Treatment options include doing nothing at all — time heals most back pain, according to the National Institute of Neurological Disorders and Stroke — to physical therapy, chiropractic care, pain medication and acupuncture. If patients are still suffering after four to six weeks, Biel says doctors should use X-rays, MRIs or CT scans to get side, back and front views of the spine to check for instability. Most doctors agree surgery should be the last option.
“Ninety percent of patients don’t end up with anything surgical done,” Biel says. “It’s rare a patient should, on an initial visit, be told they need surgery unless they’ve had a few months of treatment or an immediate problem like a tumor.” Those who’ve tried alternatives and still endure pain should talk to multiple doctors about surgical options.
Ten percent of Angie’s List poll respondents say they’ve had back surgery and three quarters say it helped reduce their pain. Members report getting back surgeries from orthopedic surgeons who focus on the musculoskeletal system, and neurosurgeons who study the nervous system, spine and brain. Both are qualified to perform back surgery, doctors say, but it’s best to seek board certified doctors who specialize in the spine and who’ve completed a spine surgery fellowship, says highly rated Dr. Raj Rao, American Academy of Orthopaedic Surgeons spokesman.
• Know your back surgery options
• Spinal fusion surgeries on the rise
It’s estimated doctors perform more than 1 million back surgeries every year. Laminectomy, which removes part of the vertebra to relieve nerve pressure, and spinal fusion, where vertebrae are joined, are the most popular inpatient procedures, according to the Agency for Healthcare Research and Quality. Other procedures include foraminotomy, in which bone is removed from the vertebrae to widen the space where nerves exit the spine; discectomy, which removes all or part of a disc; and disc replacement.
Doctors have developed techniques that use smaller incisions, and there’s an increasing number of patients who can benefit and be back to normal activity in a few weeks, says neurosurgeon Dr. Zoher Ghogawala of Burlington, Mass., who leads peer-reviewed clinical trials to better understand spinal procedures. Recovery for more complex surgery can take up to eight weeks and might include physical therapy and other exercises. Surgeries that use small incisions from the front of the body such as discectomy and neck fusions have good outcomes, Biel says.
Angie’s List member Sandie Reed says she's playing golf again after her back surgery from Dr. Herbert Biel
The most important aspect is getting the right surgery, Ghogawala says. “We don’t have clear-cut guidelines,” he adds. “Spinal surgery is a big deal, and most surgeons are good about cautioning patients about this.” When appropriately prescribed, he says it has an enormous impact on quality of life.
Ghogawala, along with other spine specialists, agree doctors have a high level of confidence in diagnosis if back pain symptoms are related to nerve problems. On average, those patients do much better with an operation. For back pain not involving pinched nerves, the diagnosis is less clear.
He recommends patients ask about the doctor’s surgery outcomes and the chances of needing a second surgery. Make sure the surgeon does follow-up appointments, not a nurse or a physician’s assistant, he says.
After interviewing three surgeons, member Sandie Reed chose Biel because he talked openly about the risks and recovery process. She underwent the more invasive fusion and disc replacement surgery to avoid potential future operations. She still experiences some stiffness, but she has no limitations except not being able to touch her toes. Reed, who paid a $5,000 deductible for the $150,000 surgery, says she doesn’t take her surgery success for granted. She exercises and stretches daily to keep her back in motion.