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Question: What is Back Surgery?
Answer:
Back surgery is an invasive pain management procedure in which a specially trained doctor (the surgeon) uses instruments to make incisions to repair damaged spinal tissues. The good news is that back surgery is generally not the treatment of choice for back pain. Research has shown that approximately 90% of cases of low back pain resolve themselves around 1-3 months.
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There are a variety of conditions addressed by back surgery; however, back surgery really only does 3 things:
- relieves pressure on spinal nerves or the spinal cord.
- provides stability to an area of the spine that is painful, fractured or has too much movement.
- corrects spinal deformity in children, for example scoliosis.
In general, back surgery is a decision to be made by the patient, with guidance from their doctor. Usually, there is time for research and evaluation before "going under the knife". This research will likely take the form of the patient's consideration of their level of pain as compared with expected outcomes for the surgery. However, there are rare instances when having emergency back surgery is mandatory to save life. This would include those patients with:
- weakness in the legs that gets progressively worse and/or
- bladder and/or bowel incontinence caused by the back problem.
As mentioned above, doctors will usually try conservative methods before recommending back surgery.
Conservative methods include:
- physical therapy
- ice
- exercise
- medication, including injections
Doctor and patient perceptions of a successful back surgery can be at odds with one another. Many times, patients are expecting all their pain to go away and a full recovery of activity. In fact, a 2005 study reported in Spine Journal showed that surgeons tend to predict more positive outcomes than patients subsequently report. 3 Doctors generally regard a surgery as successful if there is partial reduction of pain. Discussing your expectations with your doctor before you agree to any surgery is a good idea.
In the U.S. many more back surgeries are performed than in other countries. A 1994 study done at the University of Washington, and published in Spine Journal, found that the number of back surgeries performed in the U.S. was between 5% and 40% higher than in other countries.
Are Americans subject to excessive back surgery? The jury is still out on that one, but the study did show that the number of surgeries performed increased according to the supply of surgeons available. 2 Another 1994 study concluded that the rapid rise in number of surgeries performed in the U.S. suggests the "need for a more consistent approach to back problems". 3
Bibliography
1 J Coste, .,a G Delecoeuillerie, A Cohen de Lara, J M LeParc, J B Paolaggi Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice . BMJ 1994;308:577-580 (26 February)
2 Cherkin DC, Deyo RA, Loeser JD, Bush T, Waddell G. An international comparison of back surgery rates. Spine. 1994 Jun 1;19(11):1201-6.
2 Graz, Bertrand, Wietlisback, Vincent, Prochet, Francois, Vater, John-Paul. Prognosis or "curabo Effect?": Physician Prediction and Patient Outcome of Surgery for Low Back Pain and Sciatica. Spine. 2005 Jun 30(12): 1448-1452.
3 Taylor, Deyo, Cherkin, Krueter. Low back pain hospitalization. Recent United States trends and regional variations. Spine. 1994 Jun.
4 Ullrich, Peter, M.D. Back surgery and neck surgery Spine-Health website. Oct 7, 2005.
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