Is Spinal Surgery Necessary?

Eighty percent of Americans will at some time experience low back pain significant enough to see a doctor. If you find yourself among those seeking help, you might be surprised to hear that spinal surgeries are on the rise. What should you expect if you see a doctor for low back pain?

As health care technology improves, it would appear that the more tests and scans the better the treatment plan. In the case of lower back pain, this is not necessarily the case. Scans can be misleading. By middle age, most people have some spinal deterioration (disc degeneration, bone spurs, stenosis, and minor disc bulges) but do not experience pain. Thus, what shows up on a scan may not be specifically causing your pain. For that reason, MRIs and x-rays are generally not necessary unless pain continues beyond four weeks.
Because the cause of lower back pain can vary, so does the treatment plan. There is no magic bullet and no one-size-fits-all program. The one thing that research clearly supports in reducing lower back pain is exercise. But, that being said, it has to be the right exercise program tailored to you and your specific condition. A recent study found that of 38 patients originally recommended for surgery, only three still needed it after a 13 month tailored exercise program.

The typical lower back pain treatment plan should follow these general steps:

1. A prescription of anti-inflammatory medication, muscle relaxers, and/or pain medication. A heavy dose of ice (no heat), physical therapy, and potentially acupuncture.
2. If pain persists greater than four weeks an x-ray and/or MRI is generally ordered.
3. The most common next treatment recommendation once the MRI is performed is an epidural injection.
4. If a series of 3 epidurals and a long course (1 year) of physical therapy is not successful, then surgery may be considered.

At most 10 percent of patients are candidates for surgery. Some studies indicate that long term outcomes are the same whether with or without surgery.

So what should you expect if you’re going to see a doctor with lower back pain?

• Don’t be surprised if x-rays or an MRI is not immediately recommended.
• Exercise (not bed rest) should be part of the prescription.
• Ice and not heat should be strongly encouraged.
• As the right exercise program is a must, a prescription for physical therapy should be expected.
• If the doctor starts talking surgery early on, seek a second opinion.