Last updated: Apr 30, 2008

The time may come when all the exercise, acupuncture, pain relievers, and injections are no longer doing the job. You're in pain, all the time. At this point, you may be offered surgery or seek it out. That may seem drastic and scary, but pain and sleepless nights can be pretty persuasive. How do you decide?

A lot depends on what's causing your back pain. For example, if you have muscle or soft-tissue pain, you're not likely to benefit from surgery. If your pain is caused by a herniated disk, or nerve damage, you might be a candidate, if non-surgical treatments haven't worked.

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Success stories
Some operations are routinely more successful than others. If you experience pain that radiates from the back down into your leg—probably sciatica—then your pain is likely caused by a herniated disk or stenosis (the narrowing of the spinal canal), compressing the nerve. Laser surgery used to decompress herniated disks is successful up to 90% of the time, by some estimates, while, according to a 2002 article in the Journal of the Southern Orthopaedic Association, surgery to treat stenosis is effective about 70% of the time.

Degeneration is harder to treat
Surgery for pain that comes from the lower back alone and is caused by degenerative disk disease—ordinary aging—is often less predictable and successful. It can be difficult to determine the exact cause or origin of the pain, let alone to factor in the impact of social, psychological, and other factors that can exacerbate it.

The payoffs and tradeoffs
Studies show that recovery rates for surgical vs. non-surgical treatments have similar results. A 2005 study in the United Kingdom found that patients who had spinal fusion surgery reported roughly the same decrease in the amount of pain experienced during everyday activities (including sitting, standing, socializing, and traveling) as those patients who had intensive physical rehabilitation and cognitive behavioral therapy.

Any back surgery may initially be successful and may address pain more rapidly than non-surgical treatments, but long-term follow-up studies show that people who've had surgery aren't much better off than those who don't. In some cases, patients had to repeat the surgery within 10 years.

It's also important to remember that surgery always presents a risk for unforeseen complications even with the best surgeons. These risks include nerve damage, infection, and adverse reactions to anesthesia.

To take an interactive quiz on whether to have surgery, visit our A-Z Health Library.