Weighing the Risks, Benefits of Back Surgery

Millions of people experience back problems that cause pain or disability. Of these, a small number will seek relief through surgery.

"Spine surgery is less invasive and recovery is much faster than it was 10 to 15 years ago. Still, it's a major procedure most people choose only as a last resort," says Thomas J. Errico, M.D., an orthopedic surgeon in New York City.

The reasons for back surgery typically vary with a person's age:

• Teens may consider surgery to correct deformities. These include scoliosis, or curvature of the spine.

• Adults ages 20 to 50 most likely have problems with disks that have degenerated or slipped out of position. This can cause severe back and leg pain.

• Older adults may have spinal stenosis. This is a narrowing of the spinal canal that can press on nerves leading to the legs.

Only a small number of people will choose surgery to relieve their back pain.

Seldom a first choice

Surgery is the first or only option in just a few cases—for example, when a person is in severe pain, has back instability from trauma, or has nerve problems, such as loss of motor or bladder control.

For a less-severe problem, most doctors and patients prefer to try other treatments first. These include exercise and education, physical therapy, medication, and nerve-block injections. If the problem persists, they may weigh the risks and benefits of surgery.

If you choose to have spine surgery, it will probably be one of three types:

• Decompression, in which bone or other tissue is removed to take pressure off a nerve or the spinal cord. In a laminectomy, for instance, the surgeon removes part of the bone surrounding the spinal cord. Decompression is also used to relieve spinal stenosis.

• Stabilization or fusion, in which a surgeon uses bone grafts or metal rods and screws to fuse vertebrae together, making a strong bridge across a missing or damaged disk.

• Corrective procedures, which use spinal fusion and other techniques to straighten deformities, such as scoliosis.

Faster recovery

Less invasive techniques have reduced the size of the incision and the amount of blood lost. They have also reduced the normal recovery time for some common procedures. Disk surgeries, for example, now can be performed under a microscope, using an incision that's only slightly more than an inch long.

If you have a micro-discectomy, you may be on your feet within a day or two, in physical therapy within a week, and back at work in two to four weeks.

Recovery after fusion surgery can take eight to 10 weeks.

How fast you recover from any back surgery depends on several things, including your age and general physical condition.

When back problems occur, talk with your primary-care doctor first. Ask to be referred to a spine specialist if your condition doesn't improve after six to eight weeks of treatment.

"The decision to have a back operation is a personal one, based on the life you lead and the life you want to live in the future," says Dr. Errico.