Lower Back Pain: How to Know When Surgery is an Option
Lumbar back pain is the second most common reason to see a doctor, second only to the common cold. So it is not unusual for your lower back to hurt; however, it can be very painful and last on average for six weeks.
If on the physical exam by your physician they find tender tight muscles, no other studies need to be obtained to know that this is muscular back discomfort. Treatment with muscle relaxants, physical therapy, massage or trigger point injections (injections of local anesthetic into the tender muscle) can offer effective relief. If any of these remedies alleviate the pain, more extensive testing can only be misleading.
“Thirty percent of people over the age of 30 with no discomfort in their lumbar spine have abnormalities on their MRI.”
It is easy to assume that an abnormality seen on a MRI is the cause of your current discomfort, but this is just an assumption and is most likely not accurate. I caution everyone about obtaining images of the lumbar spine unless they have severe leg pain.
“It is very important to understand that the spine usually causes two types of discomfort, lumbar back pain and radiating leg pain or sciatica. “
Severe nerve pain going to the legs is certainly very treatable by many modalities. You do not need to suffer with radiating leg pain for years just to avoid surgical intervention. Surgery is actually quite successful in relieving this discomfort if, and only if, the location of the nerve pressure can be determined through imaging and local injections.
In spinal surgery, it is very important to begin with radiating leg pain as the most significant symptom. If you have radiating leg pain as the most significant symptom there usually is an answer for you surgically, but lumbar back discomfort unfortunately is not a symptom that is well treated with surgical intervention historically. There are newer techniques that are better as we become better at diagnosing and understanding what hurts and how to treat it.
“A big challenge to relieving lumbar back discomfort is a diagnostic one; being diagnostically accurate, knowing exactly what in your back hurts.”
If your lower back pain is muscular, surgical intervention has no role in your treatment. Some patients have chronic back pain after multiple surgeries possibly due to the muscle damage that is caused by the surgical intervention.