Tuesday, June 5, 2012

Should I consider surgery for back pain?

Patients in considerable pain often ask at what point they should consider surgery. Surgery is the very last resort and should only be considered when all other options have been exhausted.  Often, patients dealing with intense pain, understandably, would like to get relief as fast as possible.  This approach, however, at least in the long run, is almost never a good choice.  Even very successful surgeries leave the patient with scar tissue, permanent weakness in the spine, distortion and instability.

Spinal surgery is a much less reliable type of surgery than an appendectomy, a heart valve replacement, or removing a cancerous lesion. These are very straight forward surgeries because of their very clear and obvious purpose. This is not the case with surgery for back pain. Spinal surgery is the only type of surgery that has led to a syndrome being named for its failures-- Failed Back Surgery Syndrome.  It’s reported that 10%-40% of patients who have undergone spinal surgery fall into this category. These patients develop intractable pain and functional incapacitation as a result of surgery. This syndrome only represents the short term outcome, not the long term.  The long term results are often even less satisfactory.  
Perhaps the most important reason the surgical option is not a good one is that it’s difficult to determine the exact cause of low back pain.  Multiple studies have shown that MRIs are only 50% accurate in determining the cause. The MRI can picture areas of abnormal tissue, but low back pain functions on many complex levels. Simply removing abnormal tissue does not guarantee success.  Often healthy tissue is cut, damaged or removed and the tissue causing the pain is left behind.  Also, scar tissue produced during the surgery often crowds the injured nerve, creating its own, sometimes more serious, problem.  In addition, cut muscles and newly formed scar tissue will change the basic mechanics of the spine, creating early spinal degeneration and pain.  Most importantly, surgery does not address the underlying mechanical abnormalities that originally caused the back pain.

Further Reading:  
Medical Insurance perspective on back surgery:
Failed Back Surgery
An interesting alternative
USA Today article

  1. Fager C. A., Freiberg S. R. (1980). "Analysis of failures and poor results of lumbar spine surgery.". Spine 5 (1): 87–94. DOI:10.1097/00007632-198001000-00015. PMID 7361201
  2. Spengler D. M. et al. (1980). "Low-back pain following multiple lumbar spine procedures. Failure of initial selection?". Spine 5 (4): 356–60.