What to expect from spine surgery for low back pain
Deciding when to see a spine surgeon for possible
low back surgery is also somewhat dependent on the
type of surgery that is being considered. If a surgical
procedure is more involved and there is a prolonged
healing time (e.g. lumbar fusion), then a more concerted
effort at conservative (non-surgical) treatment is
probably reasonable. The following outlines a few common
types of spine surgery and the condition and symptoms
that they treat.
Spine surgery for leg pain
If most of the patient’s pain is leg pain
(radiculopathy), the pain may be due to a pinched nerve.
If the leg pain does not start to resolve with conservative
treatment after 4 to 6 weeks, an imaging study (such
as an MRI scan) may be recommended to determine whether
or not there is nerve pinching (e.g. from a herniated
disc).
If there is pressure on the nerve, then either injections or
a lumbar decompression spine surgery to take
pressure off the nerve may be recommended. Back surgery
for a pinched nerve can usually be done with a minimally
invasive approach, and will usually result in early
return to normal function (1 to 3 weeks). The success
rate for decompression spine surgery is high, with
approximately 90% of patients experiencing good relief
of the leg pain after the surgery.
Surgery for low back pain
Surgery to treat low back pain can be a far more
extensive type of back surgery, with a longer healing
period and a somewhat lower success rate, than back surgery
for a pinched nerve (leg pain). If the patient does not
get low back pain relief after 6 to 12 months of conservative
treatment, however, a fusion surgery may
be a reasonable option. When the patient has the
right indications, low back surgery to stop the motion at
a painful motion segment and remove the pain generator
should reduce the patient’s lower back pain.
Recovery after surgery for low back pain or leg pain
After a spine fusion surgery, it takes 3 to 12 months
to return to most normal daily activities, and the
success rate in terms of pain relief is probably between
70% and 90%, depending on the condition the spine surgery
is treating. Soon a total disc replacement—or
artificial disc surgery—may also be
available as a treatment option for patients with certain
types of conditions that cause ongoing low back pain.
For patients who are 55 or older, symptoms of back
pain and/or leg pain are much more likely to be due
to degenerative arthritis (osteoarthritis) that
might result in a narrowing of the canal (spinal stenosis)
and/or instability of one vertebral segment. Generally,
the low back pain and/or leg pain created by these
back conditions will get worse with walking and will
improve with sitting. Often, the symptoms will have
been present for years, and may get worse at a very
slow rate. Once a patient gets to the point that he
or she can no longer adequately function because of
the low back pain, lumbar decompression with or without spine
fusion may be recommended to help increase the
individual’s activity tolerance and quality of
life.
When spine surgery is an emergency
The vast majority of spine surgery procedures to
treat severe back pain and/or leg pain are elective.
However, there are a few symptoms that are possible indications
of a serious medical condition, and patients with these
symptoms should seek emergency medical care. These symptoms
include:
-
Sudden bowel and/or bladder incontinence (either
the inability to retain or hold waste) or progressive
weakness in the legs. Either of these symptoms
could indicate nerve damage or cauda equina syndrome.
-
Severe, continuous abdominal and back pain, which
could indicate an abdominal aortic aneurysm.
Any patients with either of these symptoms should
seek immediate medical attention as they may need emergency
spine surgery.
By: Peter
F. Ullrich, Jr., MD
June 20, 2000 (Updated October
5, 2004)
|
