Thursday 23 May 2019

Dear Dr Nina: Does back surgery have a good success rate?

The Lancet Series findings are of huge importance to people suffering from low back pain in Ireland
The Lancet Series findings are of huge importance to people suffering from low back pain in Ireland


Q: I have recently been diagnosed with bulging discs and have been advised that, after an MRI, I may need surgery. I know I don’t have the final details yet but I was wondering if I could get your opinion on whether or not back surgery is a good idea. I have a low level of pain a lot of the time, and I would take paracetamol and ibuprofen together about a week out of every month. A few people have mentioned to me that back surgery should be avoided at all costs. What is your experience of patients who have had similar surgery?

A: Back pain is a common reason for many people to go to their GP. Thankfully in the majority of cases are due to acute strain, the pain eases over days to weeks and no chronic damage has occurred. The pain itself can be quite severe making simple things like turning, dressing or sneezing very painful and difficult. A common cause of back pain is simple muscular strain and often you may not be aware when this occurred. Other causes of back pain can be bulging or ruptured intervertebral discs, arthritis, bony abnormalities or conditions such as osteoporosis.

Pain may be felt in the lower back or radiate into the buttocks, hips or down the legs. You may notice numbness, pins and needles or sharp shooting pains if there is any pressure. You may also have reduced flexibility in your back and simple things like trying to put on socks or shoes can be excruciating or near impossible. Weakness in the legs that gets worse over time, incontinence of urine or bowel motions or fever with back pain may indicate more severe damage and these symptoms require urgent medical attention.

Simple back strain is usually treated with a combination of painkillers and physiotherapy sessions and x-rays or scans are not usually necessary. If your pain has become prolonged or seems to be getting worse over time then it is well worth following up with your doctor again.

Chronic pain is pain that has persisted for more than 12 weeks. Back pain occurs most commonly in those aged 30 to 50 and occurs equally in men and women. Leading a sedentary lifestyle, being obese, poor posture or heavy lifting makes back pain more likely. If pain or disability is prolonged further tests may be necessary. X-rays will looks at the bones of the back but the better test is an MRI scan which can also look at the discs nerves and tissue surrounding the spine. If there is a nerve element to the pain there are a number of prescription drugs that may help and so if simple painkillers aren't working or physiotherapy hasn't helped do talk to your doctor about other options.

Lifestyle can help with back pain. Simple exercises like walking or swimming can beneficial and exercise that focuses on strengthening the muscles of the abdomen and lower back will help support the spine. Pilates can be especially helpful in those with a tendency to lower back pain. If there is a lot of muscle spasm applying ice or heat packs or having a warm bath can help these relax.

Specialist appointments are only usually required if there are worrying features or other measures haven't worked. Thankfully the majority of cases of back pain can be well managed by good back care and a visit to your local physiotherapist and GP. The decision whether or not to have elective surgery is a very individual one. Surgery is usually only recommended if there is significant nerve stress or damage or if other treatments have failed. If you are considering this you should explore the pros and cons in detail with your surgeon who is the expert who can better advise you as to the outcomes you can expect. Surgery may or may not be the right option.

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