Not every back issue has to be solved under the knife. Even if you have chronic, and debilitating back pain, there are often other solutions. Find out when to get a second opinion, and other ways to manage back issues.
Most back pain doesn’t need surgery
A rather cynical statement says: there are only two types of back surgery, those that have failed and those that are still going to fail. Although this is not quite accurate it does highlight the negative edge of the blade. So, how do you know whether you really need to go under the knife?
Only 5% of people with back pain actually need surgery. Most pain resolves within two months with conservative treatment. Only patients with persistent and disabling symptoms should be considered for surgery, and even then there is a larger than acceptable rate of failed surgery, meaning that symptoms are not relieved. This is called “Failed Back Surgery Syndrome” (FBSS).
So, how do you make sure you don’t become part of this statistic?
It’s important to understand that surgery can only achieve two things:
- Decompress a nerve root that is pinched
- Stabilise a painful joint.
Better surgical outcomes are seen if the surgery is to relieve pain and numbness down the arms or legs, rather than attempting to relieve lower back pain. These symptoms are commonly caused by nerve compression in the spine due to disc problems and bony overgrowth.
Spinal fusion surgery has better results if done for instability, and poorer results are seen in multi-level lumbar degenerative disc disease.
Why does some back surgery fail to get rid of pain?
It is very important to have thorough tests and investigations done if you are considering surgery. FBSS usually occurs when the operation didn’t actually get to the root of the problem. Although x-rays and scans are helpful, not all abnormalities that the surgeon sees are the cause of the pain.
Other causes of FBSS include:
- disease progression after surgery
- nerve damage before or during surgery
- the formation of scar tissue around nerve roots due to surgery
If you’re uncertain about your options, go for a second opinion, and make sure the surgeon explains both surgical and non-surgical options to you. When it comes to back surgery, it is often wiser to try the physio and training-programs before going under the knife.
Thus, conservative and physical therapy is vital and results in the resolution of most back pain. Whist some patients need surgery, don’t be in a rush, and make sure you understand the risks and benefits. Although the surgeon is the expert, it’s still your body, so make an informed choice!
By: Dr Ingrid de Beer