Back surgery: When is it a good idea?

Back pain is extremely common, and surgery often fails to relieve it. Find out why your back hurts and whether surgery might help.

Oh, your aching back. Not simply an ache. This pain is serious. You wonder — Could back surgery 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 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 therapies, within 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 it's not often indicated. Back surgery is usually reserved for times when a nerve is pinched, the spinal cord is compressed or there's too much movement between the spinal bones.

Your doctor may recommend back surgery if you have neck or back pain accompanied by symptoms of nerve damage. Signs and symptoms include:

Pain that radiates down your legs (sciatica) or arms
Numbness, weakness or tingling in your arms or legs
Loss of bladder or bowel control

Squeezed disks and pinched nerves

Your vertebrae are separated by soft, flexible disks that have a tough outer shell and a soft, gel-like center. They act as cushions between the vertebrae. Your spinal cord runs down through your vertebrae, and nerves pass through gaps in the spinal column.

Many types of problems can reduce the amount of space in the spine, so nerves become pinched. As people age, it's common for spinal disks to dry out and shrink, reducing their effectiveness as shock absorbers. Disks 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. One alternative to fusion may be a new procedure that replaces the damaged disk with an artificial one.

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

Types of back surgery

Different types of back surgery include:

Diskectomy. This involves removal of the herniated portion of a disk to relieve pressure on 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 lamina that overlays 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 or when there's excessive motion between vertebrae. It may also be used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation.
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 procedure — called kyphoplasty — a balloon-like device is inserted 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 as a back surgery option.

Consider all options

Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. 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, and control your weight.