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

• In comments following the post, Musk said the surgery was a “gamechanger” and reduced his pain significantly.
• 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 may be performed for a number of reasons, including slipped discs in the neck, as appears to be the case for Musk.
• 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?

• But there has been very little research comparing disc replacement surgery with non-surgical treatments.
• Unfortunately, these crucial first research steps have largely been skipped for disc replacement surgery for both neck and back pain.
• 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.

• Complications are not uncommon, and can include disclocation of the artificial disc, fracture (break) of the artificial disc, and infection.
• Revision surgery means a re-do to the primary surgery if something needs fixing.

Are there effective alternatives?

• 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.
• 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.

• Christine Lin receives funding from the National Health and Medical Research Council (NHMRC), and Medical Research Future Fund.
• Christopher Maher receives funding from the National Health and Medical Research Council (NHMRC), and Medical Research Future Fund.