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When is it needed?

When conservative treatments don't help, spine surgery may offer relief. But it doesn't help every type of back pain. In fact, spine surgery is needed in only a small percentage of cases.

Whether to have spine surgery should be a cooperative decision made by you, your family, and your family physician. Your doctor may refer you to a specialist for a thorough evaluation to determine if you could benefit from this surgery.

Most people have back pain at sometime during their life, and 90 percent of these people get better without treatment or with conservative therapy after four to six weeks. Only 5 percent remain disabled longer than three months.

Most conservative treatment calls for pain relief, rest, steps to reduce inflammation and measures to restore strength and normal activity. Severe cases of disk degeneration that put pressure on the spinal nerve roots may permanently affect the nerves that control muscle movement or sensation in an extremity. Herniated disks generally heal themselves, and surgery is rarely necessary.

If the disk is just temporarily distorted, the potential for complete recovery is excellent. If the outer membrane actually breaks or ruptures and loses some of its gelatinous center, the damage to the disk may be permanent.

In most situations, an operation won't be considered unless conservative measures have failed, and even then surgery is not often indicated. Spine surgery is usually reserved for times when spinal nerves are compressed, causing numbness along the back of your leg.

Back pain can be caused by a number of different health situations.

Trauma or wear and tear

Trauma, aging, improper body mechanics and normal wear and tear can injure your spine. Damage to any part of your back — especially damage that puts pressure on your nerves — can cause pain and other symptoms.

Direct injury to the spine may cause a bone fracture anywhere along your vertebral column. Osteoporosis — loss of bone density — can weaken vertebrae, causing them to fracture or collapse.

Pinched nerves or pressure on the nerves

When the amount of space in the spine becomes reduced, nerves can get pinched. The disks separating the bones in your spine can also bulge or rupture (herniate), which can irritate nearby nerves. However, many people with bulging disks have no pain.

Spinal disk problems

When a herniated disk causes weakness or paralysis of the nerves that control muscles of the back and limbs, or if you lose control of your bladder or bowels because of the damaged disk, your doctor may recommend surgery.

Other medical conditions

The following conditions may require surgery if they're progressive, painful or causing nerve compression:

  • Scoliosis, a curvature of the spine
  • Kyphosis, a humpback deformity
  • Spondylolisthesis, the forward slippage of a segment of the spine
  • Spinal stenosis, narrowing of the spinal canal typically from arthritis
  • Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
  • Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear
You have options.  Evidence suggests that, depending on your condition or injury, alternative treatments such as anti-inflammatory medication, weight loss, and modified physical activity, can work just as well as surgery.  See Alternative Treatments for more information.


Please visit these resources for more information:

Understanding Spinal Disk Problems -- Diagnosis and Treatment, 2009, WebMD.

Back surgery: When is it a good idea?. 1998-2010. Mayo Foundation for Medical Education and Research (MFMER). 

Low Back Pain.  May 2009.  American Academy of Orthopaedic Surgeons.

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