WHEN TO HAVE SURGERY FOR LOW BACK PAIN?

Back Surgery works when the patient experiences severe lower back pain and has not responded to the non-surgical or conservative treatments in the course of 2-3 months (6-12 weeks). The non-surgical or conservative treatments includes the following –

• Pain relievers as needed
• Physical Therapy
• Ice and heat application
• Stretching and strengthening exercises
• Epidural Injections

Why do you need low back surgery?

The decision to consider back surgery should always be after trying the non-surgical or conservative treatments. But if the problem is major and causing mechanical problem in the spine then the patient might have to discuss it with his/her pain management doctor or neurologist.

Numbness in one or both arms and legs due to compressed nerves of the spine could be one of the main reasons of not responding well to conservative treatments options. The nerves of the spine get compressed due to the following reasons –

• Disc Problems

Slip disc is a disorder in which these inter-vertebral discs protrude into the spinal canal. This causes pressure on the spinal cord and spinal nerve, thus resulting in back pain or pain along the course of the affected nerve, often termed as ‘Sciatica’. It may be accompanied by burning, numbness, or tingling, radiating from the lower back and buttock down the back of the thigh to the leg and foot. Most episodes of slip disc settle with medication and physiotherapy, while some may require surgical intervention.

·Spinal Stenosis

Spinal stenosis refers to a narrowing of the spinal canal, commonly seen in middle aged and older population. Spinal stenosis is another cause of back pain along with radiating pain with or without numbness of one or both lower limbs. Spinal stenosis may be due to thickened ligaments, bony spurs or enlarged joint cartilage from arthritic changes. This condition often results in back pain that worsens with moderate to long periods of standing or walking, along with heaviness, tingling and numbness in lower limbs.

Goal:

The goal and outcome of surgery depends on the disease or underlying conditions. Following are the categories of immediate goals of the surgery –

1. Stabilisation of the Spine
2. Decompression of Neurological Structures
3. The Combination of both a. and b.

In case of spine surgery, the main goal is to reduce the pain and improve the functionality and activities of the patient.

Types of low back pain surgery:

1. Discectomy

Discectomy is performed to remove the damaged low back herniated disc material that is pressing on one of the nerve roots or the spinal cord.

2. Laminectomy or Laminotomy

Laminectomy, also known as Decompression Surgery, is performed to remove a portion of vertebra which is known as lamina.

Lamina is the roof of the spinal canal. This procedure enlarges the spinal canal to relieve from the pressure causing on the spinal cord or nerves. The pressure caused to the spinal cord or nerves is caused to those patients who have Osteoarthritis (Arthritis in Spine). It is usually recommended to perform Laminectomy only if the symptoms are severe or worse.

3. Spinal Fusion

Spinal fusion is performed to correct the problems of vertebrae in the spine. In this procedure, two or more vertebrae are fused together so that they can heal into a single and solid bone. Basically, Spinal Fusion is done to eliminate the painful motion and restore the stability of the spine.

4. Artificial Discs Replacement

This is a type of Arthroplasty. This type of surgery is performed to replace the artificial discs in the lumbar or cervical spine with the degenerated intervertebral discs in the spinal column.

Conclusion:

There are various reasons that causes back pain which may also be part of our daily activities such as lifting heavy weights, uncomfortable sleep positions, wearing poorly fitting backpack, heavy workouts, prolonged sitting or lying down, etc. Such activities may sometimes cause a discomfort on the back or spine which can lead to a major problem.

When you experience low back pain, visit a pain management clinic as early as possible to determine the cause of the back pain and rule out any injury. The pain management doctor provides proper medications and other conservative treatments after based on diagnostics results. . If such treatments do not provide symptoms relief in maximum 3 months than the pain management doctor may suggest for a back or spine surgery depending upon which part of the back or spine is damaged.

After surgery, follow all the instructions given by the surgeon and do not skip the routine visits to the surgeon.