It’s not always the best solution for a bad back. So when is back surgery worth it and when are other options better?
The five lumbar vertebrae (L1 to L5) between your ribcage and pelvis form a flexible curve that carries most of your body weight. They’re separated by shock-absorbing discs and bony joints, and linked at the lower end to the sacrum bone.
Each vertebra contains a hole (for the spinal cord), while connecting ligaments provide strength and stability. Our spinal cords carry nerve signals to and from our brains, but stop at L1/L2, so the nerves that supply our lower body and legs dangle down, emerging on each side between the vertebrae.
There are several things which may go wrong with this area of your body to cause you pain. But if you’re offered surgery, your specialist should discuss how it could help and explain any potential hazards, including cord damage.
This common cause of low back pain can be brought on by heavy lifting or a minor tweak to muscles or ligaments, but usually clears quickly with sensible self-care. Chronic strain may be due to poor posture (when standing or sitting) or bad lifting technique.
Surgery won’t help, but see your GP if back pain is severe, lasts more than six weeks, follows a fall or cancer, makes you feverish or unwell, or is linked to leg weakness or numbness. Get urgent help if both legs are affected or you develop bladder or bowel problems, because your spinal cord may be damaged. You may need blood tests, X-rays or a CT/MR scan.
Intervertebral discs have a gel-like centre and fibrous coating. They can rupture (‘slip’) and press on nearby nerves, producing pain, numbness and/or weakness. For example, if your sciatic nerve is affected, you’ll notice symptoms in your buttock, back of your leg and foot.
Surgery is usually only worthwhile if alternatives haven’t worked and a scan confirms the nerve is being squashed. You may be offered keyhole surgery, such as microdiscectomy (to remove damaged disc tissue and any bone or ligament fragments that are compressing the nerve), or interspinous distraction decompression (IDD), where a synthetic ‘spacer’ is inserted to widen the gap.
Sometimes laser treatment is used or an artificial disc inserted. Other treatments to relieve nerve pressure include laminectomy (which removes
an arch of bone) and spinal fusion using a bone graft (for example, from your hip).
Spinal canal narrowing, caused by ageing changes, arthritis or vertebral disease, squeezes spinal arteries and nerves, producing pain in the back and legs, especially when exercising or walking uphill.
Bending forwards may relieve it. Losing weight and steroid spine injections can help, but you may need a laminectomy or IDD to create the necessary space.
Permanently linking vertebrae in their ‘best position’ can relieve pain and instability in many spinal conditions, such as trauma, vertebral slippage (spondylolisthesis) or severe arthritis.
Fusion involves metal rods, screws and bone grafts, and your mobility may be quite restricted afterwards, so it’s only worthwhile as a last resort or to prevent spinal cord damage.In kyphoplasty, cement is injected to strengthen vertebrae that have collapsed because of osteoporosis or tumours.
7 Alternatives to surgery for your back
1. Keep mobile to maintain strength and flexibility. Bed rest is rarely recommended these days.
2. Apply a hot-water bottle, heat pad or TENS machine to relieve pain.
3. Take painkillers. But check with your GP first if you take other medicines or have other medical conditions.
4. Physiotherapy helps many acute and chronic back problems. Try Pilates or yoga to strengthen supportive muscles, if your doctor agrees.
5. Nerve root pain can be relieved with prescribed medicines, such as tricyclic antidepressants or drugs used for epilepsy.
6. Ask your GP about NHS ‘back schools’ which can teach you how to live with chronic back pain.
7. Get support and advice from the charity Backcare. Call 020 8977 5474, or visit backcare.org.uk