Low Back Pain
(Part 6/6)
Surgical Treatment
Surgery for low back pain should be considered only when nonsurgical treatment options have been tried and have failed. It is best to try nonsurgical options for 6 months to 1 year before considering surgery.
In addition, surgery should be considered only if your doctor can pinpoint the source of your pain and believes that surgery can improve it.
Surgery is not a last resort treatment option. Some patients are not candidates for surgery, even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply cannot be treated with surgery.
Spinal Fusion. Spinal fusion is essentially a welding process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis), or severe degeneration of one or more of your disks. The theory is that if the painful spine segments do not move, they should not hurt.
Fusion of the vertebrae in the lower back has been performed for decades. A variety of surgical techniques have evolved. In most cases, a bone graft is used to fuse the vertebrae. Screws, rods, or a cage are used to keep your spine stable while the bone graft heals.
The surgery can be performed through your abdomen, your side, your back, or a combination of these approaches. There is even a procedure that is performed through a small opening next to your tailbone. No one procedure has been proven better than another.
The results of spinal fusion for low back pain vary. It can be very effective at eliminating pain, not work at all, and everything in between. Full recovery can take more than 1 year.
Disk Replacement. This procedure involves removing the disk and replacing it with an artificial disk. It is performed through the abdomen, usually on the lower two disks of the spine.
The goal of disk replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion.
Although no longer considered new technology, the results of artificial disk replacement compared to fusion are controversial.
Diskectomy. Diskectomy involves removing the damaged portion of a herniated disk. This relieves pressure on the nerve, allowing sciatic to resolve.
Laminectomy. Laminectomy involves removing the thickened ligaments and bone spurs that are compressing the nerves. This relieves pressure on the spinal canal, resulting in less nerve pain.
Kyphoplasty/Vertebroplasty. This procedure involves injecting cement into the broken bone to stabilize an osteoporotic compression fracture. This may help improve the sharp pain associated with the fracture. Learn more about the procedure in Osteoporosis and Spinal Fractures.
Prevention
It may not be possible to prevent low back pain. We cannot avoid the normal wear and tear on the spine that goes along with aging. But there are things we can do to lessen the impact of low back problems. Having a healthy lifestyle is a good start.
Exercise Regularly
Combine aerobic exercise, like walking or swimming, with specific exercises to keep the muscles in your back and abdomen strong and flexible.
Use Proper Lifting Technique
Be sure to lift heavy items with your legs, not your back. Do not bend over to pick something up.
Keep your back straight and bend at your knees. Learn more: Preventing Back Pain at Home and at Work and Preventing Back Pain: Tips for New Parents
Maintain a Healthy Weight
Being overweight puts added stress on your lower back.
Avoid Smoking
Both the smoke and the nicotine cause your spine to age faster than normal. If you smoke, take steps to quit. Learn more: Smoking and Musculoskeletal Health
Use Proper Posture
Good posture is important for avoiding future problems. A therapist can teach you how to safely stand, sit, and lift.