How To Know If You Can Avoid Back Surgery

Hundreds of thousands of back surgeries are performed every year in the US. Overall the successful outcomes from these surgeries range dramatically depending on why the surgery was performed and the technical skill with which it is performed.

How can surgery be avoided and how would a person know if they fall into a category of having the choice of knowing that opting out of surgery will not be harmful in the long run?

The first thing to understand is your diagnosis. The most common diagnoses causing back pain include:

1. Degenerative Disc Disease

2. Herniated Lumbar Disc

3. Degenerative Spondylolisthesis

4. Degenerative Spinal Arthritis

5. Vertebral Compression Fracture

Once you understand what's generating your pain, the diagnosis can then be placed into the categories of either 1) Quality of Life issue or 2) Indicated for Surgery.

Let's look first at Degenerative Disc Disease, which often occurs in patients between the ages of 30 and 60. Degenerative discs do not always result in pain, there is actually a significant portion of the population who has DDD noticeable on MRI but no back pain at all. In some patients, though, it may cause significant back pain and lost time from work.

DDD is not a diagnosis that necessitates surgery, it is a quality of life decision. In fact, surgery for DDD, which is typically a fusion, only results in 50-70% success rates and a significant amount of patients end up needing future surgery and continued pain medications. Non-operative treatment for DDD may help considerably including chiropractic treatment, aerobic exercise, NSAIDS, and pain management treatments.

Most diagnoses are similar to degenerative disc in a sense that surgery is not absolutely necessary. If considerable conservative treatment is unsuccessful, then surgery may be considered as a quality of life decision. A lumbar herniated disc that is pinching a nerve may fall into this category if it's only causing pain and/or numbness. If a patient can deal with the pain, studies show that the outcomes with surgery versus nonoperative treatment are identical after one year.

If however, one of the above diagnoses is causing a worsening neurologic deficit such as a foot drop, then surgery may in fact be indicated and not elective. The longer one waits when a neurologic deficit exists, there is a question of whether or not it will improve even with a surgery performed perfectly.

This is exactly the point with spinal arthritis. No one ever died as a result of arthritis. So if arthritis causes degeneration or a spondylolisthesis along with spinal stenosis and there's no muscle weakness from pinched nerves, the situation is elective. Opting for surgery is fine if conservative treatment has been exhausted, there is a surgery for the specific condition with a successful track record, and the patient is healthy enough to undergo it. But if the condition is in fact elective, patients need to weigh the risks and benefits considerably to make sure they are okay with the potential for a sub-optimal outcome compared to the potential for marginal improvement with nonoperative methods.

These may include physical therapy, spinal decompression treatment, chiropractor treatment, and pain doctor treatments.