Often, when patients come to see me for their back pain, they are afraid that I’ll tell them they need surgery. Who are the people who need back surgery?
The short answer to the question is that almost nobody needs back surgery. Surgery can be classified roughly into three different types: there is emergency surgery, which must be done immediately to save life or limb. There is urgent surgery, which must be done relatively quickly to prevent a problem from deteriorating. Then there is elective surgery, which is done to alleviate a pesky problem that a patient could live with, but chooses not to. Problems in the back can certainly be extremely painful. They can lay you up, or make work or normal activities difficult. But the good news about back problems is that they very rarely cause any progressive or permanent damage.
Surgery on the back is almost always elective. A patient chooses to have it to get rid of pain which has not responded to any other treatment. But it is very uncommon for a patient to suffer permanent damage to the back or nerves by waiting. It’s almost unheard of for a patient to end up in a wheelchair because he or she delayed having back surgery. Usually the worst that will ever happen without surgery is that a patient’s pain will continue. In fact, the trend for most acute back problems is to get better rather than worse.
Of course, there are exceptions to this rule, where immediate surgery is truly necessary. Some examples of problems that need surgery right away are a tumor in the back, a patient with progressively worsening leg weakness, or a loss of bowel or bladder control. That is why a persistent back problem should be checked by a doctor. However, my usual advice to patients who have been told “you need a back operation” is to get a second opinion! Sometimes surgery will be the best option, but it is rarely the only option.