When does back pain require surgery?

Most people will suffer from back pain at some point in their lives, and it can range from moderate to severe. In his latest article, leading London-based neurosurgeon Mr Dan Plev explains what can cause back pain, as well as the most effective treatments for the pain, such as physiotherapy or surgery.

When should someone consider surgery for their back pain?

People mainly consider surgery for back pain when it is in conjunction with leg pain, which would be caused by a disc herniation pressing on a nerve in the back. In most cases, addressing the leg pain in conjunction with physiotherapy will resolve the back pain.

If the back pain does not improve despite addressing the leg pain, the cause of the back pain needs to be determined. This can be quite difficult to do. It is often due to the degeneration of the disc, which leads to a loss of height of the disc. Loss of disc height means that more strain and pressure is applied to the other supportive structures in the back, which can generate even more pain.

If this specific back pain does not respond to the right physiotherapy, one may want to discover whether restoring the disc height with a surgical intervention might be successful.

What is the purpose of the surgery?

This surgery is done to restore the support of the disc, which has degenerated. This will take pressure off of the adjacent structures, such as facet joints and ligaments. It will also make space in the spinal canal if this disc is pressing on and irritating the nerve root. In conjunction with physiotherapy, over 80% of patients will notice a significant improvement in their symptoms.

Is the surgery recommended when the pain isn’t resolving, or if the pain is affecting their quality of life?

Absolutely. Firstly, patients should seek advice from a physiotherapist, and follow their instructions. The exercises will increase the muscular support of the disc, decreasing pain. After 4 weeks of these exercises, you should start to feel that you have a stronger core, although it can take up to three months for the benefits of these exercises to really be felt. After three months, you can decide if you are happy with the results, or if you would like to go down the surgical route.

How common is it for patients to choose surgical treatment for their back pain?
Most of the patients are able to address their back pain with conservative pain management procedures, but about 10% of patients will need surgery.
 

Mr Dan Plev is a renowned neurosurgeon based in London, with over 25 years of experience. If you are concerned about your back pain, you can book a consultation with Mr Plev today via his Top Doctors profile.