Approximately 4/5 people will suffer back pain at some time in their lives. Lower back pain is the single leading cause of disability worldwide, and it is one of the most common reasons for missing work.
In most cases, back pain can be treated with non-surgical means, as issues such as strained muscles, sprained ligaments, and irritated joints are often the cause of the pain and will run their course in a couple weeks or so.
In other cases, when a nerve is being compressed/pinched, or when a disc has herniated and is pressing on an adjacent nerve, the pain is chronic and surgery may be the best option to relieve it. At DFW Center for Spinal Disorders, we perform various surgeries on the lower back.
What Constitutes the Lower Back?
The spine divides into five regions. The lumbar spine consists of vertebrae L1-L5. It is the location of most lower back pain problems. Above the lumbar spine is the thoracic/mid-back spine, whose function is to hold the rib cage and protect the heart and lungs. Twelve vertebrae make up the thoracic spine, T1-T12. Below the lumbar spine is the sacrum, whose job is to connect the spine to the hipbone.
The job of the lumbar spine is to bear the weight of the body. The vertebrae of the lumbar spine are much larger to absorb the stress of lifting and carrying objects. The strain of lifting weight or twisting while lifting causes most cases of lower back pain.
Risk Factors for Back Pain
As mentioned above, just about everyone will have back pain sometime. But there are some issues that increase a person’s risk:
- Age. Back pain is more common as we age. First issues with back pain usually occur when a person is from 30 to 40 years old.
- Poor physical fitness. As we become more sedentary in our lifestyles, the muscles that help support the lumbar spine weaken.
- Being overweight. Carrying extra weight puts further stress on the lower back.
- Heredity. Some problems such as spinal arthritis have a genetic tendency.
- Occupation. Lifting, pushing, and pulling while twisting for work can cause acute back injury. Sitting at a desk all day, especially with poor posture, can lead to chronic back pain.
- Smoking. Smoking affects the body’s ability to deliver nutrients to the discs of the spine.
When Is Back Surgery Necessary?
Conservative treatments can alleviate most back pain. But in cases where a nerve is being pinched or where movement in a section of the spine causes repeating pain, surgery may be the only way to make the pain go away. At DFW Center for Spinal Disorders, we view back surgery as a last resort, when conservative treatments have been tried and failed to relieve the pain, or when the patient is in danger of losing function due to nerve impingement.
Most Common Back Surgeries
There are two general types of lumbar spine surgery that are the most common — lumbar decompression and lumbar fusion.
Lumbar Decompression Surgery
The goal of decompression surgery is to remove the pressure that is compressing or pinching the nerve. The most common causes of nerve compression are spinal stenosis and herniated discs.
- Stenosis is a narrowing of the spinal canal, the opening through which the nerve roots pass. This can happen due to a collapsed disc, bone spurs, or cysts.
- A herniated disc, also known as a ruptured disc, happens when a disc pushes out beyond its normal parameters and the outer membrane cracks. This allows the inner gel-like material to push against the nearby spinal nerve roots, causing back pain and shooting pain into the buttocks and down the legs.
Decompression surgery involves removing a small portion of the vertebra that covers the nerve root and/or the disc material that is contacting the nerve. The two most common types of decompression surgery we use at DFW Center for Spinal Disorders are microdiscectomy (removing the damaged disc with minimally invasive methods) and laminectomy (removing a portion of the vertebra, usually the lamina, which is the backside of the vertebra).
With lumbar fusion, the goal is to eliminate the motion in a segment of the spine. To do this, two discs are fused together. The most common causes leading to fusion surgery are lumbar degenerative disc disease or spondylolisthesis.
- Degenerative disc disease usually begins with a non-descript injury such as improperly lifting an object. The insignificant initial injury cannot repair itself, as the discs don’t have a blood supply, so it continues to degenerate until the disc wears out.
- Spondylolisthesis is a condition where a vertebra slips out of place, usually forward, compressing the nerves exiting the spine. This can happen due to repetitive overuse, spinal arthritis, and other causes.
There are many approaches used in lumbar spinal fusion surgery, but they all involve removing all or most of the disc between two vertebrae, adding bone graft material, and securing the two vertebrae with screws or other instruments. This allows the two vertebrae to permanently fuse together, eliminating the area of movement that was causing pain.
Back Surgery Recovery
Thanks to minimally invasive techniques used by the DFW team, recovery from many lumbar decompression procedures has become dramatically easier, requiring as few as six weeks. After as little as one to two weeks, office workers could consider returning to work part-time. Of course, this varies between patients.
Fusion procedures require more recovery, as the bones must fuse together. Bone fusion procedures usually require two to three days in the hospital. It will take up to six weeks before the patient can return to an office job, much longer if the patient works in a physical occupation. The issue is that the bones take many months to fully fuse, and that process cannot be disturbed by stress on the bones.
Whatever your surgery, the team at DFW Center of Spinal Disorders will walk you through every step of your recovery.
Risks of Back Surgery
While the surgical risks of back surgery are like those involved with any surgery — bleeding, infection, blood clots, reaction to anesthesia, and the like — there are rarely any complications with back surgery.
The real risk involved is whether your back pain will be alleviated with surgery. Due to the complex relationship between the spine, the nerves, and the discs, sometimes surgery does not fully relieve the pain. In fusion and decompression surgery, around 80 percent of patients are satisfied with their degree of pain relief following their surgery.
Schedule a Consultation
If you are suffering from back pain and think you may need surgery, the DFW team is here to help. Call (817) 916-4685 to schedule a consultation. DFW Center for Spinal Disorders serves Fort Worth, Dallas, and surrounding areas in Texas.