Back surgery: When is it a good idea?

Oh, your aching back. Not simply an ache. This pain is serious. You wonder — could surgery end the discomfort once and for all?

Injury, aging, improper body mechanics and normal wear and tear can all injure your spine. And damage to any part of your back — especially pressure on your nerves — can cause pain and other symptoms.

Most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage or physical therapy. When conservative treatments don't help, surgery may offer relief. But it doesn't help every type of back pain. In fact, back surgery is needed only a small percentage of the time.

Is surgery right for you?

Most people will have back pain sometime during their lives. And 90 percent of these people will get better, with or without treatment, within four weeks. Only 5 percent remain disabled longer than three months.

In most situations, an operation wouldn't be considered unless conservative measures had failed, and even then it's not often indicated. Surgery is usually reserved for times when a nerve is pinched, the spinal cord is compressed or there's too much movement between the spinal bones (vertebrae).

Your doctor may recommend surgery if you have neck or back pain accompanied by symptoms of nerve damage. Signs and symptoms include:

• Pain that radiates down your legs (sciatica) or arms
• Numbness, weakness or tingling in your arms or legs
• Loss of bladder or bowel control

Squeezed and pinched

Your vertebrae are separated by soft, flexible disks that have a tough outer shell and a soft, gooey center. They act as cushions between the vertebrae. Your spinal cord runs down through your vertebrae, and nerves pass through gaps in the spinal column.

Many types of problems can reduce the amount of space in the spine, so nerves become pinched. As people age, it's common for spinal disks to dry out and shrink, reducing their effectiveness as shock absorbers. Disks can also bulge or rupture (herniate), which can irritate nearby nerves. However, many people with bulging disks have no pain.

To relieve pressure on the spinal cord or nerves, surgeons can remove portions of bone to widen the narrowed area in the vertebrae. Removing the gel-like interior of ruptured disks also helps relieve pressure on pinched nerves. Sometimes the entire disk must be removed, with the adjoining vertebrae fused together surgically. One alternative to fusion may be a new procedure that replaces the damaged disk with an artificial one.

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 vertebrae 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

Consider all options

Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat.

To prevent recurrent back problems, use good body mechanics, keep your back muscles conditioned with regular exercise and stretching, and control your weight.