Surgery and Invasive Procedures
The health care provider should give patients complete information on the expected course of their low back pain and self-care options before discussing surgery. Patients should ask their health care provider about evidence favoring surgery or other (nonsurgical) treatments in their particular case. They should also ask about the long-term outcome of the recommended treatment. Would the improvements last and, if so, for how long? Another consideration when surgery is an option is the overall safety of the recommended procedure, weighed against its potential short-term benefits and its benefits in the long run.
Patients should generally try all possible non-surgical treatments before opting for surgery. The vast majority of back pain patients will not need aggressive medical or surgical treatments.
The most common reasons for surgery for low back pain are disk herniation and spinal stenosis. In general, surgery has been found to provide better short term and possibly quicker relief for selected patients when compared to non surgical treatment. However, over time, nonsurgical treatments are as effective.
Many approaches and procedures are available or being investigated. However, there have been few well-conducted studies to determine if any type of back pain surgery works better than others, or if a single procedure is better than no surgery at all.
It should be noted that surgery does not always improve outcome and, in some cases, can even make it worse. Surgery can be an extremely effective approach, however, for certain patients whose severe back pain does not respond to conservative measures.
Diskectomy is the surgical removal of the diseased disk. The procedure relieves pressure on the spine. It has been performed for 40 years, and increasingly less invasive techniques developed over time. However, few studies have been conducted to determine the procedure's real effectiveness. In appropriate candidates it provides faster relief than medical treatment, but long-term benefits (over 5 years) are uncertain.
Diskectomy is recommended when a herniated disk causes one or more of the following:
Review Date: 04/07/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.