When is spine surgery considered?

Surgery is rarely the first step

Anyone living with persistent pain may wonder how long to wait before an operation is discussed. The sources used here agree on the order of events: other treatments come first. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says surgery for back pain may be suggested if all other treatments tried have not relieved the pain. It adds that not everyone is a candidate for surgery, even when the pain continues.

For a slipped disc (a soft cushion between the spine's bones that bulges outward), the NHS says surgery is not usually needed. The American Association of Neurological Surgeons (AANS) says most herniated discs do not require surgery. It reports that symptoms of sciatica or radiculopathy (symptoms from a compressed or irritated spinal nerve) improve in approximately 9 out of 10 people, over a time that ranges from a few days to a few weeks. For background, see what a slipped disc is and what sciatica is.

Situations where surgery is discussed

The NHS says a GP may refer someone to a specialist to discuss surgery if symptoms have not improved with other treatments or include worsening muscle weakness or numbness. AANS lists situations in which a person may be considered a candidate for spinal surgery:

• Pain from a nerve root limits normal activity or lowers quality of life.
• Nerve problems get progressively worse, such as leg weakness or numbness.
• Normal bowel and bladder function is lost.
• Standing or walking becomes difficult.
• Medication and physical therapy are not effective, and the person is in reasonably good health.

Mayo Clinic describes laminectomy, an operation that makes more room in the spinal canal, as typically done only after medicines, physical therapy or injections have not helped enough. It says the operation might be recommended if symptoms are severe or getting worse. In the case of a herniated disc, MedlinePlus says that bowel or bladder problems, or pain so bad that strong pain medicines do not help, mean surgery is needed right away.

What surgery can and cannot promise

NIAMS says research shows surgery can be helpful for people with herniated discs, spinal stenosis (a narrowing of the spinal canal) and spondylolisthesis (a vertebra that slips out of place). AANS says that although a large percentage of patients with herniated discs report significant pain relief after surgery, there is no guarantee that surgery will help. For spinal fusion, Mayo Clinic notes that study results are mixed when the cause of back or neck pain is not clear.

The main operations are outlined on separate pages: discectomy, spinal decompression and spinal fusion. The risks of spine surgery have their own page, and the whole collection sits under surgery in outline. None of these pages recommends or advises against an operation. That decision belongs to a person and their surgeon.

When to get help

Practice varies by country and by clinician, so a local doctor is the right person to ask whether surgery is worth discussing. The NHS advises seeing a GP if painkillers are not helping or back pain is not getting better after a few weeks. It lists symptoms that need emergency care in someone with back pain: numbness around the bottom or genitals, being unable to pee, losing feeling in one or both legs, being unable to control the bladder or bowels, or pain that began after a serious accident. In the UK that means calling 999 or going to A&E, and elsewhere it means using the local emergency number.