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School of Medicine
Do You Need Back Surgery -- Really?
With 24 mobile vertebrae and an intricate network of nerves, disks, joints, muscles and tendons, backs are complex – and when things go wrong, back pain can make life miserable.
It’s only natural to want to be rid of back pain once and for all, but surgery isn’t always necessary. While you need to discuss treatment options with your physician, here are a few guidelines to consider when you have back pain.
Strains and Sprains: The Usual Suspects
According to Daniel Sciubba, M.D., associate professor of neurosurgery, orthopedic surgery and oncology at Johns Hopkins, the majority of acute back pain is caused by strains and sprains that will heal on their own without surgery.
A sprained back is not an emergency, but it can certainly feel like one.
“When it’s really soon after the injury, patients can hardly move,” Dr. Sciubba says. “You want to rest your back for a few days or even a week, while being careful not to repeat the action that set off the pain.
“You can take over-the-counter anti-inflammatory drugs, or your doctor can prescribe stronger versions or even a round of steroids to calm the inflammation and help you get the pain under control.”
He says that after a week or so, patients can start or resume some exercise or physical therapy to build back strength and support continued recovery.
When to Consult with a Surgeon
How do you know if you need a consultation with a surgeon? Though every case is different, Dr. Sciubba says that more serious back conditions often come with red flags, such as:
- Pain that’s the same (or worse) after two weeks
- Weakness or loss of function
- Tingling or numbness in arms or legs
Degenerative conditions of the spine are common, especially in older people. One example is stenosis, a shrinking and tightening of the bony passageway surrounding the spinal cord.
Over time, pressure on the spinal cord can result in myelopathy, with pain, numbness, tingling, and dysfunction affecting your arms and legs.
Your doctor may recommend an operation on the bony part of the spine called a laminectomy that can make more room for the spinal cord so your nerves can work properly.
For some degenerative back problems, a minimally invasive spine procedure can yield excellent results with a smaller incision and less downtime.
Other conditions a surgeon should see as soon as possible:
- A slipped disk that’s not getting better on its own
- A broken or dislocated bone
- A spine infection
- A tumor of the backbone or spinal cord
The Question Mark
Not all back pain has an explanation. But even if your problem doesn’t have a name, it may well have a solution. An individualized plan for pain management and physical therapy or other rehabilitation can get you back on your feet.
With some patience, time and effective collaboration between you and your professional team, you’ll have the best chance for relief and recovery.
More on Back Pain:
Spine neurosurgeon Timothy Witham, M.D. discusses "The Aches and Pains of the Aging Back" in an in-depth webinar.
Complex Spine Surgery: David's Story
After two accidents that resulted in spine surgeries that left David Beach hunched over and in pain, Johns Hopkins neurosurgeon Daniel Sciubba rebroke David's back during a two-day surgery and reconstructed his spine. David is now back to cycling and running. But best of all, he's able to stand tall again.