Back surgery is quite controversial and the key question is when to operate…

These are generally seen as good reasons for back surgery:

  1. Compressed nerves – when the nerves to the leg are squeezed/pinched/compressed, permanent damage can result, causing weakness and even paralysis, as well as incontinence. Surgery can relieve the pressure and save the nerves.
  2. Unstable spine – when the spine is physically unstable, usually due to congenital deformities or injuries (falls and car accidents are the most common), spinal surgery may be needed to avoid further serious damage.
  3. Severe chronic pain – if other measures fail to control back pain, surgery may be considered.

The first two are usually fairly clear (although there is more and more evidence that compressed nerves do not always need surgery) but the third is the tricky one and this is where careful judgement is needed. One person may cope with pain that another cannot and there is no doubt that some resilience is needed with any chronic pain condition. Back surgery is major surgery and not without complications. Nor is it always as successful as we’d wish. The trick is to avoid back surgery unless it is truly unavoidable. It is wise to try non-surgical approaches first and fully. If in doubt, pause and seek a second opinion.

What does the surgeon do?

There are three main types of back surgery:

  • Laminectomy is the removal of some of the bone of the spine.
  • Discectomy is removal of some or all of the intervertebral discs between the bones of the spine.
  • Fusion is where the bones of the spine are fixed together using metal or bone taken from elsewhere.

Combinations of these procedures, and surgery at more than one level in the spine, may be needed. Newer techniques are being tried in places. Back surgery is usually done by orthopaedic surgeons (bone specialists) and or by neurosurgeons (brain and nerve specialists).

Back surgery is somewhat controversial for good reason. It is sometimes absolutely necessary and hugely beneficial but there are complications and the long-term results are not always as good as we’d wish. Empowering yourself with some basic knowledge may help you if you face possible surgery.