8 out of 10 Americans will suffer from at least one major episode of back pain at some point in their lives. While surgery might seem like a good way to relieve chronic back pain, in most cases surgery is not “needed”. In fact, for many people spine surgery is not successful and it can result in ongoing or even increased pain. Nevertheless, there are limited times when surgery is the right option. Indications for spine surgery include infection, trauma, neurological dysfunction, tumors, or severe structural abnormality like scoliosis. The last indication for surgery is pain refractory to more conservative treatments with imaging evidence to suggest there is a surgically correctable abnormality that could result in pain relief if operated on. Today, we’ll discuss some of those situations to help you know what type of treatment might be right for you.
Before considering spine surgery, it’s almost always a good idea to first try more conservative non-surgical options. The most conservative treatments include physical therapy, medications, anti-inflammatories and lifestyle modifications. When these treatment options fail to provide relief an interventional pain management specialist like Dr. Jeffrey Glaser can often help. Interventional pain management offers many non-surgical solutions to treat a patient’s pain. Some of these options include epidural steroid injections, nerve blocks, nerve ablations, regenerative medicine (i.e. PRP and stem cell treatments) and spinal cord stimulation (SCS).
If you have back pain that is not relieved through non-surgical treatments, your doctor might suggest that you consider surgery. One important thing to note is that even in these circumstances, surgery should only be considered in cases where the exact source of pain can be determined. For example a herniated disc, scoliosis or spinal stenosis. Other conditions that are good candidates for surgery are ruptured discs, spondylolisthesis, vertebral fractures and degenerative disk disease. If the source of your pain has been identified and non-surgical treatments have not been effective, then you might be a candidate for spinal surgery.
The seriousness of back surgery is dependent on the type of surgery that you have. Spinal surgery can be either traditional open surgery or minimally invasive spine surgery (MISS). MISS does not involve long incisions and it avoids open manipulation of muscles and tissues surrounding the spine. As a result, it usually results in a faster recovery with less pain.
Because of its proximity to the nervous system, back surgery can carry higher risks than some other types of surgery. The most serious of the risks are paralysis and infection. While the potential complications are largely the same for open spinal surgeries as they are for MISS, some studies seem to indicate that there’s a lower risk of infection for MISS than traditional back surgery. Other potential complications for either type of surgery include bleeding, persistent pain at the graft site, recurring symptoms, nerve damage, blood clots and, in the case of spinal fusions, pseudarthrosis.
MISS procedures help to shorten hospital stays, with most patients going home the same day or within 1 or 2 days, whereas traditional surgery generally results in a 3 to 5-day hospital stay. Even with a successful surgery, however, the recovery time can be long and painful. Most patients will need ongoing pain management and physical therapy.
The success of spine surgery depends on what surgical procedures is performed. For example, with lumbar spinal fusion the success rate as measured by pain relief is often not more than 50%. Furthermore, despite initial success as measured by pain relief many lumbar spine surgeries fail in 3-5 years. This is due to changes in the biomechanical structure of the spine from the surgery resulting in problems arising in adjacent spinal levels. In fact, so many spine surgeries are unsuccessful that there is a medical term for this: failed back surgery syndrome. There are a number of reasons for this low success rate, but the primary reason is that the location operated on was not the cause of the patient’s pain. This is why it’s crucial to identify an exact source of pain before undergoing spine surgery.
In summary, for most patients with back pain and/or sciatica, surgery is not “needed”. However, if you believe that you are a candidate for surgery, it’s important to get a second opinion before undergoing surgery. Not only will this confirm whether surgery is truly necessary or not, but it will also ensure that you receive the right type of surgery and the most minimally invasive procedure possible. If you have ongoing back pain and/or sciatica, contact us today to schedule a comprehensive physical exam, imaging review and evaluation so we can determine the most effective treatment plan for you.
