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Deciding when to see a spine surgeon for possible low back surgery is also somewhat dependent on the type of surgery that is being considered. If a surgical procedure is more involved and there is a prolonged healing time (e.g. lumbar fusion), then a more concerted effort at conservative (non-surgical) treatment is probably reasonable. The following outlines a few common types of spine surgery and the condition and symptoms that they treat.
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Spine Surgery for Leg Pain
If most of the patient's pain is leg pain (radiculopathy), the pain may be due to a pinched nerve. If the leg pain does not start to resolve with conservative treatment after 4 to 6 weeks, an imaging study (such as an MRI scan) may be recommended to determine whether or not there is nerve pinching (e.g. from a herniated disc).
If there is pressure on the nerve, then either injections or a lumbar decompression spine surgery to take pressure off the nerve may be recommended. Back surgery for a pinched nerve can usually be done with a minimally invasive approach, and will usually result in early return to normal function (1 to 3 weeks). The success rate for decompression spine surgery is high, with approximately 90% of patients experiencing good relief of the leg pain after the surgery.
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Surgery for Low Back Pain
Surgery to treat low back pain can be a far more extensive type of back surgery, with a longer healing period and a somewhat lower success rate, than back surgery for a pinched nerve (leg pain). If the patient does not get low back pain relief after 6 to 12 months of conservative treatment, however, a fusion surgery may be a reasonable option. When the patient has the right indications, low back surgery to stop the motion at a painful motion segment and remove the pain generator should reduce the patient's lower back pain.
Recovery after Surgery for Low Back Pain or Leg Pain
After a spine fusion surgery, it takes 3 to 12 months to return to most normal daily activities, and the success rate in terms of pain relief is probably between 70% and 90%, depending on the condition the spine surgery is treating. Soon a total disc replacement - or artificial disc surgery - may also be available as a treatment option for patients with certain types of conditions that cause ongoing low back pain. For patients who are 55 or older, symptoms of back pain and/or leg pain are much more likely to be due to degenerative arthritis (osteoarthritis) that might result in a narrowing of the canal (spinal stenosis) and/or instability of one vertebral segment. Generally, the low back pain and/or leg pain created by these back conditions will get worse with walking and will improve with sitting. Often, the symptoms will have been present for years, and may get worse at a very slow rate. Once a patient gets to the point that he or she can no longer adequately function because of the low back pain, lumbar decompression with or without spine fusion may be recommended to help increase the individual's activity tolerance and quality of life.
See Modern Lumbar Spine Fusion Surgery
When Spine Surgery is an Emergency
The vast majority of spine surgery procedures to treat severe back pain and/or leg pain are elective. However, there are a few symptoms that are possible indications of a serious medical condition, and patients with these symptoms should seek emergency medical care. These symptoms include:
- Sudden bowel and/or bladder incontinence (either the inability to retain or hold waste) or progressive weakness in the legs. Either of these symptoms could indicate nerve damage or cauda equina syndrome.
- Severe, continuous abdominal and back pain, which could indicate an abdominal aortic aneurysm.
See Cauda Equina Syndrome Symptoms
Any patients with either of these symptoms should seek immediate medical attention as they may need emergency spine surgery.
