Surgery for Low Back Pain?

Every one of us who never had backache must consider themselves very lucky as it has been reported that LBP affects as much as 70-90% of the adult population at some point of time.
The good news is that only one fourth get recurrence or progression to longstanding LBP. The person who has been suffering from LBP for a long time seeks solace at any cost even if it means undergoing a major operative procedure. But nowhere the role of operative treatment of any disease has been as controversial as in low back pain.
What I am trying to tell you is not a substitute to the opinion of a well informed doctor but it may help you to arrive at a correct decision pertaining to your individual condition.
There is insignificant correlation between back pain and the findings on different imaging studies. An overdependence on the diagnosis of disc herniation occurred with early use of MRI that show disc herniations in 20% to 36% of normal volunteers. This incidence increased to 76% of asymptomatic controls when they were matched to a population at risk for work-related lumbar pain complaints.
Severe nerve compression demonstrated by MRI or CT correlates with symptoms of distal leg pain; however, mild to moderate nerve compression disc degeneration or bulging, and central stenosis do not significantly correlate with specific pain patterns.
Lumbar MRI scans of 67 asymptomatic patients and found that 20% of those younger than 60 years of age had herniated disc, which were also present in 36% of those over the age of 60 years. Asymptomatic abnormalities were found in 57% of those 60 years of age or older. Lumbar disc degeneration was found in 35% of those from 20 to 39 years of age and in 100% of those over 50 years of age.

If you have been considering surgery for LBP here are certain things to consider before making a decision.
If the pain is mainly in your back with no or minimal radiation with no other abnormality other than a disc bulge reconsidering surgery would be better.
Appropriate treatment for what can be at times excruciating pain generally should begin with evaluation for significant spinal pathology. This being absent, a brief (1 to 3 days) period of bed rest with institution of painkillers and rapid progression to an active exercise regimen with an anticipated return to full activity should be expected and encouraged. Generally, patients treated in this manner improve significantly in 4 to 8 weeks. Diagnostic studies, including roentgenograms, often are unnecessary because they add little information.
Structural abnormalities do not always cause pain and diagnostic injections can help to correlate abnormalities seen on imaging studies with associated pain complaints. In addition, epidural injections can provide pain relief during the recovery of disc or nerve root injuries and allow patients to increase their level of physical activity. Because severe pain from an acute disc injury with or without radiculopathy often is time-limited, therapeutic injections help to manage pain and may alleviate or decrease the need for oral analgesics.
Surgical treatment can benefit a patient if it corrects a deformity, corrects instability, or relieves neural compression, or treats a combination of these problems.
There have been various studies comparing the long term results of operations for LBP ranging from microscopic discectomy to circumferential fusion.
Both the surgeon and the patient must realize that disc surgery is not a cure but may provide symptomatic relief. It neither stops the pathological processes that allowed the disc prolapse to occur nor restores the back to a normal state. If you have a prolapsed disc on the much coveted MRI examination, to conclude that a removal of disc will bring total relief from pain may not be true for everyone.
Disc surgery with fusion of the affected spinal segments definitely provides relief from pain arising from instability but may also increase the motion strain on adjoining segments thereby increasing the chances of degeneration at these levels.
The patient must practice good posture and body mechanics after surgery. Activities involving repetitive bending, twisting, and lifting with the spine in flexion may have to be curtailed or eliminated. If prolonged relief is to be expected, then some permanent modification in the patient's lifestyle may be necessary.
This does not mean that chronic LBP patients are doomed to suffer. The most important aspect in treatment of such patients lies in education of the patient pertaining to his problem and to mutually manage the condition with medicines, life style modifications, structured exercise programs with constant supervision and surgical intervention in cases that would definitely be benefited.
The question that “Is surgery for LBP a solution to a problem or itself a problem” still remains unanswered not only in the minds of patients but also the people responsible for treating Low Back Pain.
Dr Sameer Agarwal can be reached at International Medical Center.