When Surgery Can Help Chronic Back Pain

Surgery is seldom used to treat low back pain. In most cases, the cause of low back pain cannot be helped by surgery.

Most back surgeries are performed to treat herniated discs. Still, most people with herniated discs do not need surgery. Herniated disc surgery may be used when a disc problem is causing severe and disabling sciatica. Surgery is sometimes done to treat spinal stenosis if it is causing severe symptoms. As with herniated discs, most people with spinal stenosis do not need surgery.

Surgery may also be considered in more unusual situations, as in the case of:

• A spinal fracture caused by an injury.
• A spinal infection, such as osteomyelitis or an abscess.
• An "unstable spine" condition, such as spondylolysis and spondylolisthesis.
• A spinal tumor.
• Spinal stenosis.

Rehabilitation after surgery
A comprehensive rehabilitation program is very important after back surgery. As you regain flexibility, recondition your back and stomach muscles, and increase your endurance for activity, you increase your chances of treatment success.

If you are unable or unwilling to commit to physical therapy after surgery, you may not be a good candidate for surgery.

Surgery choices
If nonsurgical treatment has not been successful and your doctor suggests that you consider surgery, the type of procedure he or she recommends will depend on the cause of your back problems and the experience and preference of the surgeon.

• Herniated disc surgery removes disc material that is pressing on the spinal cord or a nerve root. For more information, see: Should I have surgery for a herniated disc?
• Spinal stenosis surgery (spinal decompression with or without spinal fusion) widens a narrowed spinal canal and relieves pressure on the spinal cord or a nerve root. For more information, see the topic Lumbar Spinal stenosis.
• Spinal fusion (arthrodesis) for spondylolisthesis and other "unstable spine" conditions joins vertebrae together to relieve pressure on the spinal cord or a nerve root and to stabilize the spine.
• Vertebroplasty or kyphoplasty relieves pain from compression fractures.
• Surgery for infection includes debridement with or without joint fusion, or drainage of an abscess.
• Disc replacement surgery removes a spinal disc that is severely damaged by degenerative disc disease (DDD), and replaces it with an artificial disc. This is currently only for carefully selected patients, and it is done by specially trained surgeons.
• Surgery for spinal tumors includes tumor removal and stabilization with or without fusion.

What to think about
Back surgery is not always successful. Depending on the condition, you may still have back pain after surgery.

If you and your doctor are considering surgery, get as much information as you can about possible outcomes, and consider whether you will be willing to participate in a physical therapy program after surgery. It is also a good idea to get a second opinion before you decide to have surgery.