Review Evaluates Lower Back Pain and Surgery

A herniated disk is one of the most frequent causes of low back and leg pain in adults, according to a literature review published in the Journal of the American Academy of Orthopaedic Surgeons. The review also states that back surgery is not suitable for everyone.

"Orthopaedic surgeons can help by educating patients about the risks of back surgery and work with the patient to determine the best course of treatment, whether it be surgical or non-surgical," stated review co-author Mark Weidenbaum, MD, director of Orthopaedic Spine Surgery, Department of Orthopaedic Surgery, New York-Presbyterian Hospital-Milstein Pavilion, Columbia University Medical Center, New York, through a press release.

While some patients with low back pain may receive relief after a few months of nonsurgical treatment, such as physical therapy, medications, or epidural steroids, some patients are treated with diskectomies. These include: conventional open diskectomy, micro-diskectomy, minimally invasive diskectomy, and open diskectomy with fusion.

"The main thing for patients who may be contemplating surgery for back pain is that it must be a mutual decision agreed upon by both doctor and patient,” Weidenbaum said, in a press release. “Both parties need to discuss the type of disk herniation and all the potential options for treatment before deciding on surgery."

Approximately 5% to 15% of patients experience a recurrent disk herniation after a definite pain-free period from the initial surgery.

The literature also suggested that patients with larger herniations are more likely to experience a recurrence of pain and those who had endoscopic surgery may be more likely to experience a recurrence than those who had a more invasive procedure.

“When a patient has recurring pain, surgeons should perform a complete workup, including an MRI, to learn whether the cause is actually recurrent disk herniation or another problem, such as spinal instability,” Weidenbaum said, in a press release. “If a patient has spinal instability a revision diskectomy isn't going to help that person - another type of surgery may be needed.”