The good news is that the overwhelming majority of back pain sufferers don’t need surgery to heal on their own, either completely or with only a small functional impairment to their daily lives. The bad news is that healing can take a fair amount of time, sometimes years. Severe, relentless back pain pain has compelled hundreds of thousands of those with back problems to opt for surgical relief, propelling back surgery to among the most common types of operations performed. Here we take a look at what those operations are, and who needs them.
Do You Need Surgery?
When we think of elective surgery – that which is not life saving, but chosen – cosmetic procedures such as face lifts and tummy tucks are probably what spring to mind. The fact is, most back surgery falls into this category as well. Other than procedures performed for those with fractures or dislocations, infections, tumors, or other life-threatening diseases, many back operations are not absolutely necessary in the true medical sense of the word.
Back pain alone – even if very severe – is technically not sufficient cause for surgery, nor is it something that surgery can necessarily cure. Surgery has been found to be helpful only in one in one hundred cases of low back problems. In some people, surgery can even cause more problems. This is especially true if your only symptoms are back pain.
If, on the other hand, your pain is caused by neurologic rather than musculoskeletal trouble, or if you have any of the conditions mentioned above, surgery can help. An ongoing joint study begun four years ago by researchers from the Maine Medical Assessment Foundation, Massachusetts General Hospital, and the University of Washington at Seattle found that surgical approaches can offer better back pain relief than nonsurgical treatment for patients with two common causes of low back and leg pain: sciatica, the lower back pain that radiates into a leg and is usually caused by a hemiated disk pinching a nerve; and spinal stenosis, the narrowing of the spinal canal in the area of the spinal cord that can also compress nerves. In these cases, patients who had experienced symptoms for a shorter duration had better outcomes than patients whose symptoms had already been prolonged.
Continued study has also revealed that in the stenosis groups, patients with symptoms in one leg fared better over time than those with bilateral symptoms. Long-term effects, however, won’t be known for several more years.
The key is in having surgery for the right reasons, which is apparently not as obvious as it might sound. Appropriate patients, appropriate diagnoses, and the right approaches, performed correctly are key. Diskectomy – the operation to repair herniated disks – is one of the most common surgeries in the United States, yet population-based rates of this procedure vary widely around the country. Where the rates are higher – indicating, perhaps, less discrimination in who gets the operation and who doesn’t – outcomes may not be as good.
Social, economic, and psychological factors also come into play. Just as they can significantly affect the response to back symptoms, they can have a big influence on the effectiveness of back pain treatment methods, including surgery. If a patient is depressed, lacks a social support group, or has financial problems, for instance, the success rate of any surgical procedure will fall.
With or without surgery, more than 80 percent of patients who have significant lumbar disk herniations will eventually recover, says Robert B. Keller, M.D., executive director of the Maine Medical Assessment Foundation in Manchester and coauthor of the above mentioned studies. Though some people take longer than others.
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