Is It Time for Back Surgery?

Aching back? You’re hardly alone. Back pain that just won’t go away is the most common type of chronic pain in the U.S. If you’re living with severe pain, you might be thinking about surgery. While that’s a decision only you and your doctor can make, here are a few things to keep in mind.

Most Back Pain Doesn’t Require Surgery

Chances are, you can ease your back pain without going under the knife or laser. Ice, heat, spinal injections, physical therapy, and nonsteroidal anti-inflammatory (NSAIDs) medications like ibuprofen can help. Research shows that regular exercise also eases back pain and can keep it from coming back, too.

Unless you have a serious spinal cord injury, your surgeon will only recommend back surgery if you’ve tried other treatments first, says Ronald A. Lehman Jr., MD, director of degenerative and minimally invasive spine surgery at Columbia Orthopedics in New York.

Reasons You May Need Back Surgery

Your doctor may tell you to see an orthopedic surgeon if you have:

  • A slipped disk that isn’t getting better on its own
  • Bone spurs in your spine (these are often caused by arthritis) that are putting pressure on your spinal cord
  • A degenerative spinal condition like stenosis (narrowing of the protective bony canal around the spinal cord) that’s causing side effects, like weakness
  • Weakness or numbness in your arms and legs
  • Trouble walking or using your hands
  • Lost bladder or bowel control because of a problem with the nerves in your back
  • A spinal infection, or a high fever with back pain -- this can be a sign of a spinal infection
  • A broken or dislocated bone in your back
  • A tumor on your spinal cord

Remember, talking to a surgeon doesn’t mean you’re saying yes to surgery. Instead, it’s a chance to learn more about your options.

“Surgeons often decide people don’t need surgery,” Lehman says. “For example, I might recommend trying [another treatment] like spinal injections and physical therapy. Or I may recommend imaging tests to make a diagnosis in order to clarify whether surgery will help.”

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If You Do Need Surgery, Timing Matters

In most cases, back surgery isn’t a rush.Lehman often tells patients with herniated (or “slipped”) discs, or degenerative spine conditions that are slow to get worse, to wait 6 weeks before surgery. This gives him a chance to see if your body will heal on its own. It also lets him see if more conservative treatments, like spinal injections and physical therapy, can help.                 

But there are some reasons why you may need surgery sooner than later -- or even right away. “If you have severe, unrelenting pain and neurological symptoms like foot drop, or a serious problem such as a spinal cord injury, your surgeon may not want to wait long,” Lehman says. If you have any doubts about whether you need surgery at any point, seek a second opinion, he says.                

Surgery is always a joint decision between you and your surgeon. Keep in mind that if he does recommend surgery and you put it off, that can cause more problems.

That’s especially true if your spinal cord is being compressed by a degenerative condition, says Federico Girardi, MD, an orthopedic spine surgeon at the Hospital for Special Surgery in New York City. “Your spinal cord is made of nerves, and they need oxygen and nutrients in order to function.” Too little blood flow to your spine for long periods of time can contribute to nerve damage and problems such as weakness, he says.               

Whether you have surgery or not, a healthy lifestyle can lower your changes of having back pain in the future. If you maintain a healthy body weight, exercise regularly, eat a healthy diet, and don’t smoke, you’ll help your spine and surrounding tissues stay healthy.

WebMD Feature Reviewed by David T. Derrer, MD on January 23, 2016

Sources

SOURCES:

American Academy of Orthopaedic Surgeons: “Cervical Spondylotic Myelopathy: Surgical Treatment Options.”

American Academy of Orthopaedic Surgeons: “Cauda Equina Syndrome.”

Carey, T. JAMA Internal Medicine, January 2016.

Cleveland Clinic: “Back Pain: When Is Surgery Appropriate?”

Federico Girardi, MD, orthopedic spine surgeon, Hospital for Special Surgery, New York.

Johns Hopkins Medicine: “Do You Need Back Surgery -- Really?”

American Academy of Pain Medicine: “AAPM Facts and Figures on Pain.”

Ronald A. Lehman, Jr., MD, professor of orthopedic surgery, Columbia University

Medical Center; director of Degenerative & Minimally Invasive Spine Surgery, Columbia Orthopedics, New York.

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