03/24/15
back is killing me

9 Reasons Back Surgery Might Help

9 Reasons Your Back Pain Might Improve With Surgery—Or Not

back is killing me

Back pain is a fact of life—if you are a human being (and presumably if you are reading this you are) sooner or later you will have back pain. That’s the bad news.

The good news is that for most of us, it will run its course and we will be none the worse for it. Most of us will have a single bout, perhaps two, lasting a few hours to several days, and that will be it. Some of us will have more, and sometimes that will be recurring pain (every few months or once every few years as an example), or chronic low level discomfort that’s just enough to interfere with life’s enjoyment but not at all incapacitating.

Others will be saddled with incapacitating pain, though even then most folks will find a happy medium and be able to function with certain accommodations, as with any other chronic illness (diabetes, heart disease, kidney failure) or condition (rheumatoid or osteoarthritis, fibromyalgia, emphysema).

But for an unlucky few, and unfortunately the masses of people on this earth mean the numbers work out to hundreds of thousands each year, back pain just might be an indicator for back surgery. This sort of back pain typically doesn’t get better without surgery—or at least doesn’t get better quickly enough for we busy humans. That’s the bad news.

The good news is that for these few, back surgery is overwhelmingly successful.

Here are nine reasons your back pain might need to be treated with surgery.

1. If it’s associated with leg pain.

Back pain that’s associated with leg pain may indicate a pinched nerve. Although even then most of these won’t need surgery, if the pain becomes unrelenting or lasts more than two months, see a physician. This kind of pain generally responds well to surgery, especially if the leg pain is worse than the back pain.

In the overall scheme of things, back pain that is purely and truly back pain is rarely an indication for surgery, though there are always exceptions. There are hundreds of ligaments, bones, and nerves in the back and any one (or group) of them can be a pain generator. This sort of pain might be from a stress fracture, a pulled ligament, a small muscle tear, or any of a thousand other sources—most of little consequence in the long run and most of which will heal and resolve on their own, though it will almost always take longer than you would like or expect.

2. If it’s off the midline to one side or the other.

Back pain that’s off the midline may indicate a pinched nerve or arthritic joint on one side of the back. If it’s always in the same place, it might respond to fusing the joint, deadening the nerve, or decompressing (unpinching) a pinched nerve.

3. If it’s always in the same place and does not roam around.

Pain that will respond to surgery does not roam around. The intensity may vary, and frequently does, but the location of the pain is a constant. Usually it is one sided and off the midline of the spine.

Roaming back pain rarely responds to back surgery and seems more likely related to muscle strain or spasm, or perhaps has no relation to the back at all. 

4. If it’s associated with leg weakness as opposed to pain or numbness.

One of the most frequent back problems is a pinched nerve, and while these don’t always require surgery they certainly can. Leg weakness with back pain is one indication of a pinched nerve and generally indicates that surgery should be strongly considered, especially if it is severe or not getting better with time. In general, if weakness is present, see a physician sooner rather than later.

5. If it’s been present for more than 6-8 weeks and doesn’t seem to be getting better.

Most back pain is self-limited and improves even without therapy, though it takes time since something is wrong and that something takes time to heal. Sometimes pain itself is a diagnostic tool though, and pain that isn’t obviously improving after two months is such a tool and should be thoroughly investigated. 

By the same token, chronic back pain that has been present for more than 2-3 years and is stable is generally unlikely to have a surgically treatable cause, even if severe at times. However, such pain should be thoroughly investigated at some point (at least once) since exceptions do exist.

6. If it’s always present in the morning and does not improve as the day advances.

Back pain that is worse in the morning after just getting out of bed and improves with activity rarely responds to surgical intervention. This is often age related. There’s a reason professional athletes retire around age forty. 

On the other hand, if you have back pain from the time you get up and it consistently does not improve (or even worsens) with activity, you should see a physician if it persists over weeks or months.

7. If the pain increases with walking—until you MUST sit down or else.

Pain that consistently worsens with activity to the point of intolerability, especially if just sitting down for a few minutes improves or alleviates it (sitting for five or ten minutes, not an hour or two), may indicate narrowing in the spinal canal—a condition which responds very well to surgery.

8. If the pain is associated with trouble walking—and you can improve the walking by leaning over a shopping cart.

This is known as a positive shopping cart sign and is so suggestive of a problem that can be fixed that if you have noticed this you should discuss it with your physician. Note that the trouble walking may be pain or weakness or both. Sometimes patients complain of “rubbery legs.”

Typically a person notices these symptoms when grocery shopping—they have to both push the cart and lean forward over it in order to shop. Just hanging on to the cart has no effect, the uncomfortable pain persists. Typically, those with a surgically treatable problem get great relief leaning over the cart as they move around the store. In fact, leaning over the cart becomes a must and is the difference between being able to do their own shopping or not being able to shop at all.

As the severity of the condition progresses, even leaning over the cart becomes ineffective and patients stop doing their own shopping. They become homebound.

9. If the “back pain” is really buttocks and leg pain.

In general, the more leg pain one has, the more likely their problem is to be treatable with surgery. Surgery for back pain alone is, in general, a disappointing experience (except in cases of fracture, tumor, infection, or perhaps scoliosis), but back pain associated with leg pain is a different story.

To understand why, one has to consider the generalized nature of back pain, which makes it difficult to narrow down an exact cause and thus limits what surgery can do. However, the occurrence of leg pain often indicates a pinched nerve and since each nerve has a stereotypic course, the location of the leg pain often marks which nerve is pinched—and hence the location of the back problem—with more or less precision. Surgery can then unpinch, or decompress, the nerve.