Conservative vs Surgical Care for Lower Back Pain

For most people, any episode of lower back pain will tend to get better within two weeks to three months. During this time period that an episode of back pain is resolving, or if the back pain is chronic, it is important to consider the appropriate course of conservative (meaning non-surgical) treatment in order to:

  • Reduce pain and spasm
  • Provide conditioning for the back
  • Assist in managing issues frequently associated with back pain, such as sleeplessness or depression.

Treatment options are considered "conservative" when they are non-invasive (such as medication) or markedly less invasive (such as injections or chiropractic manual manipulation) than surgery.

As a general rule, surgery for lower back pain is considered if conservative back treatment fails and the lower back pain and/or leg pain persists for an extended period of time, or if the patient is unable to maintain a satisfactory ability to function in everyday activities.

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There are a few exceptions to this general rule. Conservative treatments are not the first option of choice if:

  • The patient loses bowel or bladder control, or develops progressive weakness in the legs - these symptoms constitute a medical emergency and require immediate surgery. However, surgical emergencies for back pain are extremely rare and most episodes of lower back pain can be treated nonsurgically. For more information, see When Back Pain May Be A Medical Emergency.
  • The patient has lower back pain, but an anatomical cause of the pain cannot be identified, surgery is not advisable and conservative treatments are the only recommended course of action. For more information, see What to Expect from Spine Surgery for Low Back Pain.

The length of time that conservative treatment should continue varies widely. Here are two general rules to help provide some context for patients:

  • In general, the more pain and dysfunction a patient experiences, the earlier surgical treatments will be considered.
  • The morbidity (e.g. incidence of post-operative discomfort) or extent of the surgery must also be considered, and therefore a microsurgery (small surgery using microscopes) will be considered much earlier than a much more extensive fusion operation.

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For a more complete discussion of the role of back surgery, see Back Surgery and Neck Surgery Overview.

At the onset of lower back pain it is generally advisable to try one or two days of bed rest to decrease muscle spasm and allow the back to rest. More extensive bed rest seems to be counterproductive because it leads to further deconditioning (weakening) of the muscles that provide critical support for the spine.

In addition to initial bed rest, either one or a combination of several conservative treatment options is often recommended in order to alleviate pain and rehabilitate the lower back. To review nonsurgical treatments, see Back Pain Treatment: Non-Surgical Options for Pain Relief

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