Back pain: best to avoid surgery

I don’t have much experience with low back pain, but I have read that it is the number one cause of disability throughout the world. That’s a pretty big deal. I have two friends who have had back surgery: in neither case did the pain go away. In 2007, 27 million US adults reported back problems. More than 1,500,000 opt for back operations each year. The record of success is pretty dismal.

One study looked at the records of 1,450 patients diagnosed with disc problems. Half had two or more vertebrae fused; the other half had no surgery. After two years, only 26 percent of those who had the surgery returned to work while 67 percent who'd not had surgery returned to work. What’s more, 41 percent of those who'd had the surgery increased their use of opiates.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. Between 1995 and 2010, there was an eight-fold jump in this type of operation. For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Dr. William Welch, chief of neurosurgery at Pennsylvania Hospital, admits “We are less successful at treating back pain” than leg pain. The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.” In other words, we all have degenerating disks.

Here are the common types of back surgeries.

Diskectomy: removes the herniated portion of the disk; requires removal all or part of the back part of the vertebra to access the ruptured disk.

Laminectomy: removes the bone overlying the spinal canal to enlarge it the canal.

Fusion: fuses two or more bones in the spine to eliminate painful motion between vertebrae.

Artificial disks: implanted to replace an injured disk; a treatment alternative to spinal fusion.

Next week: Back pain: try postural changes

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