Surgery for Low Back Pain

surgery, medicine and people concept - group of surgeons at operation in operating room at hospital

Overview

Low back surgery is rarely an emergency event, even in the presence of severe pain. The number of low back surgeries is increasing significantly, but there does not appear to be a corresponding reduction in disability or the incidence of low back pain. Still, for many patients, surgery may seem the only remaining option.

Back surgery is performed by medical doctors and osteopathic doctors who are Board Certified in either orthopedic surgery or neurological surgery.

RESCU Treatment Ratings

R = Risk      E = Effectiveness      S = Self-Care

C = Cost     U = Usefulness (overall rating)

1 = Least Favorable     5 = Most Favorable

R

RISK: 2/5

One recent large study looked at 940 patients who underwent spinal surgery. 87% experienced at least one complication, and 14 patients died. They reported, “The incidence of postoperative complication was 73.5% (wound complications, 13.5%; delirium, 8%; pneumonia, 7%; neuropathic pain, 5%; dysphagia, 4.5%; and neurological deterioration, 3%).”

Source:

Street JT et al. The Spine Journal, Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients: January 2012Volume 12, Issue 1, Pages 22–34

Other studies have shown a risk of about 1:1000 patients for nerve root damage, and in 1 10,000 patients can suffer bowel or bladder incontinence. More common side effects include leakage of cerebrospinal fluid (1 to 3 %) which will require the patient to lie flat for 24 hours, and infections (1%) which may require additional surgery and IV antibiotics.

Unless there is evidence of a progressive neurological condition such as new onset loss of bowel or bladder control, low back surgery is rarely an emergency event, even in the presence of severe pain. Studies suggest a majority of disc problems will improve over time. Some conditions, such as stenosis, may continue to get worse. 

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