The majority of
the time surgery
is rarely used
as a method for
lower back pain
treatment. In
fact, many times
surgery may not
even help. Most
surgeries for
the lower back
are performed to
treat herniated
discs. However,
even those with
herniated discs
do not need
surgery. It is
generally only
recommended if a
disc causes
severe and
disabling
sciatica.
While surgery is
not likely, it
is still a
possibility
depending on the
cause of your
pain. The
following are
some instances
where surgery
may be a
possibility;
however, surgery
may still not be
needed in these
conditions:
If nonsurgical
treatment has
not been
successful and
your doctor
suggests that
you consider
surgery, the
type of
procedure he or
she recommends
will depend on
the cause of
your back
problems and the
experience and
preference of
the surgeon.
-
Herniated disc
surgery removes
disc material
that is pressing
on the spinal
cord or a nerve
root.
-
Spinal stenosis
surgery (spinal
decompression
with or without
spinal fusion)
widens a
narrowed spinal
canal and
relieves
pressure on the
spinal cord or a
nerve root.
-
Spinal
fusion (arthrodesis)
for
spondylolisthesis
and other
"unstable spine"
conditions joins
vertebrae
together to
relieve pressure
on the spinal
cord or a nerve
root and to
stabilize the
spine.
-
Vertebroplasty
or kyphoplasty
may relieve pain
from compression
fractures.
-
Surgery for
infection
includes
debridement with
or without joint
fusion, or
drainage of an
abscess.
-
Disc replacement
surgery removes
a spinal disc
that is severely
damaged by
degenerative
disc disease
(DDD), and
replaces it with
an artificial
disc. This is
currently only
for carefully
selected
patients, and it
is done by
specially
trained
surgeons.
-
Surgery for
spinal tumors
includes tumor
removal and
stabilization
with or without
fusion.
Understand that
surgery is a
last resort.
Discuss the
option with your
doctor with the
understanding
that back
surgeries are
not always
successful.
You will also
likely have to
commit to
physical therapy
after the
surgery.
Spine Surgery
for Leg Pain or
Lumbar
Decompression
Surgery
If most of the
patient’s pain
is leg pain
(radiculopathy),
the pain may be
due to a pinched
nerve. If the
leg pain does
not start to
resolve with
conservative
treatment after
4 to 6 weeks, an
imaging study
(such as an MRI
scan) may be
recommended to
determine
whether or not
there is nerve
pinching (e.g.
from a herniated
disc).
If there is
pressure on the
nerve, then
either
injections or a
lumbar
decompression
spine surgery to
take pressure
off the nerve
may be
recommended.
Back surgery for
a pinched nerve
can usually be
done with a
minimally
invasive
approach, and
will usually
result in early
return to normal
function (1 to 3
weeks). The
success rate for
decompression
spine surgery is
high, with
approximately
90% of patients
experiencing
good relief of
the leg pain
after the
surgery.
Surgery for Low
Back Pain
Surgery to treat
low back pain
can be a far
more extensive
type of back
surgery, with a
longer healing
period and a
somewhat lower
success rate,
than back
surgery for a
pinched nerve
(leg pain). If
the patient does
not get low back
pain relief
after 6 to 12
months of
conservative
treatment,
however, a
fusion surgery
may be a
reasonable
option. When the
patient has the
right
indications, low
back surgery to
stop the motion
at a painful
motion segment
and remove the
pain generator
should reduce
the patient’s
lower back pain.
Recovery after
Surgery for Low
Back Pain or Leg
Pain
After a spine
fusion surgery,
it takes 3 to 12
months to return
to most normal
daily
activities, and
the success rate
in terms of pain
relief is
probably between
70% and 90%,
depending on the
condition the
spine surgery is
treating. Soon a
total disc
replacement—or
artificial disc
surgery—may also
be available as
a treatment
option for
patients with
certain types of
conditions that
cause ongoing
low back pain.
For patients who
are 55 or older,
symptoms of back
pain and/or leg
pain are much
more likely to
be due to
degenerative
arthritis
(osteoarthritis)
that might
result in a
narrowing of the
canal (spinal
stenosis) and/or
instability of
one vertebral
segment.
Generally, the
low back pain
and/or leg pain
created by these
back conditions
will get worse
with walking and
will improve
with sitting.
Often, the
symptoms will
have been
present for
years, and may
get worse at a
very slow rate.
Once a patient
gets to the
point that he or
she can no
longer
adequately
function because
of the low back
pain, lumbar
decompression
with or without
spine fusion may
be recommended
to help increase
the individual’s
activity
tolerance and
quality of life.
When Spine
Surgery is an
Emergency
The vast
majority of
spine surgery
procedures to
treat severe
back pain and/or
leg pain are
elective.
However, there
are a few
symptoms that
are possible
indications of a
serious medical
condition, and
patients with
these symptoms
should seek
emergency
medical care.
These symptoms
include:
-
Sudden bowel
and/or bladder
incontinence
(either the
inability to
retain or hold
waste) or
progressive
weakness in the
legs. Either of
these symptoms
could indicate
nerve damage or
cauda equina
syndrome.
-
Severe,
continuous
abdominal
and back
pain, which
could
indicate an
abdominal
aorticaneurysm.
Any patients
with either of
these symptoms
should seek
immediate
medical
attention as
they may need
emergency spine
surgery.
