Elon Musk says ‘disc replacement’ worked for him. But evidence this surgery helps chronic pain is lacking

Last week in a post on X, owner of the platform Elon Musk recommended^[1] 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^[2]” 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^[3]. 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^[4] of metal and plastic.

Disc replacement may be performed for a number of reasons^[5], including slipped discs in the neck, as appears to be the case for Musk.

Disc replacement is major surgery^[6]. 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.

Read more: Elon Musk says ketamine can get you out of a 'negative frame of mind'. What does the research say?^[7]

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^[8].

Disc replacement surgery is not performed as much as other spinal surgeries (for example, spinal fusion^[9]) but its use is increasing.

In New South Wales^[10] 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^[11] and eight years^[12].

Complications are not uncommon, and can include^[14] 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^[15] 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^[16] 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^[17]. Indeed, the research evidence used to support disc replacement mainly comes from studies that compare disc replacement^[18] to spinal fusion^[19]. 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^[20] by evidence comparing it to non-surgical alternatives and, like disc replacement, it’s also expensive and associated with considerable risks of harm^[21].

Fortunately for patients, there are new, non-surgical treatments for neck^[22] and back^[23] 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^[24].

Read more: Surgery won't fix my chronic back pain, so what will?^[25]

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.

References

1. ^{^} recommended (x.com)
2. ^{^} judo throw (nypost.com)
3. ^{^} controversy (x.com)
4. ^{^} a combination (orthoinfo.aaos.org)
5. ^{^} a number of reasons (pubmed.ncbi.nlm.nih.gov)
6. ^{^} major surgery (www.uhcw.nhs.uk)
7. ^{^} Elon Musk says ketamine can get you out of a 'negative frame of mind'. What does the research say? (theconversation.com)
8. ^{^} A$12,000 out of pocket (www.hcf.com.au)
9. ^{^} spinal fusion (theconversation.com)
10. ^{^} New South Wales (www.mja.com.au)
11. ^{^} two years (www.bmj.com)
12. ^{^} eight years (pubmed.ncbi.nlm.nih.gov)
13. ^{^} Yan Krukau/Pexels (www.pexels.com)
14. ^{^} can include (pubmed.ncbi.nlm.nih.gov)
15. ^{^} 26 of the 77 surgical patients (www.bmj.com)
16. ^{^} second opinion (bmchealthservres.biomedcentral.com)
17. ^{^} often presented to patients (www.arthritis.org)
18. ^{^} disc replacement (www.ncbi.nlm.nih.gov)
19. ^{^} spinal fusion (www.ncbi.nlm.nih.gov)
20. ^{^} not well supported (theconversation.com)
21. ^{^} risks of harm (theconversation.com)
22. ^{^} neck (pubmed.ncbi.nlm.nih.gov)
23. ^{^} back (theconversation.com)
24. ^{^} cognitive functional therapy (pubmed.ncbi.nlm.nih.gov)
25. ^{^} Surgery won't fix my chronic back pain, so what will? (theconversation.com)