Millions of people have back pain, and chronic pain can get worse over time. There are plenty of surgery options available nowadays, but are they suitable for everyone? While the orthopedic surgeon is the best to answer this question based on each individual’s medical condition, let’s review in this article which types of pain require surgery and which options can be discussed with the doctor.
What type of back pain requires surgery?
Not everyone is a good candidate for back surgery. For example, most cases of acute low back pain are self-limited and resolved with home remedies and medication. Thus, surgery is not needed.
Back surgery is considered when the pain becomes a long-term problem, not relieved with conservative measures, is getting worse, and very important- the underlying cause is identified. For example, back pain is caused by nerve damage, significant injuries to the muscles, ligaments, and bones, or nerve compression. Surgeries can correct an anatomic defect, thus the problem has to be identified in order to have surgery.
Bulging and herniated discs are the most common conditions treated with surgery. Bone spurs, osteoarthritis of the spine, degenerative disc disease, spondylolisthesis (also known as vertebral slippage), and spinal stenosis can also be managed with surgery if other treatments fail.
A specialist will review the benefits and risks of having back surgery and the best type of surgery is assessed based on the underlying conditions that cause the back pain.
Another important aspect is overall health. For example, individuals with poor control of their blood sugar levels are at higher risk to develop complications after surgery such as infections or poor wound healing. Therefore they need to have better control of their diabetes first before being able to have surgery. Excess weight (obesity ) is also associated with poor results and those who have a BMI over 40 are not eligible for elective spinal surgery. They would need to lose weight before having surgery.
Smokers need to discuss the doctor’s ways to quit, at least before the surgery and for at least 3 months. In the case of spinal fusion surgery, the fusion rate is significantly lower in smokers compared with those who don’t smoke.
Back surgery options
These are some of the options considered by an orthopedic surgeon:
- Vertebroplasty and kyphoplasty. These minimally invasive procedures indicated in case of fractures of the vertebrae due to osteoporosis. A substance is injected into the vertebrae.This substance hardens, strengthening the bone and hopefully, decreases the pain.
- Spinal decompression is used when back pain and associated numbness and weakness is caused by the narrowing of the spinal canal. Also known as laminectomy, this procedure involves the removal of the bony walls of the vertebrae and bony spurs, with the goal of relieving pressure on the nerves.
- Discectomy is often done with spinal decompression. Discectomy involves the removal of the disk that is herniated and causes the pain. Microdiscectomy is a newer procedure, with a smaller incision and a faster recovery time.
- Foraminotomy. Formen are the naturally occurring holes, through which spinal nerve roots exit the spinal canal. Bulging disks can narrow these spaces, pressing on the nerves. Foraminotomy involves the removal of small pieces of the bone to reduce pressure on the nerves and relieve the associated pain.
- Nucleoplasty is indicated in case of back pain caused by a mild herniated disk. This is a laser surgery that removes small parts of the disc, and thus relieves the pressure on the nerves and the pain.
- Spinal fusion. As the name implies, this surgery involves the fusion of vertebrae using bone grafts or metal parts. Before fusion, the problematic disc is removed. This surgery is indicated in case of degenerative disc disease (DDD) or after a spinal decompression. The recovery time is longer because it takes time for the vertebrae to fuse together.
- Artificial (total) disc replacement is recommended in cases of neck pain or low back pain associated with extensive damage of the discs. The damaged discs are removed and replaced with an artificial disc made from metal or metal and plastic. This is an alternative to spinal fusion.
- Interspinous spacers are minimally invasive surgeries recommended for those with spinal stenosis. Small spacers made of metal or plastic are placed into the vertebrae to keep the spinal canal open and prevent pressure on the nerves.
- More options. Implanted nerve stimulators are newer therapies. Small devices are implanted in the lower back. The nerves are stimulated with electric impulses that block the pain signals.
Back surgeries can help many people, but they are not always successful. While some procedures are minimally invasive, most people need months to recover. In some cases, there is a permanent loss of flexibility in the area of the spine where surgery was performed.
For example, the commonly recommended spinal fusion is associated with decreased flexibility in the spine and increased risk for degenerative discs in the area of the spine adjacent to the surgery. Make sure you ask your doctor about the pros and cons of having surgery, and specific surgery options available to you.