Back Surgery - Pain Relief, Benefits & Risks of Spinal Surgery

By Dr. Stuart Gold, M.D., Orthopedic Surgeon & Author

Spinal surgery is an option for people whose back pain cannot be cured by regular medication and conservative therapy. Going under the knife is considered to be a final resort to people, and it’s important to think about the recuperation time associated with it. Recovery and rehabilitation can take three to twelve months following a major back surgery. Severe ailments like chronic spondylitis (degenerative disc disease) herniated spinal discs (pinched nerve) and spinal instability (excessive movement between the bone blocks know as vertebra) are the primary causes of low back and leg pain.  When all else has failed spinal surgery can be considered.

Surgical intervention in the lumbar spine should be directed at accomplishing one or all of three important things:

Spinal surgery basically does three important things:

  • It helps in relieving pressure on the spinal nerves or the spinal cord.
  • It provides stability to an unstable segment in the back.
  • It is used for correction of spinal deformities.

Background of Back Surgery

The history of the spinal surgical procedure dates back to 1950 when the first major back surgery was carried out. The methods were completely different from what we see nowadays; the procedure involved large posterior incisions and the only methods of diagnosis were the X-ray and the myelography. 1960s saw the introduction of the introduction of the lumbar fusion and new approaches for the thoracic disc herniation.

The next decade saw significant advancements in the field of neuro-imaging, with the development of the CT scanner and MRI machines. Minimally invasive surgery was born and various other surgical procedures concerning anterior and posterior c lumbar fusion techniques were perfected. The next three decades saw various other improvements in spinal surgery with endoscopic, laparoscopic, and thorascopic techniques. With these new advancements in place, came the hope that recovery would be quicker. 

Challenges With Back Surgery

Though the size of the posterior incisions has decreased over time, the risks associated with the spinal surgery have not considerably reduced. The back proves to be a sensitive structure of the human body, and the utmost care needs to be taken while operating on it. There are new procedures like the percutaneous arthroscopic discectomy and video-assisted spinal procedures, which are relatively new and have not been tested by time. Hence the complication rate of these methods cannot be assessed.

Minimal-invasive surgical techniques are employed to make sure that the recuperation time can be reduced and the patient can return to normalcy earlier. One of the biggest challenges faced by the patients is the lengthy convalescence period associated with the spinal surgery. The recuperation time has to be viewed, as a time of rehabilitation, and while extra care has to be taken not to cause damage to the back. Regular prescribed exercises help in strengthening the core muscles, which are key in stabilizing the lumbar spine.

Back Surgery Risks

There’s a certain bit of risk involved in all medical surgical procedures, and the spinal surgery is no exception. In fact, the risk associated with this type of surgery is more because the backbones, known as vertebrae and the discs (shock absorbers), take time to heal, and provide stability to the torso.

It is common knowledge that the spinal cord houses vital nerves which connects the whole of the body – the fact that the surgical procedure is done close to the spinal cord makes it dangerous. The spinal cord or the associated nerve roots, which come off of the spinal cord, can be damaged by pressure or in rare cases cut, particularly when excessive scar tissue is present. This can lead to permanent weakness numbness, or chronic pain. Infection can occur with spinal surgery even though proper care is taken. Bone grafting and supporting the spinal column by using metal rods and screws makes the process more susceptible to infection. 

Other potential complications include, excessive blood loss, blood clots, leak of spinal fluid, and most importantly failure of pain relief. The medical achievements in the field of spinal surgery have reduced the chances of risks, though not completely.

Benefits & Opportunities Of Back Surgery

In cases where a long course of conservative medicine for back pains proves futile, the spinal surgery could help cure the problem, though at the cost of an extended recuperation time. New minimally invasive procedures may improve chronic ailments with minimum posterior incisions. Unstable spines (spondylolisthesis) necessitate curbing movement between adjacent bones in the spinal cord, which can be done by spinal fusion processes. Spinal surgery is also used in cases of medical emergencies like weakness in the legs due to large disc herniation and bladder/bowel incontinence. The technical term for this condition is cauda equina syndrome, and is a true emergency.

Overall, if you’re faced with unbearable and intractable pain which regular medication, exercise, rehabilitation and other noninvasive methods have failed, then surgery should be considered as long as all the potential ramifications are understood. Most notably not everyone is improved, let alone cured.

> To learn more about back surgery and spinal surgery, click here.