Is Surgery Necessary to Relieve Back Pain?
The second most common complaint your family doctor hears is about low back pain, and it is not always easy to diagnose the cause. The pain might be dull, sharp, burning, or aching. Usually, it will resolve within three months with conservative treatments, including anti-inflammatory medications, physical therapy, and application of ice or heat.
I have had two back surgeries due to osteoporosis from long-term prednisone use for my systemic lupus. I actually need a third surgery, but I do not want to go through another long procedure and an even longer recovery period. But my case is different. Some people actually do quite well after surgery.
In this article, I'll introduce some common causes of back pain, give tips on how it can be prevented, and discuss the various types of back surgery and when they might be necessary.
What Causes Back Pain?
Back problems may occur for a multitude of reasons. It could be a sprain or fracture caused by an accident; diseases including fibromyalgia, spinal stenosis, some autoimmune diseases like lupus, and arthritis.
One of the most common causes is osteoarthritis, which may cause bone spurs to form on your vertebrae, which sometimes causes pain. Hinge joints on the back of the spinal column that narrow the space where nerves are located can cause nerve pain.
Another common cause is bulging or ruptured (herniated) spinal disks, which—although they may not directly cause the pain—can lead to pain because there is no more cushion to prevent the vertebrae from pressing on spinal nerves.
Can Back Problems be Prevented?
There are several ways to help prevent back problems, including simple exercises and lifestyle changes:
- Regular physical exercise eases muscular tension and reduces inflammation.
- Stay within ten pounds of your ideal weight. Extra weight, especially in your midsection, can shift your center of gravity forward and cause back pain.
- Stop smoking as it restricts the flow of blood to the spinal discs.
- Sleep in a good position. If you sleep on your side pull your knees up slightly, or if you sleep on your back put a pillow under your knees and one under your back. Sleeping on your stomach is hard on your back, so you might put a pillow under your hips.
- Good posture is important. A straight back chair is ideal or one with low back support. Stand with you head up, stomach pulled in and shoulder straight.
- Lift objects with your knees bent, without bending over, and using your leg muscles. Hold the object close to your body. Never twist your body when lifting.
- Avoid high heels as they also shift your center of gravity. If you need to wear heals, a 1” heel is ideal.
- Skinny jeans can be a problem as they interfere with sitting, bending, or even walking.
- Fat wallets in the back pocket can cause discomfort, especially if you are sitting for an extended period of time.
- A handbag or a briefcase can cause an imbalance in your posture if you always carry it on one side. The perfect design is similar to a messenger bag that has a strap on the opposite shoulder. Lighten your purse, and switch hands occasionally while walking.
- While back supports are readily available, they do not help prevent back pain.
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When Is Back Surgery Appropriate?
Despite efforts to prevent the pain, sometimes it can still occur. What is the solution then? There are some back problems where surgery is the only recourse to relieve pain and restore movement.
These conditions include:
- Spinal stenosis: The narrowing of the spinal column, which puts pressure on the spinal cord and branching nerves.
- A ruptured (herniated) disc: When one or more discs of the spine are damaged.
- Vertebral fractures: Caused by an injury to the vertebrae in the spine.
- Degenerative disk disease or damage: Occurs more often with aging.
- Rare conditions: These include infections, tumors, or cauda equina syndrome (a nerve root problem).
Types of Back Surgeries
Minimally invasive back surgeries are used more commonly today. However, major back surgeries are still done frequently. There are several newer techniques used over the past few years, but some major surgeries remain the same.
The various surgeries include:
- Discectomy: Treats pinched nerves, removes a bone spur or the herniated portion of a disk, and treats sciatica, which radiates pain through the limbs.
- Foraminotomy: This procedure enlarges the tunnel in the spine where the nerve root exits the spinal canal to keep bulging disks or thickened joints from pressing on the nerve.
- Kyphoplasty: This is an outpatient procedure that involves the injection of bone cement into a fractured vertebra to relieve compression.
- Nucleoplasty (plasma disk decompression): This involves the removal of a portion of the herniated disc using a plasma field. This surgery treats a mildly herniated disk.
- Laminectomy: This procedure enlarges the spinal canal by removing the bone overlying the spinal canal to relieve nerve pressure due to spinal stenosis.
- Spinal fusion: This procedure connects two or more bones permanently, which adds stability in cases of spinal fractures.
- Artificial disc implantation: One or more artificial vertebral discs are implanted between the vertebrae—usually in cases with degenerating or injured discs.
Laser spine surgery is a good alternative to the long midline incision in conventional back surgeries. It is minimally invasive, which means less blood loss, less pain, and a shorter hospitalization. The surgeon can remove portions of soft tissue pressing on a nerve or a tumor from the spinal cord or bone. It can also shrink disk material that is pressing on a nerve. The caveat is that laser surgery only treats particular conditions. Discuss with your doctor to see if laser surgery is an option and whether it is the best option for your condition.
Dr. Matthew Neal: Minimally Invasive Spine Surgery
What to Expect When Recovering From Back Surgery
Patients are usually hospitalized for 1-4 days, depending on which type of surgery was undergone and the patient's general health. There are typically stitches or staples on the incisions. The pain following back surgery can be significant, but it is managed while in the hospital. If you are taking pain medications at home, remember to avoid activities like driving or operating other heavy machinery.
Physical rehabilitation after most back surgeries is the best way to regain strength, but it will take at least 4-6 weeks for the back to heal. It can take months following some major surgeries to regain your previous activity level, particularly if you are elderly.
Complications That Need Immediate Medical Attention
There are some obvious times when you should call your doctor, or for more severe problems, call 911. Some of those times include:
- The wound is leaking fluid or blood.
- Stitches start coming out.
- You have a high temperature.
- You have increasing pain, weakness, and numbness in your back, legs, or buttocks.
- You have a severe headache.
- You experience sudden shortness of breath.
- You can’t move your legs.
Major back surgeries require good rehabilitation. There are many things you must not do, like try to pick something up off the floor. All did not go smoothly when I had two eight-hour back surgeries only a few months apart, and recovery was difficult. Ultimately, I got my life back, but the recovery was difficult.
I know others who had a smooth recovery after back surgery and went back to full health relatively quickly. It never hurts to get a second opinion before proceeding with any surgery.
- American Society of Anesthesiologists. (n.d.). Back Surgery.
- Arthritis Foundation. (n.d.). Surgery for Back Pain: Options to consider when conservative treatments don't bring relief.
- Mayo Clinic Staff. (5 Oct., 2017). Back surgery: When is it a good idea?
- Peloza, J., MD. (20 Apr., 2017). Surgery for Lower Back Pain.
- WebMD Staff. (7 May, 2018). 11 Ways to Avoid Back Pain.
Have You Ever Experiences Back Pain?
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2019 Pamela Oglesby