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Back surgery: When is it a good idea?
By Mayo Clinic staffMayo Clinic Health Manager
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Back pain is extremely common, and surgery often fails to relieve it. Find out why your back hurts and whether surgery might help.
By Mayo Clinic staffOh, your aching back. Not simply an ache. This pain is serious. You wonder if back surgery could end the discomfort once and for all.
Trauma, aging, improper body mechanics, and normal wear and tear can all injure your spine. And damage to any part of your back — especially damage that puts pressure on your nerves — can cause pain and other symptoms.
Most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy. When conservative treatments don't help, back surgery may offer relief. But it doesn't help every type of back pain. In fact, back surgery is needed in only a small percentage of cases.
Do you need back surgery?
Most people will have back pain sometime during life. And 90 percent of these people will get better, without treatment or with conservative therapy for four to six weeks. Only 5 percent remain disabled longer than three months.
In most situations, an operation won't be considered unless conservative measures have failed, and even then surgery is not often indicated. Back surgery is usually reserved for times when spinal nerves are compressed, causing numbness along the back of your leg.
Many types of problems can reduce the amount of space in the spine, so nerves become pinched. The disks separating the bones in your spine can also bulge or rupture (herniate), which can irritate nearby nerves. However, many people with bulging disks have no pain.
To relieve pressure on the spinal cord or nerves, surgeons can remove portions of bone to widen the narrowed area in the vertebrae. Removing the gel-like interior of ruptured disks also helps relieve pressure on pinched nerves. Sometimes the entire disk must be removed, with the adjoining vertebral bodies fused together surgically.
Bone fractures and deformities
Direct injury to the spine may cause a bone fracture anywhere along your vertebral column. Osteoporosis — loss of bone density — can weaken vertebrae, causing them to fracture or collapse.
In most cases, fractured vertebrae heal without any help. But if the spinal column is unstable, some doctors opt to fuse two or more vertebral bodies together, using bone grafts and metal plates, screws, rods, or cages.
The following conditions may require surgery if they're progressive, painful or causing nerve compression:
- Scoliosis, a curvature of the spine
- Kyphosis, a humpback deformity
- Spondylolisthesis, the forward slippage of a segment of the spine
- Spinal stenosis, narrowing of the spinal canal typically from arthritis
- Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
- Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear
Types of back surgery
Different types of back surgery include:
- Diskectomy. This involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. It's done as an open surgery and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
- Laminectomy. This procedure involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
- Fusion. Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
- Vertebroplasty. During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar but more expensive procedure — called kyphoplasty — a balloon-like device is inserted to attempt to expand compressed vertebrae before bone cement is injected.
- Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it's not yet clear what role they might play in treating spinal disk disease.
Consider all options
Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Spine surgeons hold differing opinions about when to operate, what type of surgery to perform, and whether — for some spine conditions — surgery is warranted at all. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat.
To prevent recurrent back problems, use good body mechanics, keep your back muscles conditioned with regular exercise and stretching, control your weight and don't smoke.
- Chou R. Subacute and chronic low back pain: Surgical treatment. http://www.uptodate.com/home/index.html. Accessed June 5, 2009.
- Hu SS, et al. Chapter 5. Disorders, Diseases, & Injuries of the Spine. In: Skinner HB, Ed. Current Diagnosis & Treatment in Orthopedics. 4th Ed. New York, N.Y.:McGraw-Hill Companies. http://www.accessmedicine.com/content.aspx?aID=2319334 Accessed June 9, 2009.
- Goroll AH. Clinician advisory: What is the role of surgery in back pain? In: Goroll AH, et al, Eds. Primary Care Medicine. 5th Edition. Philadelphia, Pa.:Lippincott Williams & Wilkins. 2008. http://ovidsp.tx.ovid.com/spa/ovidweb.cgi Accessed June 12, 2009.
- Institute for Clinical Systems Improvement. Health care guideline: Adult low back pain. 13th Edition. 2008. http://mayoweb.mayo.edu/quality-rst/documents/LBP1108.pdf Accessed June 9, 1009.
- Curlee PM. Chapter 41. Other disorders of the spine. In: Canale & Beaty: Campbell's Operative Orthopaedics, 11th Edition. http://www.mdconsult.com/das/book/body/145741546-2/0/1584/313.html?tocnode=55688147&fromURL=313.html Accessed June 12, 2009.
