Weighing the Risks and Benefits of Back Surgery

When Surgery Can Help

The most common symptom that may indicate a need for surgery is radicular pain, or pain radiating from the back to the legs, arms or hands. This may be accompanied by numbness or heaviness and occasionally loss of bladder control, all of which likely point to a compressed nerve.

• In younger adults, ages 20 to 50, these symptoms likely point to a disc problem such as a degenerated or herniated disc. Surgeries such as OLIF, XLIF and discectomy remove the faulty disc, or portion of the disc. If necessary, the space left by the removed disc is replaced with an implant that improves stability and relieves pressure on the nerve.
  
  
• Many older adults experience spinal stenosis, or a narrowing of the spinal canal, due to conditions or injuries such as arthritis, bone spurs or fractures. In these cases, surgeries such as percutaneous lumbar surgery, cervical laminoplasty and spinal fusion can shore up the spine by fusing bone together or adding instrumentation such as rods, screws or implants.
  
  
• Some teenagers with scoliosis may need surgery if the curvature is severe (more than 40 degrees) and progressive. Otherwise, the curve may cause pain and deformity over time. Both minimally invasive scoliosis surgery and traditional scoliosis surgery, can straighten the curve and create a stable spine using instrumentation such as rods and screws.
• In rare cases, a tumor may cause back pain as it presses against the nerves. A surgeon may determine that surgery can remove the tumor safely to relieve symptoms and protect the spine.

Benefits of Minimally Invasive Methods

Surgical and imaging tools and methods have evolved radically over the last decade, allowing doctors to perform back and spine surgery using very small incisions – often less than one inch – and tiny cameras and surgical instruments. This significantly reduces blood loss, damage to muscles, nerves and blood vessels, surgical complications, pain, and scarring. Consequently, patients spend less time in the hospital and recover much quicker than from traditional surgery.

"We're talking a few weeks of recovery, as opposed to a few months with traditional surgery. Patients can get back to work faster, and they require fewer pain medications," Dr. Oshtory says.

Common Risks and Concerns

Back surgery is a major procedure with some risks. These include the typical risks of any surgery, such as bleeding or infection, as well as concerns specific to back surgery. Here are the most common questions Dr. Oshtory hears from his patients and his advice.

How will my back feel after the surgery?

Most patients experience significant relief from symptoms once they’ve recovered from the surgery, Dr. Oshtory says. However, depending on the type of surgery, there may be some stiffness where the spine was fixated or fused. In some cases, pain or numbness may linger or return if the damage to the spine is very progressed or it continues to degenerate.

How long will my implant or instrumentation last?

Instrumentation designed for back and spine surgery has a very high success rate and will probably last for your lifetime. However, there is a small risk that the instrumentation could malfunction or become dislocated. That would require a second surgery to remove or replace the piece.

Is there a chance this surgery will cause paralysis?

"Many of my patients have this concern, but paralysis is exceedingly rare. It's actually non-existent in any lumbar (lower back) surgeries since the spinal cord doesn't extend to the lumbar spine," Dr. Oshtory says.

In general, back surgery today is safer than ever and largely effective at reducing symptoms and improving quality of life. "The idea is to get patients back on their feet and resuming the things they like to do. And that's very likely as long as the doctor operates for the right reasons," Dr. Oshtory says.

Non-Surgical Help

So what then to do about back pain when surgery is not the answer? The vast majority of back pain can be handled through the following methods:

• Self-care — During the days immediately after pain starts, ice the back for 20 minutes several times a day. Introduce a warm bath or heating pad after a few days, which can help reduce pain and stiffness. Take over-the-counter nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen) for pain and inflammation.
• Gentle movement — Discontinue any activities that involve high impact or repeated twisting. Instead, take regular, short walks and introduce gentle stretches as you're able.
• Physical therapy — If home treatment does not reduce pain after a few weeks, talk to your doctor about seeing a physical therapist. A physical therapist will introduce you to exercises and techniques to build strength and flexibility. These include isometric exercises, the contracting of specific muscle groups, which Dr. Oshtory calls the "most important treatment" for back pain.
• Weight loss — Extra weight, especially around your midsection, puts strain on your back and spine. Many people notice a marked reduction in back pain when they lose even a few pounds.
• Adjusting activity — You may need to learn new ways to move and function to reduce and prevent back pain. Some examples: replacing your office chair with a more back-friendly model, or refraining from tasks that require repetitive twisting or bending. Read more about back pain prevention.

If you follow these tips and your back pain increases or becomes unmanageable, see your doctor for a complete physical evaluation and to rule out a more serious problem. He or she may recommend additional pain management strategies, such as prescription medications or pain injections, or even non-invasive, integrative medicine treatments such as chiropractic care or acupuncture.