Except when symptoms are consistent with neural deficit, of course.
Wrong.
Patients who experience "neural deficit" (that's a pretty broad brush stroke) can still benefit from non-surgical techniques. Lumbar epidural steroid injection (LESI) has proven benefit in some patients with severe, intractable radiculopathic pain that results in neurologic symptoms in the lower extremity, and even sometimes bowel and bladder dysfunction. These can be effective treatments for foraminal stenosis. Many surgeons will offer foramenotomy, or even laminectomy, for these conditions.
Occassionally, if you suffer from severe, progressive stenosis of the spinal canal, with resultant neurological deficit, from herniation of a disk into the spinal canal you can also undergo chemonucleosis or RF ablation in an office setting by a qualified practitioner. This is done under fluoroscopy. Surgeons, instead, will offer various forms of surgical diskectomy.
There are other options. Interventional pain management docs can discuss these with you. It would be, at the very least, prudent to get a second opinion from one of them before you undergo back surgery, especially if you don't have a particularly complex back problem (e.g., multilevel disk degeneration, anklyosing spondylitis, severe arthritic changes, etc.).
Surgery on your back requires you be face down during the surgery. While most relatively minor surgical procedures are fairly quick and minimize time in prone position, this surgical position puts the patient at increased risk from swelling of the upper airway and even permanent vision loss. The lead article in this quarter's Anesthesia Patient Safety Foundation newsletter is about posterior ischemic optic neuropathy (PION) from prolonged surgical positioning in the prone position.
http://www.apsf.org/assets/Documents/spring2008.pdf
I'm not trying to scare anyone into not undergoing back surgery if it is
absolutely necessary. But, often lifestyle changes (weightloss, exercise, better bedding, etc.) and less invasive procedures will fix the problem with time, and they offer a less risky alternative to what many hope will be a "quicker fix" to their back problems. Many people undergo surgical procedures and actually have worse back pain than they did before. Keep that in mind. Fix the underlying condition that led to the back pain in the first place, and you are far more likely to be successful.
(
Please note this disclaimer here. This post is
not to be construed as individualized medical advice.)
~Dr. Imago
