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Back Pain

Should I Have Back Surgery?

Last modified: 
20/03/2012 - 09:57

Contributing Author: Guy Slowik FRCS

In certain cases, surgery can significantly help back pain sufferers. For many, it can completely abolish the pain; for others, it can greatly reducing the level of pain suffered daily. But surgery is always a last resort, offered when conservative treatments have failed (unless there is an emergency indication for surgery).

Back surgery has suffered an unhappy reputation over the years. Yet there are large numbers of people throughout the world whose back pain has been abolished or greatly relieved through surgery. However, there are many people whose back pain was not at all improved after surgery, and sometimes even made worse.

Why do some surgeons have such good results with their patients who have had back surgery and others often not quite as good results? The answer is simply in what is termed "correct patient selection." If surgery is undertaken for the correct reason in the appropriate patient, good results can generally be expected.

So how does a doctor decide that a particular patient's back pain is likely to respond well to surgery? Here are the guidelines that guide an experienced back surgeon to make a decision whether or not to offer back surgery to someone with back pain. Every one of these conditions should apply:

  • You have a back condition that can be helped by surgery, based on detailed specialized imaging tests. Most causes of back pain are not good reasons for surgery.
  • The pain is definitely caused by the abnormality shown on the imaging tests. For example, most disc bulges seen on MRI do not cause symptoms and are usually coincidental to the back pain.
  • Your symptoms have not been helped by conservative therapies including medication and physical therapy. For example, despite six weeks of intensive treatment for a proven herniated disc, the severe pain continues.
  • The back pain significantly affects your day-to-day living. You are unable to do your daily chores or work due to the back pain.
  • You have a positive outlook about what's involved with surgery.
  • You have chosen a skilled, experienced back surgeon.

If all these conditions are strictly adhered to, the outcome of the back surgery is very likely to be successful. But when these conditions are not strictly met, the outcome is unlikely to be successful, and the complication rate of the surgery increases.

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Back Pain

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.