong answer here today, but it is good to know what each nut’s strengths are:

    In terms of macros, pistachios have more fiber, carbs, protein, and (mostly healthy) fat. That does make them the “more food per food” option, but it’s worth noting that while hazelnuts have more fiber, they also have a higher margin of difference when it comes to their greater carb count, and resultantly, hazelnuts do have the lower glycemic index. That said, they’re still both low-GI foods, so we’ll call this section a win for pistachios overall.

    When it comes to vitamins, hazelnuts have more of vitamins B3, B5, B9, C, E, K, and choline, while pistachios have more of vitamins A, B1, B2, and B6. So, a fair 7:4 win for hazelnuts here.

    In the category of minerals, hazelnuts have more calcium, copper, iron, magnesium, manganese, and zinc, while pistachios have more phosphorus, potassium, and selenium. A clear 6:3 win for hazelnuts.

    In short, both are good sources of many nutrients, so choose according to what you want to prioritize, or better yet, enjoy both.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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  • Pomegranate vs Apricot – Which is Healthier?

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    Our Verdict

    When comparing pomegranate to apricot, we picked the pomegranate.

    Why?

    Both are great! Top tier fruits. But ultimately, pomegranate does have more to offer:

    In terms of macros, pomegranate has more protein, carbs, and fiber (and even a little healthy fat—it’s the seeds); the main deciding factor on macros for fruits is almost always the fiber, and that’s the case here, which is why we hand the win to pomegranates in this category.

    In the category of vitamins, pomegranates have more of vitamins B1, B2, b5, B6, B7, B9, K, and choline, while apricots have more of vitamins A, B3, and E. A clear win for pomegranates here.

    When it comes to minerals, pomegranate has more copper, calcium, magnesium, manganese, phosphorus, selenium, and zinc, while apricots boast just a little more calcium and iron. Another easy win for pomegranates.

    Looking at polyphenols, apricots finally win a category, with greater overall polyphenol coverage.

    Which is good, but not enough to overcome the other three categories all being in pomegranates’ favor—hence the overall win for pomegranates here!

    Of course, the solution is to enjoy both! Diversity is good, for exactly such reasons as this.

    Want to learn more?

    You might like to read:

    Pomegranate’s Health Gifts Are Mostly In Its Peel ← in other words, the one part of the fruit you don’t normally eat. However! It can be dried and ground into a powder supplement, or else made in pomegranate tea.

    Enjoy!

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  • Make Social Media Work For Your Mental Health

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    Social Media, But Healthy

    Social media has a bad reputation, and rightly so. It’s calculated to trick you into doomscrolling and rage-posting, and it encourages you to compare your everyday life to other people’s carefully-curated highlight reels.

    Rebalancing Dopamine (Without “Dopamine Fasting”)

    But it doesn’t have to be so.

    Find your community

    One of the biggest strengths social media has going for it is that it can, if used well, be a powerful tool for community. As for why that’s important from a health perspective, see:

    How To Beat Loneliness & Isolation

    Loneliness & isolation do, of course, kill people. By:

    • Accidents, e.g. household fall but nobody notices for a week
    • Depression and resultant decline (and perhaps even active suicidality)
    • Cognitive decline from a lack of social contact

    Read more:

    So, what’s “community” to you, and to what extent can you find it online? Examples might include:

    • A church, or other religious community, if we be religious
    • The LGBT+ community, or even just a part of it, if that fits for us
    • Any mutual-support oriented, we-have-this-shared-experience community, could be anything from AA to the VA.

    Find your people, and surround yourself with them. There are more than 8,000,000,000 people on this planet, you will not find all the most compatible ones with you on your street.

    Grow & nurture your community

    Chances are, you have a lot to contribute. Your life experiences are valuable.

    Being of service to other people is strongly associated “flourishing”, per the science.

    Indeed, one of the questions on the subjective wellness scale test is to ask how much one agrees with the statement “I actively contribute to the happiness and wellbeing of others”.

    See: Are You Flourishing? (There’s a Scale)

    So, help people, share your insights, create whatever is relevant to your community and fits your skills (it could be anything from art to tutorials to call-to-action posts or whatever works for you and your community)

    As a bonus: when people notice you are there for them, they’ll probably be there for you, too. Not always, sadly, but there is undeniable strength in numbers.

    Remember it’s not the boss of you

    Whatever social media platform(s) you use, the companies in question will want you to use it in the way that is most profitable for them.

    Usually that means creating a lot of shallow content, clicking on as many things as possible, and never logging off.

    Good ways to guard against that include:

    • Use the social media from a computer rather than a handheld device
    • Disable “infinite scroll” in the settings, if possible
    • Set a timer and stick to it
    • Try to keep your interactions to only those that are relevant and kind (for the good of your own health, let alone anyone else’s)

    On that latter note…

    Before posting, ask “what am I trying to achieve here?” and ensure your action is aligned with your actual desires, and not just reactivity. See also:

    A Bone To Pick… Up And Then Put Back Where We Found It

    Take care!

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  • 13 Things Mentally Strong Couples Don’t Do – by Dr. Amy Morin

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    The saying “happy wife; happy life” indeed goes regardless of gender. One can have every other happiness, but if there’s relational trouble, it brings everything else down.

    This book is not intended, however, only for people whose relationships are one couple’s therapy session away from divorce. Rather, it’s intended as a preventative. Because, in this as in every other aspect of health, prevention is better than cure!

    It is the sign of a strong couple to be proactive about the health of the relationship, and work together to build and reinforce things along the way.

    The style of this book is very accessible pop-science, but the author speaks from a strong professional background in social work, psychology, and psychotherapy, and it shows.

    Bottom line: if you’d like to strengthen your relationship skills, this book gives 13 great ways to do that.

    Click here to check out 13 Things Mentally Strong Couples Don’t Do, and strengthen your relationship(s)!

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  • Feminist narratives are being hijacked to market medical tests not backed by evidence

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, such as tobacco and alcohol.

    Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups.

    Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women.

    However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment.

    In our analysis published today in the BMJ, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.

    The AMH test

    The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test.

    Although often used in fertility treatment, the AMH test cannot reliably predict the likelihood of pregnancy, timing to pregnancy or specific age of menopause. The American College of Obstetricians and Gynaecologists therefore strongly discourages testing for women not seeking fertility treatment.

    Woman sits in a medical waiting room
    The AMH test can’t predict your chance of getting pregnant.
    Anastasia Vityukova/Unsplash

    Despite this, several fertility clinics and online companies market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “you deserve to know your reproductive potential”, “be proactive about your fertility” and “knowing your numbers will empower you to make the best decisions when family planning”.

    The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility.

    Our recent study found around 30% of women having an AMH test in Australia may be having it for these reasons.

    Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.

    While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment.

    Breast density notification

    Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue.

    While estimates vary, approximately 25–50% of women in the breast screening population have dense breasts.

    Young woman has mammogram
    Dense breasts can make it harder to detect cancer.
    Tyler Olsen/Shutterstock

    Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know such as “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification.

    However, this simplistic messaging overlooks that this is a complex issue and that more data is still needed on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms.

    Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the lack of robust evidence showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results.

    Large international advocacy groups are also sponsored by companies that will financially benefit from women being notified.

    While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought.

    Ensuring feminism isn’t hijacked

    Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care.

    But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests.

    Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.The Conversation

    Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney and Tessa Copp, 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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