If you are receiving excellent care from a qualified pain specialist, chances are good that you have worked with them to find the least invasive treatment options for back pain. From simple over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) to nerve blocks or other minimally-invasive treatments, many types of back pain can be successfully treated without surgery. Sometimes, however, a combination of minimally-invasive treatments and lifestyle changes just doesn’t adequately address back pain. There are also conditions that respond best to back surgery. For these reasons, sometimes surgery is the best option for back pain for the best results.

There are a few different conditions that may be best resolved by back surgery.

Spinal stenosis

Spinal stenosis is the narrowing of the spinal column. This narrowing occurs naturally as we age and gravity pulls down on the vertebrae. Natural or not, this narrowing can put pressure on the spinal cord, causing inflammation and pain. While inflammation can be addressed using anti-inflammatories or other treatments, if not addressed, the mechanical issue of a narrower spinal column will continue to irritate the spinal cord and cause pain.

Degenerative spondylolisthesis

This condition is caused when one disc in the spine slips forward over the other, usually as a result of weak vertebrae in the lumbar spine. This collapse results in a narrowing of the spinal column and usually causes pain that radiates down the legs.

Bulging or herniated discs

Discs are the cushions that nestle between each vertebrae. As we age, discs begin to deteriorate a bit due to wear and tear and the pressure of gravity. In some cases, a large portion of the fluid-filled disc will bulge out between the vertebrae. This often causes no pain and does not normally require treatment. A herniated disc is when the cartilage that contains the fluid actually bursts. Again, this may not cause pain, but in cases when persistent and unresponsive pain is present, back surgery can be an option.

Spinal fracture

A crack or fracture in any vertebrae that is due to age, illness, or injury can cause pressure and pain on the surrounding vertebrae. Injections or other minimally-invasive treatments may address the symptoms caused by this, but they will not fix the underlying fracture.

While surgery is no guarantee of the elimination of pain and a full restoration of good back health, there are a few procedures that may help relieve pain and restore function.

  • Discectomy: In this procedure, the herniated disc is removed, along with part or all of the back of the vertebrae where it is located.
  • Laminectomy: Laminectomy removes any bone impeding the spinal column, either bony protrusions or as a result of spinal stenosis. The enlarged spinal canal then relieves pressure and pain.
  • Spinal fusion: This surgery is performed most often in the case of spinal fracture. Two or more vertebrae are fused together to provide support and stability. It can also be used to immobilize the spine when a herniated disc creates unwanted and painful motion.
  • Artificial discs: This is a relatively new surgery that can be utilized to replace herniated discs. It is an alternative to spinal fusion to help limit motion.

Recent back surgery research

Results from back surgery are as individual as the patients themselves. There are many factors that influence the success of a spinal surgery, including the presence of other health conditions, the general health and age of the patient, and the patient’s adherence to recovery protocols.

In the case of spinal stenosis and degenerative spondylolisthesis, surgery can help patients improve their quality of life in everyday activities, specifically but not limited to sexual activity. A research trial of over 1,200 patients found that those patients who were treated with spinal surgery were less likely to report pain during sex than those who opted for other treatments. For some patients, this was important to consider when evaluating treatment options.

Says one of the study authors:

“Our current research has two important findings. The first is that sexual activity and sexual function is an important consideration for patients with degenerative spine conditions. The study also shows that sexual function is a more relevant consideration for patients who are married, younger, and male. The second important finding of our study is that patients with degenerative conditions of the spine treated with surgery reported less pain with their sex-life compared to patients treated without surgery. This finding lasted throughout the four years of follow-up.”

For some patients, surgery can restore mobility and help reduce (or eliminate) back pain, but for others, pain may persist, even if the surgery is technically a success. Mohammed Farid Shamji, MD, PhD, FAANS and his team found that even if back surgery restores structural integrity to the spine, years of chronic pain and inflammation may lead to changes on a molecular level that cause pain to persist.

Dr. Shamji noted changes in the neurons, saying:

“It is extremely novel to learn that an autoimmune neuroinflammatory radiculopathy that we clinically manage in most patients as being self-limited has the potential to cause permanent structural changes to neurons and functional sensitivity in the pain experience.”

Even when the cause of the pain is removed, the brain remembers and continues to perpetuate it. This finding is an important one and may lead doctors to respond with more urgency to prevent this neural change.

Healing after back surgery 

For the best possible outcomes from back surgery, patients can do the following:

  • Get written instructions for recovery, including medication, recommended activity levels, and any warning signs to look for
  • Ask for help after surgery with everyday tasks
  • Follow the doctor’s orders for physical therapy and rehabilitation
  • Sleep as well as you can to allow your body to heal

A common problem for any type of condition is patients who do not follow instructions for post-operative treatment. Patients can ensure the best possible outcome by following rehabilitation instructions and directions and communicating with their doctor when there are any problems.

Back surgery may not be the best choice for every back pain condition. Talk to your doctor to see which treatment is best for you.

Image by Ruhrfisch via Flickr


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