Best known for portraying Laura Ingalls on the hit television series Little House on the Prairie from 1974 to 1983, Melissa Gilbert also has been a producer, stage actor, and president of the Screen Actors Guild. In 1980, she was nominated for an Emmy for portraying Helen Keller in a special television production of The Miracle Worker. In 2016 she even ran for Congress. But behind that industrious public persona, Gilbert hid a private struggle with persistent back and neck pain that grew so serious, she says, she “was on a dangerous path with pain medications.”

It started in the mid-'90s when she injured herself on the set of her TV series Sweet Justice and herniated the C5-C6 disk in her neck. (The vertebrae that make up the spine are cushioned by disks; when one bulges severely, or herniates, it can cause weakness, numbness, and nerve pain.) After meeting with a doctor, Gilbert agreed to try everything to avoid surgery. “I had physical therapy, regular massages, and acupuncture,” she says. “But by 2001 the pain got to be too much, and I ended up having cervical fusion surgery.”

“Spinal fusion surgery unites or fuses two or more of the vertebrae together,” explains Shaheen E. Lakhan, MD, PhD, FAAN, a neurologist and pain medicine specialist based in Boston. “Removing the affected disk and restricting motion of the spine may ease pain.” While the procedure can be effective in treating a herniated disk, outcomes vary. “There is no guarantee that spine surgeries will eliminate pain and restore function. In fact, a special diagnostic code called ‘failed back surgery syndrome’ is applied to up to 40 percent of all patients undergoing surgery,” says Dr. Lakhan.

For Gilbert, the surgery succeeded in alleviating her pain, but eight years later she sustained another injury. “I'm kind of accident-prone,” she admits, half-jokingly. It was 2009, and she was rehearsing the stage musical of Little House on the Prairie—in that version, she played Laura's mother, Caroline—when her back started hurting and she couldn't move her legs. “When it got progressively worse, I went to see a doctor, who found another herniated disk, this time in my lower back,” says Gilbert. She was prescribed a round of steroids and physical therapy and massages once a week. Then she had a fall and the pain increased. Over the course of the tour, Gilbert had two epidural steroid injections three months apart and intravenous steroids on an emergency basis. Finally, Gilbert returned to the doctor who'd done her spinal fusion. After taking more images and X-rays, he determined that she had broken her back. She had a lumbar spinal fusion, resumed physical therapy, and was again pain free.

Gilbert's next “accident,” and the resulting second cervical spinal fusion, proved more problematic than the first. In 2012, while competing on the TV show Dancing with the Stars, Gilbert smacked her head on the floor, triggering whiplash, a concussion, and a new problem with her C6-C7 disk, in the lower neck just below the prior fusion. Soon after that, a patio cover in a home she was renting in Studio City, CA, detached and fell on her head, resulting in another concussion.

Initially she didn't do anything about it, she says. “I was treating the pain with opioids and muscle relaxants. I was trying to patch myself up.” But by 2016 the problem had deepened. “When I met with a neurologist about the pain, I asked, ‘What can I take that's stronger than Percocet?’” That was a wake-up call about her growing reliance on pain medications. Gilbert ended her run for Congress and underwent a second cervical spinal fusion, in which her vertebrae were fixed together with metal screws.

This time, the neck pain persisted after the fusion. “I experienced numbness and tingling in the three middle fingers on my right hand,” Gilbert says. “Sometimes my neck would ‘lock up’ and I couldn't turn my head. If I turned wrong and tweaked a nerve, the pain was agonizing.

“I think my recurring injuries have made me more compassionate about the pain of others,” says Gilbert. “I have to help.” One of the ways she's doing that is by sharing her story publicly.

Life-Altering Surgery

In 2019, with her neck pain worse than ever, she saw a neurosurgeon in New York City, who determined that her last fusion had failed and the screws had to be removed. She was now a candidate for total disk replacement, in which an artificial disk is placed between the vertebrae (instead of them being fused together), ideally affording more flexibility and movement.

“In a fusion, metal screws are used to fix the bones in place,” says Ligia V. Onofrei, MD, assistant professor of neuromuscular medicine at the University of Utah in Salt Lake City. The natural movement of the neck is reduced at the level of the fusion, so the levels above and below absorb more of the movement, which increases the possibility of additional degeneration above and below the fusion. More degeneration often means more surgeries, Dr. Onofrei says. “When you have an artificial disk, the neck continues to move freely at the level of the disk, so there is less risk of additional degeneration above and below.”

Gilbert’s surgery in 2020—performed by Robert Bray, MD, a neurologic spine surgeon in Newport Beach, CA—was a success. (All Gilbert’s surgeries were performed by Dr. Bray, except for a failed fusion in 2016.) For the first time in years, she was able to turn her head. Better still, the constant pain she'd grown used to had disappeared. That Thanksgiving back in New York City was one she'll never forget. “I quarantined in our apartment while my husband [actor-director Timothy Busfield of The West Wing and Thirtysomething] was upstate,” Gilbert says. “He'd picked up Thanksgiving dinner from our local grocery store and left it in the fridge for me. I ate turkey alone. But it was the most thankful Thanksgiving I've ever had.”

Nearly two years after her total disk replacement, Gilbert, now 58, is enjoying life with the mobility and energy to play with her grandchildren that once seemed out of reach. She and Busfield, who have two granddaughters born in the past year and a half, divide their days between an Upper West Side apartment in New York City and their “cabbage”—a hybrid cabin/cottage—in the Catskill Mountains. She recently published a second memoir, Back to the Prairie: A Home Remade, A Life Rediscovered, which chronicles her journey from Hollywood to the dilapidated cottage in upstate New York during the pandemic. (Her earlier memoir, Prairie Tale, was published in 2010.)

And while the long-term prognosis for artificial disk surgery is still uncertain, the results of research that has tracked the five-year progress of patients are hopeful. Studies published in Annals of Translational Medicine and Spine, both in 2019, suggest that the procedure can provide more range of movement than spinal fusion, and although artificial disks deteriorate over time, they do so at a much slower rate than the materials used to fuse vertebrae.

For Gilbert, two results matter most: “I'm pain free—and medication free—for the first time in decades.”

The Realities of Spinal Surgery

Before you decide to undergo surgery for back or neck pain or spinal injury, several factors must be considered, beginning with how critical the condition or injury is. “The vast majority of back pain or spine injury does not require surgery,” says Shaheen E. Lakhan, MD, PhD, FAAN, a neurologist and pain medicine specialist based in Boston.

Surgery is necessary if the pain or injury is accompanied by severe weakness of the arms or legs or an inability to control bowel or bladder functioning, he says. “These are typical indicators that the spinal cord or nerves coming off it are compressed and need rapid surgical decompression.” Otherwise, he says, surgery is an elective procedure.

In general, surgery is not required if there is no pressure on the spinal cord or nerve roots, says Ligia V. Onofrei, MD, assistant professor of neuromuscular medicine at the University of Utah in Salt Lake City. “Even if there is, surgery may depend on the severity of the pressure, if there's weakness, how much the pain is affecting the patient's quality of life, and additional symptoms,” says Dr. Onofrei. “It's all about examining and talking to the patient, not just looking at the MRI.”

If you do have spinal surgery, plan on two to six weeks for recovery depending on the type of procedure, says Dr. Onofrei. “Risks vary from bleeding and infection to permanent neurologic injury resulting in weakness, stroke, or death.” Other common risks of some neck surgeries are trouble swallowing and damage to the laryngeal nerve, which can cause voice difficulties. In addition, some patients experience problems with the fusion or hardware or additional degeneration at the levels above and below a fusion.

A 2018 study in Global Spine Journal comparing outcomes for total disk replacement (TDR) and spinal fusion found that patients who had TDR had less disability, lower risk of a second surgery, and more satisfaction than those who had spinal fusion. In 2021, a study in Spine Journal examined a new type of spinal fusion performed with the patients lying on their sides and found that it improves the fusion, reduces the length of the procedure, and allows more rapid recovery.

The cost of TDR, now widely available at major hospitals, ranges from $30,000 to $45,000, compared with $48,000 to $86,000 for spinal fusion; most insurance plans cover much of the cost.

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