Back Pain: When is it time for surgery?

Back pain is a problem for around four million Australians and people grapple with the symptoms of lower and upper back pain every day. But how do you know when back surgery is appropriate? If you’re facing the possibility of spinal surgery, here are some key things to consider.

Health Agenda magazine
July 2018

If back pain is causing you grief, you’re not alone. Recent data from the Australian Bureau of Statistics suggests around four million Aussies have back problems, and unsurprisingly, back blues are more likely to strike as we age.

Modern life: A pain in the back

Poor posture, injuries, disease and genetic or medical conditions are all possible causes of back problems and can make the pain worse. And factors like your type of work, whether you’re overweight, and your overall activity level can increase your risk of developing back complaints.

Back pain could be caused by a simple muscle or ligament strain – often following a lifting or twisting injury. Other possible causes are stress fractures, spinal curvature, and disc herniation, known as a ‘slipped disc’. Older people are more likely to have back pain due to degeneration in the spine or osteoporosis.

Back pain often resolves by itself after days, weeks or months, but can return if you lift something heavy, twist suddenly, sit for too long or have a fall. There are several things you can do to relieve the pain, address the underlying problem and prevent a recurrence. Some you can do by yourself and others include help from health professionals. If your quality of life is being significantly compromised by back pain, there are surgical options that may help, but it’s important to understand and assess the risks and benefits.

Back surgery options: The rise of spine surgery

In 2016, the Medical Journal of Australia reported an international rise in cases of back surgery over the past 20 years. The report also said that while patients have high expectations of their spinal procedures, a better understanding of the long-term pain and quality-of-life results of these surgeries is called for.

Take spinal fusion as an example. This is a surgery to connect two or more vertebrae in the spine, stopping any motion between them. A US study that compared spinal fusion with non-surgical treatment of lower back pain concluded that while outcomes were tipped in favour of spinal fusion, it was unclear whether this “lead to a … significant difference.”

At the same time, a 2017 study showed there has been a dramatic increase in the rate of spinal fusion procedures in Australia. Sydney neurosurgeon and spine surgeon, Dr Yanni Sergides, says there are several reasons for the increase in spinal surgery.

“First; degenerative conditions tend to occur with advancing age, and we are an ageing population,” he says. “Second; the available technologies and technical expertise have progressed. Third; more surgeons are being trained to perform the surgery.”

Steps to take before surgery

Dr Sergides says conservative approaches are almost always tried before any type of surgery.

Before reaching for surgical solutions, there are a range of different health professionals who may be able to help you manage your back pain. You may wish to consult a:

• GP
• physiotherapist
• occupational therapist
• chiropractor or osteopath
• acupuncturist
• massage therapist
• rheumatologist
• pain specialist
• interventional radiologist.

For back pain that persists, there are several nonsurgical treatments or interventions to consider before going into hospital. These include injections (most commonly an anaesthetic and steroid mixture into a joint or around spinal nerves), pain management programs, physical therapy, and cold laser therapy, among others.

Different medications can also be used to help reduce the symptoms associated with spine problems. Both over-the-counter and prescription medications such as anti-inflammatory painkillers may help relieve pain.

Deciding whether to have back surgery

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

Neurosurgeon and spinal surgeon Dr Richard Parkinson says the decision to recommend surgery depends on both the patient and the problem.

His advice to anyone considering surgery: “Make sure you clearly understand what you are having done, the implications – short- and long-term – the risks, and how you’ll feel afterward. Check your doctor has recognised qualifications and is currently registered. If you have any concerns, get a second opinion.”