Back painsurgeries

If your back pain has become chronic, and you’ve tried other treatments, your doctor may recommend surgery. It’s usually considered as a last resort.

You may need surgery sooner if you’ve suffered trauma, pain is severely limiting your activities or neurological complications are affecting the function of your arms, legs, bladder or bowel. If this is the case, you should request a referral to a spinal surgeon, as early surgery can reduce the risk of irreversible damage.

Four important things to know

• If you have chronic back pain that can’t be pinned down to a specific cause (non-specific back pain) then non-surgical treatments are likely to be just as effective as surgery, with less risk.
• For many back problems, surgery is no more effective than more conservative treatments.
• Before deciding on any surgical procedure, it’s important to talk things through with your doctor and discuss all the options. This is called ‘shared decision making’. If you’re not happy with the way your doctor is discussing the options with you, consider seeking a second opinion.
• If you do decide on surgery, check your health insurance covers the type of surgery you’ve chosen. Some plans exclude spinal surgery or certain aspects of the surgery. To be on the safe side, ask your surgeon for the specific Medicare item numbers and check with your health fund.

Back problems that may be improved with surgery include:

Degenerative or herniated (slipped) disc

Between each of the vertebrae in your spine is a disc full of squashy material that acts like a shock absorber. Everyone’s spinal discs degenerate with age and can become hardened. Hardened discs are prone to rupture and narrowing. A painful degenerated disc usually begins with an injury in which your spine is twisted suddenly, damaging the disc and causing inflammation. Following this, you could have recurring bouts of back pain over a long period of time (discogenic back pain). If you undertake physiotherapy and core strengthening exercises, your disc will most likely settle down. NSAIDs and other medications usually help with the recurring bouts of pain, but if they don’t, your doctor may recommend a steroid injection which can reduce the inflammation for weeks or months. This can give you a ‘window of opportunity’ to rehab your spine.

If a disc herniates, the squashy material inside the disc leaks into your spinal canal, and can put pressure on the nearby nerve, leading to pain down your leg — sciatica — (from a herniated disc in your lumbar spine) or arm pain (from a herniated disc in your neck). A herniated disc can also cause damage to your spinal cord if it’s leaked over certain parts of the cord.

If you have back pain that fails to respond to at least 6 months of treatment and rehab, and your activities are severely limited, surgery may be an option. Talk to your doctor about the risks and benefits of microdiscectomy, disc replacement or spinal fusion. 

If you have leg pain or other sciatica symptoms that fail to respond to at least 3 months of treatment, surgery may be recommended. Again, surgery can be indicated earlier if you’re severely incapacitated.

Spinal stenosis (narrowing of your spinal canal)

When your spinal canal becomes narrowed, the nerves can become pinched and cause pain (sciatica), numbness and weakness. Balance problems, incontinence and even paralysis may also occur. The narrowing can be caused by an overgrowth of bony spurs caused by osteoarthritis, a herniated disc, thickened ligaments, tumours or an injury to your spine.

Treatments include NSAIDs and other medications, physiotherapy, and steroid injections.

For other types of stenosis that haven’t responded to other treatments, laminectomy surgery may be an option.

Osteoporosis and spinal fractures

As you age, your bones lose calcium and this can lead to osteoporosis. The first bones affected are usually the spine and hip. If the problem is detected in time, calcium and other medications can help to prevent osteoporosis from progressing. Often, one of the first signs of osteoporosis is a compression or crush fracture in your spine. You may also notice that you’ve become shorter.

There’s a minimally invasive surgical procedure for new compression fractures to restore strength to vertebrae. It’s called vertebroplasty, and it can usually be done as a same-day procedure by an interventional radiologist. This may or may not be suitable for you, so you’ll need to be assessed by a spinal surgeon first.

A spinal fracture can be caused by a fall or other trauma. If the fracture is unstable, you may require emergency surgery to limit the damage to your spinal cord. After assessing the injury, your surgeon may remove the affected vertebra and replace it with a metal cage containing bone fragments or bone substitute. This is called a vertebrectomy. Alternatively, your surgeon may recommend laminectomy and/or spinal fusion.

Osteoarthritis

This is a degenerative condition which causes pain when you move. It’s the medical term for ageing bones. Because several different vertebrae are often affected by osteoarthritis, the effectiveness of surgery is limited. The vertebrae can be fused in a procedure called spinal fusion but this may limit the movement of your spine at the surgery site and can put extra stress on other parts of your spine. If nerves in your spine are affected by osteoarthritis, you may have pain, tingling or numbness in your legs. In this case, laminectomy or disc replacement may help to decompress the nerves and relieve the pain.

Sciatica

Sciatica is the name given to the pain, tingling, numbness or weakness from when a nerve in your spine is aggravated. A few different spinal problems can contribute to sciatica and for effective treatment, it’s important to identify the source of the problem. People with sciatica often get relief from NSAID medications and steroid injections. Using heat and ice packs can also be helpful. Sciatica-sufferers often see physiotherapists or chiropractors.

If a herniated disc causes the sciatica, and it doesn’t go away after other treatments, a minimally invasive surgery called microdiscectomy is usually effective. Another surgery called laminectomy may also be considered. Sometimes if the nerves are compressed, if your spine has slipped or if there’s too much movement in your spine, you may also need to have spinal fusion. Occasionally emergency surgery is necessary if you experience lack of bowel or bladder control, or if your legs become paralysed. If this happens to you, get someone to call an ambulance.

Pain radiating from the neck into the arm(s). Cervical radiculopathy

Neck pain can have several causes including an injury such as whiplash, muscle strain, damage to tendons or ligaments, damaged discs, spinal stenosis, cervical dystonia or arthritis. If the nerves in your neck become irritated, pain can radiate down your arm or up into your head.

Most neck pain gets better by itself and can be relieved with changes to posture, physiotherapy, medications such as NSAIDs and possibly muscle relaxants. Steroid injections and neurotomy (destroying the small nerves) can also be helpful.

In severe cases, decompression surgery to release the trapped nerve can help. Spinal fusion can also be used to remove a disc which is pressing on the nerve but it can restrict your ability to move your neck fully. Alternatively, the affected disc can be replaced with a prosthesis in a procedure called disc replacement. If a bone spur is pressing on the nerve, and the surgeon thinks it can be removed without damaging the nerve, a surgery called foraminotomy can relieve the pressure. Laminectomy or laminoplasty (motion-preserving decompression) are other procedures in which pieces of bone at the back of your neck are removed or shifted to create more space for the nerve and/or spinal cord.

If compression of your spinal cord is causing clumsiness, numbness, weakness in your arms or hands, problems walking, bladder or bowel problems, you may require urgent surgery such as a spinal fusion, disc replacement, laminectomy or laminoplasty to prevent spinal cord injury.

Lower back pain

Most people experience lower back pain at one time or another. There are several possible causes and for effective treatment you need to get an accurate diagnosis. The cause of your back pain could be muscle strain, trauma, overuse, a herniated or degenerated disc, stenosis, osteoarthritis, osteoporosis, scoliosis, instability, fibromyalgia or cancer. Your pain could also be coming from an internal organ. Several diagnostic procedures can help doctors find the cause of your pain, including a CT or bone scan, a local anaesthetic block or a discogram.

Surgery can help with some types of lower back pain, but it’s normally considered a last resort after non-surgical back pain treatments including changing the way you do things, medications and alternative treatments. Ask your doctor for advice.

Scoliosis

Scoliosis is when your spine has a bend in it. You may have been born with it, or it may be a result of injury or disease. If you haven’t stopped growing yet and the angle of the scoliosis is no more than 45 degrees, a back brace may be your best option.

If the scoliosis isn’t causing problems with your breathing, digestion or day-to-day activities, then supportive treatments such as physiotherapy are probably your best option.

Surgery to correct the problem (spinal fusion) can be performed but there are risks. Sixty to 70% of people are happy with the results but 20–30% of people with scoliosis find surgery to be ineffective. One in ten people end up worse off and may need further surgery. There may be differing opinions between surgeons as to the best option for you, so it’s a good idea to get a second opinion.

Tumours

Two types of tumour can occur in your spine: a primary tumour (where the tumour has originated from the spine tissues, usually in one area) e.g. osteosarcoma, and secondary or metastatic tumours (where cancer has spread from another part of your body). Tumours can grow in different parts of your spine: the bones, the spinal muscles, spinal cord linings or nerves or the spinal cord itself.

Some tumours cause severe pain and loss of function. Treatment depends on the type of tumour and where it’s located. There are several different surgeries for removing tumours. Some can be done as minimally invasive procedures. Tumours can be benign (non-cancerous) or malignant (cancerous). If the tumour is malignant, other treatments such as chemotherapy and/or radiation may be required in addition to surgery.

After surgery for a spine tumour you may need regular follow-up investigations for many years. Other specialists may be involved in your treatment.

Learn more about back surgeries

There are several different surgeries for back pain. They are usually considered a last resort, after other treatments have failed. The most common types are:

Microdiscectomy

Laminectomy

Spinal fusion

Disc replacement.