Healthcare & Insurance | Healthy Living

Chronic Back Pain: When is Back Surgery The Right Choice?

Potential Signs You Need Back Surgery

As we get older, so do our spinal bones and discs. our backs naturally undergo degeneration that can lead to chronic back pain. Back pain can also be a consequence of underlying conditions like osteoarthritis, osteoporosis or rheumatoid arthritis. Though severe back pain and numbness of limbs can affect patients’ quality of life, they are not in and of themselves signs you need back surgery. Generally, surgical back pain treatment should usually be a last resort to consider against other safer and effective non-surgical choices.

I typically advise patients to explore all non-surgical back pain treatment options before considering surgery. There is simply no guarantee that spinal surgery will relieve you of your back pain in the short or long term, and in many cases an integrative approach with physical therapies, diet, or acupuncture  may be  just as effective as surgery; plus, undergoing any surgical procedure puts you at risk for minor to serious complications. That’s why nonsurgical treatments are my preference, even for severe back pain relief.

Sometimes, though, back pain calls for surgery. There are a few conditions for which surgery is the best or only option for severe back pain relief. Even if like the majority of patients you won’t require surgical treatment, please take a minute to look over these signs you need back surgery. In some cases, awareness of serious underlying issues that accompany severe back pain can save you from paralysis and even death.

Potential Signs You Need Back Surgery

Cauda Equina Syndrome
Cauda equina syndrome (CES) is a serious medical emergency that requires immediate surgery. CES can occur as a result of a recent back injury, lumbar surgery, severe infection, or even a tumor — all of which can contribute to a herniated disc near your cauda equina. Your cauda equina is a bundle of nerves situated just below your spinal cord. It is responsible for bladder function as well as for motor and sensory aspects of your lower extremities.

Fortunately, CES is rare and you won’t easily confuse its symptoms with simply severe back pain. In addition to loss of sensation in your lower body, if you’re experiencing a sudden onset of incontinence, inability to urinate, or sexual dysfunction, you need to see a neurosurgeon immediately. Once you are diagnosed with CES, you’ll undergo surgery, ideally within 48 hours; this is going to be your best shot at avoiding permanent paralysis and loss of bladder or bowel control.

Spinal Stenosis
Spinal stenosis, on the other hand, is a common condition that typically affects middle-aged and older patients. Back pain from spinal stenosis strikes while you’re standing and walking. This pain usually disappears while you sit (especially with a slight forward lean) or are laying down.

As we age, our vertebrae undergo wear and tear that can lead to arthritic degeneration of our discs, eventually narrowing the space in the spinal canal where our nerves are housed. This is what can cause back pain, sciatica, and numbness or tingling sensations in your groin and buttocks, as well as your thighs. Tumors, trauma, and certain developmental conditions can also be at the root of your spinal stenosis.

There are many nonsurgical forms of back pain treatment than can be effective for spinal stenosis. Painkillers and medicines that reduce inflammation can offer temporary symptomatic relief, while physical therapy has been shown to be just as effective as surgery in treating back pain caused by the condition.

While physical therapy is effective, some patients experience pain so severe that they can barely walk, making physical activity next to impossible. At this point, surgery is worth considering to address spinal stenosis. Usually, a non-invasive laminectomy will get you back up and walking pain-free within a few days of the procedure. Sometimes spinal fusion surgery will be required to address a condition called spondylolisthesis, but be aware that fusing the affected vertebrae tends to eventually transfer spinal problems to neighboring vertebrae, setting you up for future back pain — in which case you’d be well-advised to pursue preventative physical therapy as part of your rehabilitation from surgery.

Spinal Tumor
Spinal tumors can put pressure on your spinal cord, causing you to experience back pain symptoms akin to spinal stenosis or CES, depending on the placement of the tumor. Keep in mind that not all spinal tumors are malignant. Nonsurgical treatments can address pain caused by spinal tumors, but in this case would include radiation or proton therapies.

If your tumor does not respond to radiation though, surgery is an option that you may choose to consider, especially if your diagnosis is not accompanied by a brief prognosis.

Spinal Infection
Spinal infections can become fatal if left untreated. If your severe back pain is accompanied by fever, chills, weight loss, and painful urination, see your doctor immediately; these may be signs that you need back surgery to address a spinal infection before it spreads.

Spinal infections typically occur in your lumbar after spinal or urological surgeries, although intravenous drug use puts you at risk for spinal infections near the cervical vertebrae. Nonsurgical treatment of a spinal infection involves antibiotics or antifungal therapies that will require you to be hospitalized for a considerable amount of time.

Life-saving surgery is required when the infection affects your neurological functions, has spread to your bones or bloodstream (sepsis), or if you are unresponsive to antibiotic or antifungal treatments. The risk for a serious complication like spinal infection is precisely why experienced health professionals prefer to explore surgery as a last resort for most conditions that cause back pain.

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