Why Treating Only the Disc Often Fails Patients Trying to Avoid Back Surgery in Dallas
- cassis101
- Dec 23, 2025
- 3 min read
By Deborah Westergaard, MD | Pain Experts | Dallas–Plano
Why “It’s Just the Disc” Is an Incomplete Diagnosis and How to Avoid Back Surgery
Many patients seeking to avoid back surgery in Dallas are told their pain is caused by a “bad disc.” This conclusion is usually based on MRI findings alone with disc bulges, degeneration, or annular tears.
The challenge is not that discs are irrelevant. The problem is that they are rarely the only pain generator.
Disc changes are common with aging and often do not correlate with pain severity or functional limitation. Yet because discs are the most visible structure on imaging, treatment strategies frequently stop there leading to disappointing outcomes, repeated procedures, or unnecessary escalation to surgery.
This is where many high-functioning individuals become frustrated: They have done everything right, followed recommendations, yet their pain persists.
The Solution: A Systems-Based Spine Evaluation Using Orthobiologics in Dallas
The spine is not a single structure. It is a load-sharing system.
A complete evaluation must consider:
Facet joints, which guide motion and bear axial load
Multifidus muscles, essential for segmental stability
Interspinous and supraspinous ligaments, critical for tensile support
Fascial and neuromuscular coordination, which governs movement efficiency
When these structures are ignored, treatment remains incomplete—regardless of how aggressively the disc is addressed.
In my Dallas and Plano practices, patients seeking orthobiologics are evaluated with:
Targeted physical examination
Functional assessment under load and rotation
Image-guided diagnostic confirmation when appropriate
This approach allows treatment plans to be precision-based, rather than imaging-driven alone.
For patients trying to avoid back surgery, orthobiologic strategies may be considered to support structural integrity and neuromuscular coordination—without destroying tissue or bypassing the underlying dysfunction.
Why This Matters for Patients Who Want to Stay Active and Independent
Surgery can be appropriate in select cases—but for many individuals, it introduces:
Permanent biomechanical changes
Muscle denervation or destabilization
Prolonged recovery with uncertain functional outcomes
Those who value long-term performance, mobility, and resilience often prefer an approach that respects anatomy rather than overriding it.
This is why a systems-based spine strategy resonates with patients who expect thoughtful analysis, precision, and individualized care, not shortcuts.
A Different Conversation About Your Spine
If you have been told your MRI is “the answer,” yet your pain tells a different story, a deeper evaluation may be warranted.
I work with patients from Dallas, Highland Park University Park, North Dallas, and Plano who are seeking a more comprehensive, non-surgical approach to spine care.
You may schedule a consultation to explore whether a precision, image-guided orthobiologic evaluation is appropriate for your situation.
Large, well-designed studies—including the SPORT trial show that while disc surgery can be helpful for selected patients, a meaningful number continue to experience back pain afterward, particularly when other spinal structures are involved. Links to these studies are included below.
What the Evidence Actually Shows About Disc Surgery
Large, well-designed studies consistently show that disc abnormalities on imaging do not automatically mean the disc is the primary pain generator, and that surgery is not universally curative.
SPORT Trial – Lumbar Disc Herniation (JAMA, 2006)
The Spine Patient Outcomes Research Trial (SPORT) demonstrated that diskectomy can provide faster relief of sciatica and better short-term improvement compared with non-operative care. However, because many patients crossed over between treatment groups, the intent-to-treat analysis showed small, non-significant differences overall. When outcomes were analyzed based on the treatment actually received, surgical patients improved more—but both groups improved over time, with partial convergence at longer follow-up. Importantly, persistent pain occu
rred in a subset of patients, particularly when additional pain generators were present.
SPORT Trial – 8-Year Outcomes (Spine, 2014)
At eight years, patients who underwent surgery showed greater improvement in as-treated analyses, but many non-operative patients also improved substantially. Outcomes remained stable from four to eight years in both groups. These data reinforce that disc surgery is not a guaranteed solution and that results depend heavily on accurate identification of the disc as the dominant pain source.
Early Surgery vs. Prolonged Conservative Care for Sciatica (NEJM, 2007)
This randomized trial found that surgery led to faster symptom relief, but at one year, functional outcomes and recovery rates were similar between surgical and conservative groups. In other words, surgery often accelerates recovery—but does not necessarily change long-term outcomes.
MRI Disc Findings in Asymptomatic Patients (AJNR, 2015)
This systematic review showed that disc bulges, protrusions, extrusions, and degeneration are common in people with no pain at all, increasing with age. These findings are frequently part of normal aging. While such changes are more prevalent in symptomatic individuals, their presence alone does not establish causation.
#BackpainDallas #BackpainPlano #AvoidBackSurgery #OrthobiologicsDallas #DallasPainSpecialist #RegenerativeSpineCare
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