Each year, over 250,000 back surgeries are done in the US. The successful outcomes from these surgeries overall depend on how well it’s performed and the reasons for it being done.
How does an individual know if a back surgery can be avoided and if he or she is in the category of having the choice to opt out of surgery without potential for future harm?
The primary thing to understand up front is what exactly is the diagnosis. Most common diagnoses for back pain include:
1. Degenerative Disc Disease
2. Herniated Lumbar Disk
3. Degenerative Spondylolisthesis
4. Degenerative Arthritis
5. Osteoporotic Compression Fracture
Once you understand what’s generating your pain, the diagnosis can then be placed into the categories of either 1) Quality of Life issue or 2) Indicated for Surgery.
Let’s look first at Degenerative Disc Disease, which often occurs in patients between the ages of 30 and 60. Degenerative discs do not always result in pain, there is actually a significant portion of the population who has DDD noticeable on MRI but no back pain at all. In some patients, though, it may cause significant back pain and lost time from work.
DDD is not a disease that needs an operation, it turns into an elective decision. Success rates for DDD fusion surgeries are fifty to seventy percent and a lot of patients end up needing more surgery in the future and more pain medication. Nonoperative treatment for DDD may help substantially including NSAIDS, acetaminophen, chiropractic, aerobic exercise, and pain management.
Most low back pain problems are quality of life decisions. If considerable nonoperative therapy doesn’t work, then an operation can be undergone electively. A lumbar pinched nerve is often in this category when it is resulting in numbness or pain. If an individual can handle the pain, research shows that the outcomes with an operation vs nonsurgical treatments are the same after one year.
If muscle weakness is present such as a foot drop, then surgery may be indicated. With a neurologic deficit, then the longer one waits to undergo an operation the chances are it will not improve even if the operation is done perfectly.
This is exactly the point with spinal arthritis. No one ever died as a result of arthritis. So if arthritis causes degeneration or a spondylolisthesis along with spinal stenosis and there’s no muscle weakness from pinched nerves, the situation is elective. Opting for surgery is fine if conservative treatment has been exhausted, there is a surgery for the specific condition with a successful track record, and the patient is healthy enough to undergo it. But if the condition is in fact elective, patients need to weigh the pros and cons considerably to make sure they are comfortable with the potential for a poor outcome compared to the potential for marginal improvement with nonsurgical treatments.
These can include spinal decompression, PT, chiropractic, and pain management.