When it comes to back pain, the vast majority of surgeons start with conservative treatment. (See sidebar below.)
But when those treatments don’t provide the relief you need, it’s time to ask your doctor: What’s next?
“Never be afraid to ask your provider questions,” said Dr. Michaux (pronounced “Misha”) Kilpatrick, a pioneering neurosurgeon with Novant Health Brain & Spine Surgery in Kernersville, North Carolina.
And, what questions should a patient ask a spine surgeon when considering surgery? According to Kilpatrick, these are the big ones:
- Do you feel like we have any other options to exhaust?
- At this point, is surgery my best shot at getting back to the life I want?
- How much better will I feel after the surgery?
- How long is the recovery period?
- What are my restrictions during the recovery period?
- How long will I be out of work?
- Will I need physical therapy?
- What will my physical therapy regimen include?
“I’m a big proponent of physical therapy,” Kilpatrick said. And not just post-surgery. “It’s one of the things that can prevent back injuries and can make your back and your core stronger,” she said. “It helps strengthen the ligaments, muscles and tendons around the joints and discs of your spine and makes you less prone to back injury.”
When surgery is called for
When should you see a doctor about back pain? Some examples: When the pain is at a 9 or 10 every day. When your bad back is interfering with work and daily activities most of the time. When walking becomes difficult.
And the next logical question is: When do you know you’ve reached the point that surgery is likely? “When you have failed conservative treatments and the source of your pain is thought to be surgically treatable,” said Kilpatrick.
One thing to keep in mind. There have been many advances in back surgery in recent years, including increased use of minimally invasive procedures with a quicker recovery time.
Find a specialist to help you alleviate your pain.
Not everyone will be a candidate for surgery. “As is true with all surgeries, smoking cigarettes, having a BMI over 40 and having serious medical conditions (diabetes, severe heart and lung conditions, for instance) increase your surgical risks and complications,” Kilpatrick said.
Surgery isn’t an automatic fix, either. Physical therapy is necessary to ensure a smooth recovery. The patient has to be active in his or her own recovery. “Follow your surgeon’s instructions and activity restrictions,” Kilpatrick advises. “Healing is a process, and you don’t want to cause injury during your recovery period.”
There are, of course, times that back surgery is unavoidable.
Kilpatrick said, “We may have to do emergency surgery – meaning we don’t even offer conservative treatment – for people who have red flag signs of cauda equina syndrome, a rare back condition.” Those warning signs are:
- Loss of bowel or bladder function.
- Numbness in the perineal or “saddle” region (If you were sitting in a horse saddle, it’s that part of your body that would touch the saddle.)
- Losing the ability to move your legs or significant leg weakness.
If you experience any of those signs, you should get to the emergency room as soon as possible, Kilpatrick said. “These are not things that can wait for an appointment with your physician.”
Maintaining a healthy spine
Kilpatrick emphasized the good news. “The majority of people aren’t presenting with cauda equina syndrome,” she said. “The majority of people aren't presenting with significant weakness. The majority of people are presenting with pain. And pain does not tend to linger forever and ever. It will usually go away after a few weeks of aggressive medical treatment.”
Of course, prevention is the best medicine of all, and Kilpatrick would rather everyone take good care of their spine than have to try even conservative treatment.
“Anything and everything you can do to strengthen your core is good for your back,” she said. “Working with a trained provider for physical therapy is one way, but there are others – water aerobics, swimming, walking, specific stretches, yoga, martial arts, Pilates.”
“I have some patients who say, ‘Oh, I'm always exercising – like working in the garden or around the house.’” But physical activity, while it may be good for heart health, is not necessarily good for spine health.
People who work in a warehouse environment or otherwise have to lift heavy boxes and packages need to be especially careful. If you're engaging in activities that are hard on your back, you need to counteract that with activities that strengthen the back.
“Gardening and heavy lifting aren’t therapy for your back,” Kilpatrick said. “We have to be deliberate about doing things to strengthen our backs. We want to differentiate between what's back-strengthening and what's back-stressful.”
Back pain? Treatment often starts conservatively
If you’re like most Americans, you’ve probably experienced back pain at one time or another.
But that doesn’t mean you had – or need – surgery to alleviate it. And that’s according to a spine surgeon.
“Greater than 80% of all Americans, at some point in their lives, suffer from back pain,” Kilpatrick said. “But 80% of the population is not walking around having back surgery. Most of the time, back surgery is not necessary.
“Most surgeons, myself included, want to start with conservative treatment,” she continued. “When we talk about conservative treatment, we mean physical therapy, different types of medications, or spinal injections. The reason we don't immediately start with surgery is because 75% of the time, symptoms of back pain improve with conservative management.”
The average person, she said, at some point in time experiences back pain in the form of occasional spasms or tightness which will improve without the need for surgery. “Back pain is multifactorial,” she said. “It can come from a lot of different things – muscle weakness, arthritis, those sorts of things that just come with life.”
For almost every patient, Kilpatrick recommends conservative approaches first. “For those for whom conservative treatment hasn’t worked, despite our best efforts, surgery is a consideration,” she said. “If back pain is interfering with quality of life, your ability to work or isn’t responding to standard treatments, then surgery may be called for.”