When Consider Surgery

No one looks forward to surgery, but sometimes it is the right treatment. A key question to ask yourself (expect your doctor to ask you too) is: are you making concessions in how you do – or whether you do – everyday activities because of the pain? The ability to do such everyday tasks as shopping for groceries and putting them away, picking up children, or driving to or sitting comfortably at work significantly impact an individual’s quality of life. Not being able to do them may mean that it’s time to consider surgery as a treatment option if patients meet the following criteria:

  • They have conscientiously engaged in at least six months of non-surgical pain treatment and active exercise-based physical rehabilitation for core strengthening. For people with ongoing severe, disabling pain and associated symptoms (e.g., numbness, tingling, difficulty sitting) it is sometimes not possible to wait for a full six months of non-surgical care to work. Consequently, surgery – either the more standard fusion surgery or the newer motion preservation surgery including artificial disc replacement – may be warranted.
  • If back pain causes one to make concessions to his or her normal lifestyle on a daily basis, despite adequate non-operative treatments, then a surgical consultation is warranted.
  • Their pain is still significant, both in terms of magnitude and its inability to be controlled with acceptable doses of medication or treatment.

Exploring Your Surgical Options

Beside discectomy and spinal decompressive surgery, there are two main types of surgery used to treat pain and symptoms from lumbar degenerated disc: lumbar fusion surgery and motion preservation techniques; artificial disc replacement and posterior dynamic stabilization. A surgeon’s clinical experience, judgment, and interpersonal skills are also important parts of the decision process.

There is strong scientific evidence in the form of prospective randomized multi-center studies that shows less pain and improved function in appropriately selected patients after either lumbar fusion surgery, artificial disc replacement surgery and other posterior motion preservation technologies. An appropriately trained spine surgeon should be able to ensure that non-operative care has been maximized, that the pain generator has been correctly defined, and that surgical options have been clearly presented so that an educated decision can be made by the patient.

The hospital stay can range anywhere from an outpatient procedure, in which case the patient may go home the same day of surgery, to a 3 to 4 day hospital stay. Either way, the patient generally has some activity restrictions for at least 3 to 4 weeks following surgery, followed by up to 3 to 6 months of post-surgical rehabilitation.

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