Do I Really Need Back Surgery?

It’s the right answer for some conditions

Common Spine Problems

You’ve tried stretching exercises, massage therapy and medications, but that nagging back pain just won’t go away. Is it time to consider surgery? The answer could be yes, depending on the type of pain and symptoms.

“See a surgeon if you have numbness, tingling or weakness in your arms or legs that does not improve or gets worse, if you lose bladder or bowel control, or if conservative options have failed,” says physical medicine specialist Sanghoon Kim, M.D., of Lehigh Valley Hospital and Health Network. Back pain improves without surgery in 80 percent of cases. When it doesn’t, here’s what the problem may be, and how to treat it:

Herniated or degenerated disc

“With a herniation, protruding disc fragments press against your spine and may hit a spinal nerve, causing leg and back pain and numbness,” says Chris Lycette, M.D., a neurosurgeon at the hospital. “With a degenerated or deteriorated disc, the space between vertebrae narrows, increasing stress on the spine and pressure on the nerves.”

Surgical treatments include laminectomy, in which a portion of the vertebra is removed to create more room in the area surrounding the spine, and microdiscectomy, a smallincision (“minimally invasive”) procedure to remove the herniated disc fragments pressing on nerves.

Artificial disc replacement is a new option, but “only if the rest of the spine is healthy,” says Lycette’s colleague, orthopedic surgeon Amir Fayyazi, M.D. That’s not the case with most disc pain sufferers.

Another possibility is spinal fusion, in which the surgeon uses rods and screws to connect vertebrae and remove pressure on the spinal cord and nerves.

Spinal stenosis

The most common degenerative problem of the spine is stenosis, a narrowing of the spinal column that eventually pinches the nerves. Stenosis usually develops gradually over the years. Surgical options are laminectomy or spinal fusion.

Compression fracture

When vertebrae are weakened by osteoporosis, they can collapse to smaller-than-normal height, creating a compression fracture that shifts a bone against a nerve. To correct the fracture, surgeons perform kyphoplasty (expanding the collapsed bone, then injecting it with bone cement) or vertebroplasty (injecting the liquid cement without expansion). Both procedures stabilize the fracture, ease pressure and prevent further collapse.

Stress fracture

Common in young athletes, a stress fracture may involve just one vertebra (spondylolysis) or be so severe it causes the spine to shift (spondylolisthesis). “Conservative treatment is usually successful,” says hospital internist Michael Ehrig, M.D. If slippage is severe enough to press bone on nerve, laminectomy or spinal fusion can correct the problem.

For any back condition, knowing all your options—both medical and surgical—is the wisest course. “It can reassure you there’s light at the end of the tunnel,” Lycette says.

Want to Know More about how to keep your back healthy? Call 610-402-CARE or click here.

Published from Healthy You Magazine, July-August 2008

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