Back surgery: When is it a good idea?

Trauma, aging, improper body mechanics, and normal wear and tear can all injure your spine. Damage to any part of your back or pressure on the nerves in your spine can cause back pain and other symptoms. If you have ongoing back pain, maybe you've wondered — could back surgery help?

In fact, back surgery is needed in only a small percentage of cases. Most back problems can be taken care of with nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy. When conservative treatments don't help, back surgery may offer relief. But it doesn't help every type of back pain.

Do you need back surgery?

Back surgery might be needed:

• If you have a condition that compresses your spinal nerves, causing debilitating back pain or numbness along the back of your leg.
• In some instances when you have bulging or ruptured (herniated) disks — the rubbery cushions separating the bones in your spine. However, many people with bulging disks have no pain.
• If you have broken bones (fractured vertebrae) or other damage to your spinal column from an injury that leaves your spine unstable.
• If you have vertebral fractures and an unstable spine related to osteoporosis.
• If you've first tried conservative measures and they fail to relieve your back pain or other symptoms.

Bone deformities and other conditions
The following conditions may require surgery if they're progressive, painful or causing nerve compression:

• Scoliosis, a curvature of the spine
• Kyphosis, a humpback deformity
• Spondylolisthesis, the forward slippage of a segment of the spine
• Spinal stenosis, narrowing of the spinal canal typically from arthritis
• Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
• Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear

Bone fractures and deformities

Direct injury to the spine may cause a bone fracture anywhere along your vertebral column. Osteoporosis — loss of bone density — can weaken vertebrae, causing them to fracture or collapse.

In most cases, fractured vertebrae heal without any help. But if the spinal column is unstable, some doctors opt to fuse two or more vertebral bodies together, using bone grafts and metal plates, screws, rods, or cages.

The following conditions may require surgery if they're progressive, painful or causing nerve compression:

• Scoliosis, a curvature of the spine
• Kyphosis, a humpback deformity
• Spondylolisthesis, the forward slippage of a segment of the spine
• Spinal stenosis, narrowing of the spinal canal typically from arthritis
• Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
• Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear

Types of back surgery

To relieve pressure on the spinal cord or nerves, surgeons can remove portions of bone to widen the narrowed area in the bones of your spine (vertebrae). Removing the gel-like middle portion of a ruptured disk also may help relieve pressure on pinched nerves. Sometimes your doctor has to remove the entire disk and fuse together the adjoining vertebrae that remain.

Different types of back surgery include:

• Diskectomy. This involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. It's done as an open surgery and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
• Laminectomy. This procedure involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
• Fusion. Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
• Vertebroplasty. During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar but more expensive procedure — called kyphoplasty — a balloon-like device is inserted to attempt to expand compressed vertebrae before bone cement is injected.
• Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it's not yet clear what role they might play as a back surgery option.

Consider all options

Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Spine surgeons hold differing opinions about when to operate, what type of surgery to perform, and whether — for some spine conditions — surgery is warranted at all. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat.