Surgery may be considered if for severe lower back pain that does not get better after a 6 to12-week course of nonsurgical treatments. It is almost always the patient’s decision to have back surgery, and only in rare situations is immediate surgery performed for low back pain.
Some factors to consider before having back surgery include:
Ability to function. If it is possible to complete daily life activities with manageable pain levels, and if pain does not interrupt sleep or activity, nonsurgical treatments are usually recommended. Surgery is more likely to be recommended if the patient has limited ability to function in everyday life.
Healing process and lifestyle. Surgery vs. nonsurgical care require varying degrees of time commitment. It is important to consider how the healing process after surgery will affect the patient, as compared to continued non-surgical care.
Type of surgery. Some surgeries are considerably more invasive than others, and include lengthier healing periods, more or less significant pain during recovery, and varying inpatient hospital stays. With modern surgical approaches and an experienced surgeon, many types of spine surgery can now be done on an outpatient basis with a shorter recovery period.
Mental health. Several studies have indicated that mental and emotional well-being have a positive correlation to improvement and satisfaction after surgery. Patients who feel more in control of their health, for instance, report a more positive recovery and outcome after surgery.4 Understanding how a patient is likely to respond to surgery can help guide more effective post-operative care.
Spine surgery is usually not recommended for mild to moderate back pain, or for pain that has lasted for less than 6 to 12 weeks. Additionally, back surgery is not an option if the cause of the pain is not detectible through imaging tests.
A decompression surgery removes whatever is pressing on a nerve root from the spinal column, which might include a herniated portion of a disc or a bone spur. There are two primary types of decompression for low back pain.
- Microdiscectomy is a minimally invasive procedure for patients with a lumbar herniated disc causing radicular leg pain (sciatica).
- Laminectomy removes part of the layer of the bone or soft tissue that is compressing a nerve or multiple nerve roots. A laminectomy will typically be performed for someone with leg pain and/or weakness from spinal stenosis caused by changes in the facet joints, discs, or bone spurs.
A decompression surgery can be performed with open or minimally invasive techniques with relatively small incisions, and minimal discomfort and recovery before returning to work or other activities. Most of these procedures are now being done as day surgery or with one overnight stay.
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Lumbar Spinal Fusion Options
Fusion surgery basically removes the soft tissues between two or more adjacent vertebral bones and replaces them with bone or metal. This procedure enables the bones to grow together over time—typically 6 to 12 months—and fuse into one long bone to stabilize and eliminate motion at those spinal segments.
In the lumbar spine, fusion can be done from the back (posterior approach), the front (anterior approach), the side (lateral approach), or combined. Modern techniques, implants, navigation, and biologics have made the surgery more predictable with easier recovery and return to normal activity and work.
The most reliable indications for lumbar spinal fusion include spondylolisthesis, fracture, instability, deformity, degenerative disc disease, and stenosis. For lower back pain caused by sacroiliac joint dysfunction, fusion of the sacroiliac joint is an option. Tumors and infections are also treated with fusion surgery, but these conditions are far less common.
Other Surgical Options
Some newer surgical options that are being used for some cases of low back pain include:
- Lumbar artificial disc. For some patients, disc replacement is a potential alternative to fusion surgery for symptomatic degenerative disc disease. This procedure has the potential for a quicker recovery and to maintain more spinal motion than lumbar fusion. Long-term data is still being collected.
- Posterior motion device. The Coflex inter-laminar device is an alternative to fusion for stenosis and mild degenerative spondylolisthesis. The goals of this approach are for similar results as fusion but with a smaller surgery and faster recovery. Long-term data is still being collected.
This is not a complete list of surgical options. Several others exist or are in development. Technologies that are being utilized today and in development include stem cells, nanotechnologies, and robotics.
Lower Back Surgery Post-Operative Care
The recovery period after low back surgery depends on a number of factors, including the patient’s condition before the surgery, the extensiveness of the surgery, and the surgeon’s skill and experience. For example:
- A microdiscectomy for a lumbar herniated disc is considered minimally invasive, and the patient usually has no overnight hospital stay and recovery time is about a week.
- A lumbar fusion may involve an overnight hospital stay, slow return to everyday activities, and possibly some activity restrictions as the fusion sets up over the next 3 to 12 months.
Physical therapy is typically prescribed to rebuild strength, range of motion, and encourage healing. Patients are also commonly prescribed painkillers or muscle relaxants, and some patients may be advised to use a back brace or special beds, shower stools, or supportive pillows to ease the healing process.
Patients in recovery are typically advised to take a short period of rest while the spine and surrounding tissues heal. Most patients take brief time off from work—a few weeks to a couple months—to avoid overexertion of the spinal structures.
- Block AR. Demoralization, Patient Activation, and the Outcome of Spine Surgery. Healthcare (Basel). 2016;4(1)