For a wide range of conditions and injuries affecting the lumbar spine, surgical treatment is considered a last resort. The risks and complications associated with surgery make non-invasive treatments far preferable. Additionally, for many patients, physical therapy, medications, and other non-surgical therapies provide long-lasting relief.
Unfortunately, not all lower back conditions can be cured with non-invasive methods. Severe lumbar spine conditions that don’t respond to several months of non-surgical treatment may require surgery for complete relief.
Conditions that cause lower back pain and may require surgery to be fully resolved include:
A herniated disc, which may also be called a slipped or ruptured disc, is a common spinal injury. It occurs when one of the intervertebral discs that cushion the spine becomes damaged. Specifically, the soft disc interior protrudes from a split in the tough disc exterior.
If the damaged disc doesn’t press on any spinal nerves, it may not cause symptoms. However, if the herniated disc does trigger nerve compression, symptoms are likely to occur and may include:
- Back pain
- Numbness, weakness, and/or tingling, often only on one side of the body
- Pain that radiates into the arms or legs
- Pain that’s exacerbated by long periods of sitting or standing
- Muscle weakness that can’t otherwise be explained
When Does a Lumbar Herniated Disc Require Surgery?
Non-invasive methods including physical therapy, anti-inflammatory/pain medications, physical therapy, and epidural steroid injections are typically the first line of treatment for a herniated disc. However, if these methods fail to provide relief after six months or more, the physician may suggest surgery.
Additionally, a lumbar herniated disc may require surgery if the patient has:
- Worsening neurological symptoms (numbness, tingling)
- Significantly restricted mobility and struggles to walk and/or stand
- Continuous pain that reduces their quality of life
- Severe sciatica (nerve pain that radiates down the lower back, buttocks, and leg)
Lumbar Vertebral Fracture
Vertebral fractures can occur in the lumbar spine as a result of serious trauma, such as an auto accident injury or major sports injury. However, osteoporosis, which occurs when the bones weaken, can also lead to fracture. Spinal fractures caused by osteoporosis are often referred to as compression fractures.
In some cases, lumbar vertebral fractures can cause spinal cord damage and neurological problems, making prompt treatment essential to the patient’s health.
The typical symptoms of a vertebral fracture include:
- Back pain that develops suddenly
- Worsened pain with walking or standing and improved pain with lying on your back
- Reduced mobility in the spine
- Loss of height
Do Vertebral Fractures Always Require Surgery?
In most cases, patients with vertebral fractures don’t need surgery. Rest, physical therapy, pain medication, bracing, heat and cold therapy, and other non-surgical treatments can help patients make a full recovery.
However, if vertebral fractures don’t heal on their own within a few months and continue to cause back pain, surgery may be necessary. Additionally, spinal fractures may need surgery if they injure nearby nerves or if the patient’s spine is significantly misaligned.
Vertebroplasty/kyphoplasty with spinal fusion is the most commonly done procedure for spinal fractures. In vertebroplasty and kyphoplasty, the surgeon injects a medical-grade cement solution into the fractured vertebra.
Severe Degenerative Disc Disease
Degenerative disc disease involves back pain that stems from the degeneration of a spinal disc. This degeneration may result simply from the aging process or repeated overuse.
Typically, degenerative disc disease causes chronic, moderate pain and periodic stretches of more intense pain. Along with persistent back pain, the condition can cause weakness, numbness, and pain that radiates into the arms or legs.
Additionally, degenerative disc disease can lead to a herniated disc. As the intervertebral disc weakens with this condition, it may eventually become damaged. If a disc becomes herniated, it may press on spinal nerves and trigger neurological symptoms, such as weakness, numbness, or tingling in the extremities.
When is Surgery Required For Degenerative Disc Disease?
Surgery is generally only required for severe cases of degenerative disc disease that cause debilitating back pain. Additionally, patients are usually only recommended to undergo surgery after having gone through at least six months of conservative treatment, such as:
- Pain medication
- Physical therapy
- Rest and lifestyle adjustments
- Chiropractic care
- Epidural steroid injections
If patients don’t respond to non-invasive treatments, they can consider spine surgery for lower back pain relief. Discectomy is often performed for patients with degenerative disc disease, as it involves removing damaged disc tissue. Patients may also undergo spinal fusion or fusion alternatives to stabilize the spine.
Spinal stenosis is a condition that occurs when the space within the spine becomes narrower, often due to gradual wear and tear. With age, the ligaments in the spine can become thicker and less flexible, eventually extending into the spinal canal. Bone spurs caused by osteoarthritis can also limit the amount of space in the spine.
In the lumbar spine, spinal stenosis can cause symptoms including:
- Chronic back pain
- Numbness, tingling, or weakness in the extremities
- Pain in one or both legs after extended periods of standing or walking
When is Surgery Necessary For Spinal Stenosis?
Doctors generally don’t recommend surgery for spinal stenosis unless the patient has undergone around six months of conservative treatment and continues to experience debilitating pain. In these cases, surgery may be required to cure the patient’s back pain.
Surgery for spinal stenosis is performed to create more space in the spinal canal, often by removing the lamina in a form of spinal decompression called laminectomy.
Fusion in Spinal Stenosis Surgery
Back surgery for spinal stenosis commonly involves spinal fusion to prevent instability after decompression. However, to reduce back surgery recovery time, patients can opt for spinal fusion alternatives. This type of spinal stenosis remedy typically involves a spine device to stabilize the vertebrae without limiting back mobility.
If you’re suffering from chronic lower back pain, schedule an appointment with your physician to talk about the treatment options available to you.