Back surgery is a booming business. About 500,000 Americans undergo surgery each year for low back problems alone. According to the Agency for Healthcare Research and Quality (AHRQ), we spend more than $11 billion each year on operations to relieve back pain. Unfortunately, it doesn’t always buy relief.
For patients with serious structural problems or disease, back operations are often highly successful. But surgery is not the treatment of choice for most people with low back pain, according to a report from Johns Hopkins Medicine. Fewer than five percent of people with back pain, according to Johns Hopkins, are good candidates for surgery.
Is back surgery right for you? A little homework may help you avoid a costly mistake. Here are the questions that the Johns Hopkins report recommends that you ask:
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What is the source of your back pain?
If no doctor can locate a structural cause for your pain, back surgery won’t work, according to the Johns Hopkins report. Conditions frequently treated by surgery include nerve damage, spinal tumors, infections, or deformity. Other candidates are a spine weakened by fractures or disease, or persistent leg pain caused by spinal stenosis, a narrowing of the spinal column that causes pain, weakness, numbness and tingling in the legs along with back pain. Second opinions are often a good idea in these cases.
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Surgery can also be used successfully to treat herniated or “ruptured” disks, but it is often unnecessary. Not only do many people have herniated disks without knowing about it or experiencing pain, but more than 80 percent of people with the condition get better without surgery in 6 to 12 weeks, according to the Johns Hopkins report.
In extreme cases, a herniated disk can press against nearby nerves, causing a person to lose bladder and bowel control. In such cases, surgery is the only way to relieve the pressure on nerves and restore the bodily functions.
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Herniated disks can also cause shooting pain down the leg (sciatica) along with numbness, tingling and weakness. If these symptoms steadily grow worse, or linger for six weeks or more, surgery may make good sense, says Richard Deyo, M.D., a professor of medicine at the Oregon Health Science University and a leading expert in treatment for back pain. But unless someone with a herniated disk has persistent sciatica or other signs of nerve damage, there’s no compelling reason to surgically repair a herniated disk, he adds.
If an aching back is your only complaint, don’t count on a quick fix from surgery. As Deyo and colleague James Weinstein, D.O., reported in the New England Journal of Medicine, surgery has never been shown to help patients with run-of-the-mill back pain.
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How is your overall health?
Have a heart-to-heart with your doctor. If you have a chronic condition like heart disease or arthritis, you may be less likely to have a good outcome. Smoking, old age, and a poor diet may raise your risk of complications as well.
Have you thought about the risks of back surgery?
“Back surgery isn’t like getting a haircut,” Deyo says. “There can be major complications.” Although the risk is low and many surgeons use minimally invasive techniques, some patients may wind up with nerve and muscle damage, blood clots, excessive bleeding, and hard-to-treat infections of the spine.
And even when the surgery goes smoothly, pain can reoccur at a later date. Operations on a spinal disk will weaken it; spinal fusion may
