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Many patients believe that surgery will be a miracle cure for chronic back or neck pain. Although for many years, studies have shown the poor long-term outcomes of neck and back disc surgeries. Unfortunately these surgeries, especially fusion-type, fail or have only a shelf-life of two-to-five years leading to failed back surgery syndrome for the patient. Then, why is surgery so frequently the treatment of choice?

Back pain is so prevalent that most people, 8 out of 10, will suffer from it at some point in their lives, and it is one of the most common reasons people seek medical care in the United States. Back pain is annually estimated to cost between $25 billion to $50 billion US. Back pain is the most common cause of disability for people under the age of 45, and it is the most common occupational disability in the United States, and it is the second leading cause of work absenteeism.

Back pain is pain in any area of the back, from the neck to the low back. When a doctor discusses back or neck pain, he or she will refer to four main spinal regions. One region is the cervical spine, consisting of 7 vertebrae, which begins at the base of the skull and continues to the base of the neck. The adjacent region, the thoracic spine consisting of 12 vertebrae, begins at the top of the shoulders and extends to the bottom of the rib cage. The next area is the lumbar spine, generally consisting of 5 vertebrae. Below that is the sacrum, more commonly referred to as the tailbone, which connects the spine to the pelvis.

Everyone experiences pain differently. Pain is subjective, and it is influenced by our many emotional and physical factors. Factors such as preconceived ideas about pain and previous episodes of pain, genetic makeup, physical makeup, personality, and underlying health conditions. Pain cannot be seen, so the level of pain for each patient is measured on an intensity scale from one to ten, as reported by the patient. Pain also determined by the duration of pain, source and location and type of pain through examinations, X-rays and other testing.

Back pain is not always the result of an immediate accident or injury, but often is due to long-term repetitive actions such as poor posture, or improperly lifting, or unevenly carrying heavy things such as purses and children. Altered body mechanics will contribute to it and definitely our lack of physical fitness. It is common that some people suffering from back pain may be unaware of the escalation of their condition. Attitude and even influence of our culture may play into why people tend to ignore and or even deny they are experiencing pain. A good example of pain progression would be increased tingling and numbness in the extremities – arms or legs – and the change from intermittent pain to constant pain. By the time pain has progressed to the point of interfering with daily life and the ability to work, there can be permanent changes and nerve damage.

In my practice, I see symptoms ranging from dull and/or sharp, shooting and stabbing pain, numbness and tingling, limited flexibility and stiffness, sharp and shooting pain into the legs, and not being able to stand straight. These are commonly caused by degenerated discs and herniated discs.

Commonly associated with herniated or degenerated discs is sciatic pain (sciatica). This pain is along the length of the sciatic nerve, the largest bundle of nerves in the body. The sciatic nerve branches off the spine at the pelvis and travels down each leg. Irritation at the root of this nerve, where the nerve exits the spine, may cause pain the entire length of the leg, and this can be accompanied by leg weakness. Sciatic pain can be severe and debilitating. Patients often misinterpret this as a problem with their legs, when the primary cause is the result of a bulging disc compressing a nerve at the base of the spine. Sometimes, with severe inflammation, pain will also be in the hips and buttocks.

Spinal stenosis can be caused because the discs in our spine degenerate over time. Spinal stenosis may occur in younger people when there has been a spinal injury or there is an abnormal narrowing of the spinal canal. A major purpose of the spine is to protect the spinal cord. It surrounds the spinal cord with vertebrae and spinal fluid. The spinal cord becomes inflamed when a disc bulges and the soft tissue around it pushes into the spinal canal, which causes a narrowing. This results in compression of the spinal cord. Diseases such as arthritis and scoliosis can cause spinal stenosis, and so can scar tissue which forms from a previous back or neck surgery. Often spinal stenosis occurs in the lumbar region of the spine with symptoms of pain in the skin, buttocks and legs, although it can occur in the cervical and thoracic regions.

Facet joints are a lot like other joints, such as knees and hips, and they can cause a patient, who has arthritis in the neck, to hear painful and disturbing grinding when turning the head. Ofen, doctors use the word arthritis when they are referring to facet joints. Facet joints are for strength and flexibility and are located next to the spinous process where ligaments and tendons attach to the spine.

Many patients I treat have had one or more failed surgeries for back or neck conditions, and in many cases, they did not have any pain relief. In some cases, surgery made their conditions worse. A notable number have had redo surgeries, which are even more likely to fail, and the risk of failure goes up with each surgery. Surgical outcomes are uncertain because the spine is complex. Surgery is a risky proposition because of the inherent risks of an operation and complicating factors from preexisting medical conditions. In addition, there is a risk because of the close proximity of the discs to the spinal cord. Residual effects can be scar tissue and nerve damage. It is for these reasons that no one can guarantee that you will be pain-free or even experience significant, long-term improvement from back or neck surgery. At specific times, surgery is indicated, and for some patients surgery can be successful. For others, it can have serious consequences and complications.

For all these reasons, you can not be guaranteed you will be free of pain or have long-term good results from back or neck surgery. Some surgeries are successful, and there are specific conditions that will require surgery. However, complications and negative consequences can happen.

Back surgery can be considered a success even when there are residual effects such as: numbness, tingling, change of gait due to muscle weakness, loss of flexibility, and accelerated degeneration. Patients are often upset after surgery and surprised, because they still have pain and weakness. After surgery, scar tissue, a fibrous, connective tissue, is created by the body for wound repair, and it is common for the scar tissue to form near a nerve root. Scar tissue can cause more pain and nerve damage. When this happens, patients will slowly begin to redevelop pain, 6-12 weeks, post surgery. These patients may originally had felt pain relief and now have what is considered a successful surgery.

There is a lack of continuity by doctors when talking about medical conditions. Patients hear doctors say terms such as pinched nerves, slipped discs, prolapsed discs, ruptured discs and bulging discs, for similar conditions. Patients can be needlessly confused about their diagnosis and confused about treatments and procedures. Surgery is more likely to be recommended as the treatment of choice when a patient sees a surgeon. According to Medicare statistics, surgery is also more likely to be recommended depending upon where you live, and according to Prevention Magazine, July 2008, surgery can be more of a practice style or a practice signature. Unless it is an emergency for a condition such as Cauda Equina Syndrome, where there is loss of body functions such as bowel and bladder control, it is an important to explore all treatment options before deciding on surgery. Surgery can never be undone, and it can always be performed later.