Lumbar Spinal Surgery….When To Have It ?

To date, there have been no reliable studies that recommend lower lumbar surgery for 

hronic back pain. The surgical literature is clear on acute low back pain and the benefit of surgery when the medical work-up reveals a problem that can be treated surgically (such as disc material extruding into the spinal canal – see picture).

Many people with chronic back pain have 2 or more mechanisms for their pain.  When there are several overlapping mechanisms for the pain (a mechanism is how the pain is actually being generated) surgery for chronic low back pain has not been proven to be more effective than other less invasive forms of therapy (such as physical therapy).

A Specialist Is Needed !

• You should have had a thorough history and physical by a licensed medical practitioner who is experienced in chronic lumbar pain.
• You should have had a lumbar MRI with contrast to evaluate all the anatomical possiblities for the mechanism of the pain.
• You should have failed a trial of less invasive therapy that was prescribed by a team of experts (Rehabilitation Specialist, Spinal Orthopedic Surgeon, Neurosurgeon, or Pain Specialist).
• You will need to get at least 2 opinions from Surgical Specialists that subspecialize in lower lumbar surgery (usually an Orthopedic Surgeon or a Neurosurgeon). Each opinion should agree that surgery is your best option. 

Choose Carefully !

It will take a little courage on your part but, you should check on the surgeon’s credentials, in what hospital the surgery will be performed, and how many lumbar operations the surgeon does per year (it should be more than 25).

Summary Comments

Of course, there are no guarantees with any surgery. You cannot eliminate complications…only reduce them. Remember…several million Americans undergo surgery each year without any serious complications.

Follow the above basic guidelines to have the best outcome possible with your back surgery.  Before you have surgery you may want to consider a 3 month trial of intense traction therapy with an inflatable traction device

Unlike other traction devices, that can only be applied in an immobile state, portable traction devices allow the wearer to use them for many hours and engage in light activities.  This significantly prolongs the period of therapy.

These types of devices are particularly effective in people who have a herniated disc at the L-5 position as their mechanism for pain generation.  This is the most common position for a lumbar disc herniation as the most torsional force is applied to this area of the back.