By Femi Ogunyemi

Patients often ask if they should consider surgery in the treatment of their back pain.

In fact a doctor colleague asked me the very same question this morning. He had just reviewed an MRI report and wanted me to see the patient who had suffered low back pain for many months. The MRI looked bad. Degenerative this, bulging that, compressed sac(k)s, arthritis, spondylosis, stenosis…….

“Ah,” he said over the phone. “Will you be sending her to a surgeon?” “It depends, I said. Let me see her, but it is highly unlikely”.

The decision to have back surgery can be difficult. In treating back pain, surgery is considered only after all other treatments have failed. The risks of back surgery are generally low, but when they occur, they can be serious in some people.

The primary reason for most back surgeries is to get relief from back pain. And for many people, the pain relief comes with many additional benefits, including: increased activity; better physical fitness and improved mood. Others are less need for pain medicines with fewer drug side effects, ability to go back to work and increased productivity at work.

But not everyone experiences a reduction in back pain after surgery. Studies show it’s difficult for surgeons to accurately predict who will benefit and who won’t. For this reason, and because most back pain improves with time, experts recommend trying non-surgical treatments like physical therapy before considering back surgery.

Types of Back Surgery:

Each type of back surgery comes with its own risks and benefits.

Spinal Fusion. Spinal fusion is the most common surgery for back pain. In a spinal fusion, a surgeon joins spinal bones, called vertebrae, together. This restricts motion between the bones of the spine. Fusion also limits the stretching of nerves.

Laminectomy. In a laminectomy, a surgeon removes parts of the bone, bone spurs, or ligaments in the back. This relieves pressure on spinal nerves that may be causing pain or weakness.

A laminectomy, however, can cause the spine to be less stable. If the spinal bones become unstable, a spinal fusion is usually performed. Spinal fusion may also be performed at the same time as laminectomy.

Foraminotomy. During a foraminotomy, a surgeon cuts away bone at the sides of vertebrae to widen the space where nerve roots exit the spine. The enlarged space may relieve pressure on the nerves, thereby relieving pain.

A foraminotomy can sometimes result in reduced stability of the spine, similar to what happens in a laminectomy. A spinal fusion may be done at the same time. Doing so increases the amount of time needed for recovery but also prevents the spine from becoming unstable. If the spine becomes unstable after a foraminotomy, a spinal fusion can be done to correct the problem.

Diskectomy.

A bulging or “slipped” disc, the cushion that separates vertebrae, may press on a spinal nerve and cause back pain. In a diskectomy the surgeon removes all or part of the disc. A diskectomy can be done through a large incision or through a smaller incision using tools from outside the body. A diskectomy may be part of a larger surgery that includes laminectomy, foraminotomy, or spinal fusion.

Disc Replacement. In artificial disc replacement, a surgeon removes a damaged spinal disc and inserts an artificial disc between the vertebrae. Disc replacement permits continued motion of the spine. It is gaining popularity as an alternative to spinal fusion.

Interlaminar Implant. Another alternative to spinal fusion is the implant of a U-shaped device. The device is placed between two back bones in the lower back and helps maintain the space between.

Pain management involves treatment with many options before deciding on surgical intervention. Conservative therapies, spinal injections, radiofrequency ablations, physiotherapy and complementary alternative therapies must have been exhausted first.

In addition, the presence (or absence) of certain clinical features may aid the decision on whether to have surgery. These include severe, incapacitating radiculopathy, arm/leg weakness and impending paralysis, pain with passing urine or incontinence, severe spinal stenosis or major spinal instability.

Theres always the possibility of return to the pain clinic with a condition known as Post Laminectomy syndrome.

Thats a separate condition on its own.