Weighing the Risks, Benefits of Back Surgery
Millions of people experience back problems that cause pain or disability. Of these, a small number will seek relief through surgery.
The reasons for back surgery typically vary with a person's age:
Teens may consider surgery to correct deformities. These include scoliosis, or curvature of the spine.
Adults ages 20 to 50 most likely have problems with disks that have degenerated or slipped out of position. This can cause severe back and leg pain.
Older adults may have spinal stenosis. This is a narrowing of the spinal canal that can press on nerves leading to the legs.
Seldom a first choice
Surgery is the first or only option in just a few cases — for example, when a person is in severe pain, has back instability from trauma, or has nerve problems, such as loss of motor or bladder control.
For a less-severe problem, most doctors and patients prefer to try other treatments first. These include exercise and education, physical therapy, medication, and nerve-block injections. If the problem persists, they may weigh the risks and benefits of surgery.
If you choose to have spine surgery, it will probably be one of 3 types:
Decompression, in which bone or other tissue is removed to take pressure off a nerve or the spinal cord. In a laminectomy, for instance, the surgeon removes part of the bone surrounding the spinal cord. Decompression is also used to relieve spinal stenosis.
Stabilization or fusion, in which a surgeon uses bone grafts or metal rods and screws to fuse vertebrae together, making a strong bridge across a missing or damaged disk.
Corrective procedures, which use spinal fusion and other techniques to straighten deformities, such as scoliosis.
Less invasive techniques have reduced the size of the incision and the amount of blood lost. They have also reduced the normal recovery time for some common procedures. Disk surgeries, for example, now can be performed under a microscope, or using magnified glasses, using an incision that's only slightly more than an inch long.
If you have a microdiscectomy, you may be on your feet within a day or 2, in physical therapy within a week, and back at work in 2 to 4 weeks.
Recovery after fusion surgery can take 8 to 10 weeks or longer.
How fast you recover from any back surgery depends on several things, including your age and general physical condition.
When back problems occur, talk with your primary-care doctor first. Ask to be referred to a spine specialist if your condition doesn't improve after 6 to 8 weeks of treatment.
The medical team involved in treating your spinal cord compression may include arthritis specialists, bone surgeons, nerve specialists, and physical therapists. Treatment depends on the cause and your symptoms and may involve medication, physical therapy, injections, and surgery. Except in cases of emergency, such as cauda equina syndrome or a broken back, surgery is usually the last resort.
- Medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs) that relieve pain and swelling, and steroid injections that reduce swelling.
- Physical therapy may include exercises to strengthen your back, abdominal, and leg muscles. You may learn how to do activities more safely. Braces to support your back or a cervical collar may also be helpful.
- Surgical treatments include removing bone spurs and widening the space between vertebrae. Other procedures may be done to relieve pressure on the spine or repair fractured vertebrae. The back may also be stabilized by fusing some of the vertebrae together.
Some other treatments that may be helpful for some people include acupuncture and chiropractic care.