Do I Need Back Surgery? Will Back Surgery Even Help?
When you're not dealing with a life-saving operation, it's easy to question whether or not you really need surgery. A lot of people facing elective orthopedic surgeries, like spine surgery, wonder if it's worth the stress and lengthy recovery. It's not uncommon for patients to ask "will back surgery really help me?", "will back surgery take away my pain", and "could surgery actually leave me worse off?".
To help answer these common questions and to better understand which back surgeries are most successful, we spoke to orthopedic surgeon, Dr. Param Singh. Dr. Singh is a popular San Francisco-based orthopedic surgeon who specializes in spine and back surgery, like spinal fusion, microdiscectomies, and other decompression surgeries.
Read on as we talk about how effective back/ spine surgery is, who the ideal surgery candidates are, and who many not be the ideal candidate for orthopedic spine surgery.
4 Different Types of Back Surgery
Before we talk about back surgery effectiveness, it's important to know the different types of back/ spine surgery. There are 4 main types of back surgery. Within each surgery type, there are variations to treat each patient's deformity, lower back pain, or specific diagnosis.
A laminectomy is considered a decompression surgery. In a laminectomy, your lamina and ligamentum flavum are cut or removed. Often times this ligament is the cause of the compression on your nerve or spinal cord. Your surgeon will determine the root of the compression and remove whatever is causing it (bone spur, disc fragment, overgrown joint or ligament etc.).
Used to treat: a herniated/ruptured disc, sciatica, nerve compression, remove tumours and/or bone spurs.
A discectomy (sometimes called a microdiscectomy, percutaneous discectomy, lumbar discectomy, herniated disc surgery) removes the portions of a herniated disc that are putting pressure on the spinal column or nerve and causing pain, weakness, or numbness. A discectomy can be performed on all levels of the spine.
Used to treat: buttock pain caused by nerve compression, leg weakness, leg numbness, pressure on the spinal nerves or cord.
3. Spinal Fusion:
In a spinal fusion, vertebrae (bones) are fused together with bone graft and held place with metal rods, plates etc. A fusion is permanent and done to stabilize an unstable spine or to correct a deformity of the spine.
Used to treat: scoliosis, spondylolisthesis, spondylosis, fractures, infection, and tumors
4. Vertebroplasty/ Kyphoplasty:
Vertebroplasty and kyphoplasty are minimally-invasive surgeries that treat vertebral compression fractures. When the vertebrae is fractured and compresses into itself, it can be very painful and sometimes causes "hunch" deformity. Compression fractures can be caused from injury and osteoporosis. In the procedure, the bone is strengthened when "bone cement" is inserted into the affected vertebrae/ fractures. This procedure is used to prevent a compression fracture from worsening.
Used to treat: vertebral compression fractures (VCF), biopsies of tumors or cancer in the bone.
Now that you're familiar with the different back types and have a basic understanding of what conditions they help treat, let's talk success rates.
Are Some Back Surgeries More Effective Than Others?
Depending on problem, some back/ spine surgery types are more effective at relieving pain and symptoms than others.
Here's when your back/spine surgery has a greater success rate (at cutting down pain and addressing the root cause of your symptoms):
Your physical symptoms match your care team's findings. Your pain and symptoms align with your medical exam, MRI and/or x-rays.
You have a treatable structural issue. For example, if you have scoliosis or a ruptured disc that is putting pressure on your spine, your surgeon has a structural issue to fix with surgery.
You have more than just "pain". Back pain is complex. A visible, structural issue that explains the pain is the key piece to a successful surgery.
You're in good physical and mental health. There is a huge physical and mental component to back pain. If you are under a lot of emotional stress, have depression, or other diagnosed psychiatric conditions, back pain can be a physical manifestation of your psychological state. In these cases, surgery may not fix the core issue. Similarly, if you have secondary conditions or other diseases, your full recovery from surgery may be more challenging.
Less invasive treatments have helped you. If you've had injections and they relieved your pain, this is a good sign! This shows that treating that specific part of your back/ spine is addressing the cause of your pain, mobility issues, numbness, tingling etc.
You don't have a history of chronic pain. If you've experienced various forms of chronic pain, especially where the cause cannot be determined, your pain may not be as easily treated by surgery.
It's your first back/ spine surgery. With each back surgery, the odds of experiencing immediate relief and correction go down. If you have never had a surgical intervention on your back/spine, your odds of relief are greater.
When is Back/ Spine Surgery Most Helpful at Relieving Pain?
If you have a treatable, structural issue that your orthopedic surgeon has pinpointed with a great level of certainty, then back/ spine surgery is likely to help. Dr. Singh explains, "if surgery is purely for back pain and an x-ray and MRI show nothing is structurally wrong, the success rate for pain highly unpredictable." Dr. Singh adds that "it's extremely rare for a surgeon to offer surgery specifically for just back pain without a structural cause".
However, when the cause of back pain is something like a slipped disc, disc herniation, a deformity like degenerative scoliosis, then the success rate of relieving pain with surgery can be 90% or more. Dr. Singh points out that decompression surgeries are among the most successful.
Dr. Singh illustrates, "if someone has shooting leg pain and on an MRI we can see structural findings that can be fixed with surgery (like a stenosis or pinched nerve) this is the most successful outcome. In these cases, pain will reliably be improved." He adds, "for example, if someone has spinal stenosis and can't walk more than 20 steps, if we decompress them and take pressure off the nerve roots, they will likely be able to walk further. If you remove compression on a nerve, the pain will likely get better along with numbness and tingling."
An exception to not having any notable structural issues, is if a patient is experiencing leg pain and numbness without back pain or a visible deformity. Dr. Singh explains that "this is likely from disc herniation or overgrown soft tissues and it is very successfully treated with surgery."
What Does it Mean for Me and My Back Pain?
In a nutshell, there a rules and patterns for which types of back pain and symptoms can be best treated with surgery. Your symptoms, the type of pain your experiencing, and the location of your pain, will help your orthopedic surgeon determine how likely a surgery is to help you.
The best way to determine if back/ spine surgery can help is to talk with a trusted, orthopedic specialist. If your back pain and symptoms are not validated with a physical exam, MRI or x-ray, surgery may not be a recommended or successful option. As Dr. Singh estimated, back/ spine surgery to treat general pain is a bit of a gamble.
Learn more about the different types of lower back pain types and recommended alternative treatments.