How to Decide to Have Back Surgery? Determining if Back Surgery Is Right for You

Is back surgery right for you? The answer is rarely simple. The decision of whether or not to have back surgery depends on several factors, from the severity of your condition to your age and risk factors. 

A spinal specialist can evaluate your unique situation to help you determine if back surgery is right for you. But, to help you make an educated choice, keep reading to learn about who may need back surgery, spine surgery success rates, and more. 

Who Needs a Back Surgery?

People with chronic back pain and/or neurological symptoms that don’t respond to non-surgical treatments may need back surgery. 

Examples of spinal conditions that may eventually require back surgery include:

  • Ruptured spinal discs can, in severe cases, require back surgery. Also known as a slipped or herniated disc, ruptured spinal discs often heal on their own with physical therapy, lifestyle adjustments, and pain management. However, if the disc is severely damaged and causes chronic pain, surgery may be necessary for symptom relief. 
  • Spinal stenosis is a condition involving abnormal narrowing of the spinal canal. Especially if it’s treated in the early stages, spinal stenosis usually doesn’t require surgery – conservative treatments are sufficient for pain relief. However, if it causes chronic or debilitating pain that doesn’t respond to other treatments, surgery may be recommended. 
  • Spondylolisthesis occurs when a vertebra is unstable and slips onto the vertebra beneath it. If the unstable vertebra compresses spinal nerves, it may require surgery to restore spinal stability and alleviate pain. 
  • Spondylolysis is a stress fracture in the pars interarticularis of the vertebra. The pars interarticularis is a small segment of bone that links the two facet joints of each vertebra. It can fracture as a result of excessive impact on the spine, particularly in young athletes.  

What Is the Success Rate of Spine Surgery?

The success rate of spine surgery is around 50%, although statistics vary depending on the procedure. 

Spine surgery is considered “failed” if it:

  • Doesn’t resolve or improve the patient’s back pain
  • Results in new pain
  • Leads to hardware failure
  • Doesn’t fuse the targeted vertebrae (for spinal fusion)

Failed back surgery syndrome, or FBSS, is the term used for continued pain, poor mobility, and neurological symptoms after spine surgery. Its prevalence ranges from 20% to 40%, making it a serious concern among patients and physicians today. Risk factors for failed back surgery syndrome include:

  • Smoking and other forms of nicotine use
  • Mental health conditions, including anxiety and depression
  • Obesity and overweight
  • Pre-existing medical conditions, including diabetes, fibromyalgia, and hypertension
  • Previous back surgeries
  • Surgical errors
  • Older age

While some of these risk factors can’t be averted, like older age and pre-existing medical conditions, you can take steps to prevent failed back surgery syndrome. Quit smoking and adopt a balanced, nutrient-rich diet before the surgery. Try a gentle, low-impact exercise routine to reach a healthy weight, and find a highly qualified spinal surgeon with years of experience in the procedure you plan to undergo. 

What Is the Most Popular Spine Surgery?

The most popular spine surgery is spinal decompression and fusion for many spinal conditions, including herniated disc, spinal stenosis, and spondylolisthesis. 

Spinal decompression surgery encompasses several different procedures, including:

  • Laminectomy is the most popular spine surgery used for degenerative spinal stenosis. It involves surgically removing some or all of the lamina, which is a section of bone that covers the back of the spinal canal. In removing part of the lamina, your surgeon can create more space in the spinal canal and alleviate nerve compression from spinal stenosis. 
  • Discectomy and microdiscectomy are spinal decompression procedures used to remove damaged spinal discs in the case of herniation or rupture. In a discectomy, an incision is made in the back to reach and remove the disc. In microdiscectomy, the surgeon uses magnification with a smaller incision to remove the damaged tissue in a less invasive procedure. 
  • Foraminotomy involves widening the foramen, which are bony openings where the nerve roots exit the spinal canal. Surgically opening up the foramen can ameliorate spinal nerve compression.

Vertebroplasty is another type of spine surgery that may be used to alleviate back pain. Unlike the spinal decompression procedures listed above, it involves injecting a cement material into a broken vertebra. This procedure is generally used for spinal compression fractures from osteoporosis. 

What is Spinal Fusion?

Spinal fusion is often performed after spinal decompression to stabilize the spine. This prevents instability resulting from removing spinal tissues during a laminectomy, discectomy, or foraminotomy. 

During the spinal fusion procedure, bone graft material is positioned between two or more vertebrae. Over several months, this material stimulates your body’s bone regeneration process, causing the treated vertebrae to fuse into a single bone. 

Spinal fusion is a very common spinal procedure, with over 300,000 fusions performed in the U.S. in a single year. While this procedure effectively prevents instability after spinal decompression, it can lead to limited spinal mobility, as all motion is eliminated at the fused segment.

Additionally, the surrounding vertebrae must undergo extra day-to-day impact to accommodate for the fusion, potentially leading to adjacent segment degeneration (ASD). This can lead to ongoing pain and may require reoperation. 

Is L4 L5 Surgery Safe?

L4-L5 surgery is generally safe if performed by a qualified surgeon on a generally healthy patient. However, as with any surgery, it comes with certain risks. 

Risks that come with any surgical procedure, including L4-L5 surgery, include:

  • Excessive bleeding
  • A severe drop in blood pressure, known as shock
  • Surgical site infections
  • Pulmonary embolism
  • Deep vein thrombosis
  • Adverse reactions to anesthesia

Your physician will talk to you about these risks before the procedure and provide pre-operative instructions to prevent them. 

Is Spinal Surgery a High-Risk Surgery?

Spinal surgery can be high-risk, as it’s done close to the spinal cord and spinal nerves. Though rare, this can lead to permanent nerve damage. 

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Regain your mobility with Premia Spine!

David danced at his son’s wedding

Bonnie explains why TOPS surgery was the right decision for her

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Scott speaks about going to surgery

If the spinal cord is injured during spinal surgery, serious complications like paralysis and incontinence are possible. However, spinal cord injuries from spinal surgery are rare, with an incidence of less than 1% for most procedures. 

Another risk of spinal surgery is a dural tear, which can lead to cerebrospinal fluid leakage. The dura is a layer of thick, fibrous membrane that encloses the spinal cord. If it’s damaged in surgery, cerebrospinal fluid can leak into other areas of the body, leading to symptoms like headaches, nausea, vision changes, ringing in the ears, and loss of taste or smell. 

Minimally-invasive forms of spinal decompression have been developed in recent years to reduce the risks of spinal surgery. Minimally-invasive techniques allow for smaller incisions, less tissue disruption, less blood loss, less postoperative pain, and a lower risk of infection. 

The TOPS System is a revolutionary spinal implant device used in conjunction with minimally-invasive spine surgery to decompress and stabilize the spine. It’s used in place of spinal fusion to stabilize the spine while preserving your full range of motion. 

If you’re suffering from chronic back pain, a physician can help you determine if back surgery is right for you. Schedule a consultation with a specialist in your area to get on the path to relief.