Does back pain require surgery?
Back pain can be an alarming and scary musculoskeletal condition. It impacts us both physically (e.g., pain and disability from tissue injury) and psychosocially (e.g., depression and fear-avoidance behaviours). In some cases, back pain can be particularly debilitating, stopping people from moving due to unrelenting pain. Back pain can also coincide with altered sensations (e.g., shooting back across the back or down the legs). It is no wonder why some people in this situation ponder surgery to alleviate pain. But, is surgery a valid option based on the current evidence, and what back pain associated symptoms warrant surgery? In this Balmain Chiropractic Centre blog, Martin, our resident chiropractor, discusses whether back pain requires surgery.
Back pain is a very common musculoskeletal condition affected up to 80% of people at least once in their lifetime. The overwhelming majority (approximately 90-95%) of back pain episodes are nonspecific back pain (NSBP) episodes. NSBP refers to pain or discomfort in the back in the absence of serious pathology (e.g., cancer or infection) or neurological involvement (e.g., ‘sciatica’ from a spinal disc injury).
Some of the types of tissues that can be injured in NSBP include muscles, tendons, capsules and ligaments. Injury to these types of tissues can cause significant pain and dysfunction. For instance, spasm of the large, postural muscles of the back can cause significant pain and immobilise movement. The reason for this is that these large, weight-bearing, postural muscles are in fact very strong, and the spasm painfully contracts the muscles and compresses surrounding structures, leading to pain.
However, it is important to point out that in most cases, these types of tissues heal and NSBP typically resolves within 4-8 weeks (and even sooner with conservative management).
Pain and tissue injury
The degree of back pain does not necessarily reflect the severity of back pain. In other words, a muscle spasm can be a very painful experience, but they are often short-lived and do cause long-term complications. In fact, most of the time, spasms resolve entirely with no consequence. Whereas, back pain that is associated with serious pathology (e.g., cancer, infection) may be associated with ‘red flag’ signs and symptoms of which pain may not necessarily be the pain reported symptom by the patient. But we know that cancer manifesting as back pain is far more serious than a simple muscle spasm.
This is where experienced clinicians are able to differentially diagnose back pain complaints. They do this with a thorough presenting condition and family history, systems review, physical and neurological examinations and further investigations (e.g., x-rays, MRI scans, blood tests etc.) in warranted.
Back pain surgery
Surgery for back pain is rarely performed nowadays. This is because we know, from the current scientific literature, that surgery outcomes for NSBP and other types of back pain, are often no better or worse than conservative care (e.g., physical therapy).
The findings from current scientific literature suggest that the goal of back pain management is to moderate pain, increase function, decrease healthcare utilisation and seek care in a multidisciplinary context. Conservative management, as part of multimodal care, should include physical exercise, education, acupuncture, manipulations and mobilisations. Some patients may also require cognitive-behavioural therapy to help manage pain and psychosocial factors that may arise with chronic back pain.
However, if these conservative measures fail to help patients and their back pain continues to limit quality of life, surgery may be explored. A ‘stepwise model’ with increasing use of invasive surgery can be effective in the management of a select few patients. Surgical procedures including arthroplasty, non-fusion stabilisation, and interspinous implants provide intermediate options for these patients.
These select few patients often present with ‘red flag’ signs and symptoms (e.g., bowel and bladder changes, unexplained weight loss, unrelenting night pain, cold sweats and chills etc.), have failed to resolve with conservative management, and have persistent pain for more than 6 months, or begin to present with new symptoms like radicular symptoms (i.e., pain and referral down the leg, like ‘sciatica’).
Back pain is a very common, but complex, multifactorial, musculoskeletal disorder, which has biopsychosocial implications. Most (about 90-95%) back pain episodes are regarded as nonspecific, meaning they have a biomechanical cause (e.g., muscle, ligament, disc etc.). In most cases, patients with this kind of back pain only require conservative care to manage their pain and disability. Even in patients presenting with pain down the leg (i.e., radicular pain) that may be associated with a disc injury often only require conservative care. Conservative management should usually be exhausted first. However, a select few patients who present with particular ‘red flag’ signs and symptoms (i.e., pathological cause to back pain) and who have failed to respond to conservative care may require surgical intervention.
At Balmain Chiropractic Centre, our chiropractors are highly skilled and trained to identify back pain due to serious pathology and neurological injury, and have a strong interpersonal referral relationship with medical doctors and specialists in the Inner West area. Visit us at our Inner West clinic today.
Please visit our website and blog pages for more information on what causes back pain: