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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  • True Age – by Dr. Morgan Levine

    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.

    Yesterday’s book review (Counterclockwise) was about psychological factors affecting physical aging (progression or reversal thereof); today we have a book about the physiological factors affecting physical aging (progression or reversal thereof).

    Dr. Levine is first and foremost a gerontological epigeneticist, and a lot of this book touches on her research in that field and that of her colleagues.

    She does also discuss direct environmental factors also though, and—as you might well expect—lifestyle factors.

    Regular readers of 10almonds are unlikely to gain anything new in the category of lifestyle matters, but a lot of the other material will be enlightening, especially with regard to the things that might at first glance seem set in stone, but we can in fact modify, and thus “choose our own adventure” when it comes to how the rest of our life plays out, healthwise (so: choose wisely!).

    The book is mostly an overview on the (at time of writing: 2022) current state of affairs in the world of longevity research, and although it’s not a “how to” manual, there is plenty in the category of practical takeaways to be gleaned too.

    The style is is mostly light pop science, but with a lot of hard science woven in—she is a good explainer, and has clearly made a notable effort to explain complex concepts in simple ways, while still delivering the complex concepts too (i.e. not overly “dumbing down”).

    Bottom line: if you’d like to know about what can be done to increase your healthspan and general longevity, this book has a lot of answers!

    Click here to check out True Age, and shift yours in the direction you prefer!

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  • If You’re Not Flexible, These Are The Only 3 Stretches You Need, To Fix That

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    If you can’t put your leg behind your head while standing, try doing the splits against a wall first, and progress from there! ← text version of an item from a “if you can’t do this yet, try this first” picture set this writer saw on Instagram once upon a time

    So, what if you’re more at the point of not quite being able to touch your toes yet?

    From zero to…

    Liv, of LivInLeggings fame, has these three starter-stretches that are actually starter-stretches:

    Stretch 1: Reverse Tabletop with Foot Tuck Variation

    1. Sit on the floor, feet slightly wider than your hips, lean back onto your hands (fingertips pointing outward).
    2. Lift your hips towards a reverse tabletop, engage your glutes, and flatten the front of your hips.
    3. Add a foot tuck variation by stepping one foot back and pressing your weight forward.

    Benefits:

    • Stretches multiple muscles, including the soles of the feet.
    • Improves foot arches, balance, and stability.
    • Loosens fascia, enhancing flexibility in subsequent stretches.

    Stretch 2: Squat to Forward Fold

    1. Start in a low squat (feet wider than your hips, toes mostly forward).
    2. Alternate between a low squat and a forward fold, keeping your hands on the floor or your toes.

    Benefits:

    • Stretches hamstrings, glutes, and lower back.
    • Maintains good form and avoids overstraining.

    Stretch 3: Side Lunge with Side Body Reach

    1. Begin in a tall kneeling position, step one foot out to the side (toes pointing outward).
    2. Lunge your hips towards your front ankle, keeping your tailbone tucked.
    3. Add a side body reach by resting your forearm on your thigh and reaching the other arm overhead.
    4. For a deeper stretch, cradle the back of your head with your hand, pressing lightly for a tricep stretch.

    Benefits:

    • Stretches inner thighs, lats, and triceps.
    • Improves posture, shoulder mobility, and low squat ability.

    For more on each of these plus visual demonstrations, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Test For Whether You Will Be Able To Achieve The Splits

    Take care!

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  • Uric Acid’s Extensive Health Impact (And How To Lower It)

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    Uric Acid’s Extensive Health Impact (And How To Lower It)

    This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.

    What does he want us to know?

    He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.

    First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.

    However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.

    More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:

    How can we reduce our uric acid levels?

    Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…

    Liver-debilitating things:

    • Alcohol (especially beer)
    • High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
    • Other refined sugars
    • Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)

    Purine-rich things:

    • Red meats and game
    • Organ meats
    • Oily fish, and seafood (great for some things; not great for this)

    Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.

    Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.

    Water is important for all aspects of health, and doubly important for this.

    Hydrate well!

    Lifestyle matters beyond diet

    The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:

    How To Unfatty A Fatty Liver

    …in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.

    Want to know more about this from Dr. Perlmutter?

    You might like his article:

    An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!

    And/or his book:

    Drop Acid: The Surprising New Science of Uric Acid―The Key to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health

    …on which much of today’s main feature was based.

    Take care!

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  • Caffeine: Cognitive Enhancer Or Brain-Wrecker?

    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.

    The Two Sides Of Caffeine

    Bar chart showing varying opinions on caffeine, with the largest number considering it a safe cognitive enhancer, and progressively fewer respondents viewing it as a moderately safe recreational drug, a substance with addictive properties that make

    We asked you for your health-related opinions on caffeine itself, not necessarily the coffee, tea, energy drinks, etc that might contain it.

    We have, by the way previously written about the health effects of coffee and tea specifically:

    As for our question about caffeine itself, though, we got the above-depicted, below-described, set of results:

    • About 59% said “caffeine is a safe stimulant and cognitive enhancer”
    • About 31% said “caffeine is a moderately safe recreational drug”
    • About 8% said “caffeine’s addictive properties make it de facto bad”
    • One (1) person said “caffeine will leave you a trembling exhausted wreck”

    But what does the science say?

    Caffeine is addictive: True or False?

    True, though one will find occasional academics quibbling the definition. Most of the studies into the mechanisms of caffeine addiction have been conducted on rats, but human studies exist too and caffeine is generally considered addictive for humans, for example:

    Caffeine addiction and determinants of caffeine consumption among health care providers: a descriptive national study

    See also:

    The caffeine dilemma: unraveling the intricate relationship between caffeine use disorder, caffeine withdrawal symptoms and mental well-being in adults

    Notwithstanding its addictive status, caffeine is otherwise safe: True or False?

    True-ish, for most people. Some people with heart conditions or a hypersensitivity to caffeine may find it is not safe for them at all, and for the rest of us, the dose makes the poison. For example:

    Can too much caffeine kill you? Although quite rare, caffeine can be fatal in cases of overdose; such circumstances are generally not applicable to healthy individuals who typically consume caffeine via beverages such as tea or coffee.❞

    ~ Dr. Jose Antonio et al.

    Read more: Common questions and misconceptions about caffeine supplementation: what does the scientific evidence really show?

    this paper, by the way, also includes a good example of academics quibbling the definition of addiction!

    Caffeine is a cognitive enhancer: True or False?

    True, but only in the case of occasional use. If you are using it all the time, your physiology will normalize it and you will require caffeine in order to function at your normal level. To attain higher than that, once addicted to caffeine, would now require something else.

    Read more: Caffeine: benefits and drawbacks for technical performance

    Caffeine will leave you a trembling exhausted wreck: True or False?

    True or False depending on usage:

    • The famously moderate 3–5 cups per day will not, for most people, cause any such problems.
    • Using/abusing it to make up for lost sleep (or some other source of fatigue, such as physical exhaustion from exertion), however, is much more likely to run into problems.

    In the latter case, caffeine really is the “payday loan” of energy! It’ll give you an adrenal boost now (in return, you must suffer the adrenal dumping later, along with lost energy expended in the adrenaline surge), and also, the tiredness that you thought was gone, was just caffeine’s adenosine-blocking activities temporarily preventing you from being able to perceive the tiredness. So you’ll have to pay that back later, with interest, because of the extra time/exertion too.

    Want to make caffeine a little more gentle on your system?

    Taking l-theanine alongside caffeine can ameliorate some of caffeine’s less wonderful effects—and as a bonus, l-theanine has some nifty benefits of its own, too:

    L-Theanine: What’s The Tea?

    Enjoy!

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  • Guava vs Passion Fruit – Which is Healthier?

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    Our Verdict

    When comparing guava to passion fruit, we picked the guava.

    Why?

    There aren’t many fruits that can beat passion fruit for nutritional density! And even in this case, it wasn’t completely so in every category:

    In terms of macros, passion fruit has more carbs and fiber, the ratio of which give it the slightly lower glycemic index. Thus, a modest win for passion fruit in this category.

    In the category of vitamins, guava has more of vitamins B1, B5, B6, B9, C, E, and K, while passion fruit has more of vitamins A, B2, and B3. A clear win for guava this time.

    When it comes to minerals, it’s a little closer, but: guava has more calcium, copper, manganese, potassium, and zinc, while passion fruit has more iron, magnesium, and phosphorus. So, another win for guava.

    Adding up the sections makes for guava winning the day, but by all means enjoy either or both; diversity is good!

    Want to learn more?

    You might like to read:

    Fruit Is Healthy; Juice Isn’t (Here’s Why)

    Enjoy!

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  • Salt Sugar Fat – by Michael Moss

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    You are probably already aware that food giants put unhealthy ingredients in processed food. So what does this book offer of value?

    Sometimes, better understanding leads to better movation. In this case, while a common (reasonable) view has been:

    “The food giants fill their food with salt, sugar, and fat, because it makes that food irresistibly delicious”

    …but that doesn’t exactly put us off the food, does it? It just makes it a guilty pleasure. Ah yes, the irresistible McDouble Dopamineburger. The time-honored tradition of Pizza Night; a happy glow; a special treat.

    What Pulitzer-winning author Michael Moss brings to us is different.

    He examines not just how they hooked us, but why. And the answer is not merely the obvious “profit and greed”, but also “survival, under capitalism”. That without regulation forcing companies to keep salt/sugar/fat levels down, companies that have tried to do so voluntarily have quickly had to u-turn to regain any hope of competitiveness.

    He also looks at how the salt/sugar/fat components are needed to mask the foul taste of the substandard ingredients they use to maintain lower costs… Processed food, without the heavy doses of salt/sugar/fat, is not anywhere close to what you might make at home. Industry will cut costs where it can.

    Bottom line: if you need a push to kick the processed food habit, this is the book that will do it.

    Click here to check out Salt Sugar Fat, and reclaim your health!

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