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Turning your back on back surgery

Men considering surgery for back pain relief may benefit from more conventional treatment methods.

Back pain remains one of the top reasons people seek medical care for pain. For many older men, the source of their pain is spinal osteoarthritis.

Finding relief is an ongoing struggle, but men should think hard before turning to surgery without first trying less invasive treatments. “No one ever goes from initial back pain to needing surgery, unless the pain is due to something like cancer or an infection,” says Dr. Steven Atlas, an internist with Harvard-affiliated Massachusetts General Hospital. “You can’t fix arthritis. Surgery may help control the pain in some cases, so you can function better, but it won’t cure your pain — no matter what doctors may promise.”

Diagnosing back pain

Osteoarthritis strikes men after age 40, and while it can occur in many places in the body, the spine is a common target. “The lower back tends to be more susceptible to osteoarthritis because it bears more of the body’s weight than other areas,” says Dr. Atlas. In spinal osteoarthritis, the discs between the spinal bones shrink. Besides causing pain, this can irritate the nerves that travel from the spine to the legs.

An x-ray can show if you have osteoarthritis, but it can’t tell you whether that’s the cause of your back pain. Treatment is designed to relieve the pain and increase your ability to function.

“That is something men need to understand when exploring all treatment options, including surgery,” says Dr. Atlas. “People with back pain want a cure, but the goal should be to provide relief and improve quality of life. You don’t cure heart disease or diabetes — you manage it. The same principle applies with back pain caused by osteoarthritis.”

Even if you do opt for back surgery, there is no guarantee it will relieve pain from osteoarthritis. “Symptoms may go away for awhile, but may return years later with the natural progress of arthritis,” says Dr. Atlas.

Types of back pain surgery

Discectomy. This surgery removes part of a herniated disc, which occurs when a disc ruptures and its jelly-like center leaks, irritating nearby nerves. “Most older men with a herniated disc also have some component of arthritis,” says Dr. Atlas.

Laminectomy. Laminectomy is for arthritis due to spinal stenosis (narrowing of spaces in the spine), causing pressure on a nerve going into the legs. The procedure involves removing the lamina, the back part of the spinal canal that forms a “roof” over the spinal cord. This is a low-risk surgery, and about 60% to 80% of people who undergo it experience improvement in their pain, says Dr. Atlas.

Spinal fusion. Spinal fusion is used for degenerative disc disease—arthritis where the pain is localized to the back. Here, two adjacent vertebrae (the large bones of the spine) are joined to form a single unit. Fusion may involve metal screws and rods to stabilize the spine. Dr. Atlas says spinal fusion is a controversial treatment because it helps only about 50% of the time.

Other treatment options

Dr. Atlas finds that many of his patients can manage back pain with noninvasive and conservative treatments for many years before seriously considering surgery. There are many options that have proved helpful, but no single treatment has been shown to be superior.

Some treatments are done on daily or regular basis, while others are used only to treat flare-ups. “You should speak with your doctor about trying different approaches to see which you best respond to,” says Dr. Atlas.

Yoga. Although the evidence is limited, the gentle stretching and flowing motion of yoga has long been linked with easing low back pain. A review of 12 trials involving more than 1,000 adults published online Jan. 12, 2017, by the Cochrane Database of Systematic Reviews found that a yoga routine specifically designed to treat low back pain can offer short-term relief and reduce symptoms compared with doing no exercise at all. Many yoga studios offer workshops on managing back pain.

Walking. A small 2013 study in Clinical Rehabilitation found that over a six-week period, people with back pain who walked two to three times a week for 20 to 40 minutes were able to lower their pain levels and increase endurance compared with those who only followed a muscle-strengthening program.

Over-the-counter (OTC) pain medication. OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) may ease discomfort or reduce inflammation in the short term. The downside: they do not work for everyone, and if taken every day they can lead to side effects like an upset stomach or a rise in blood pressure. In fact, a meta-analysis published online Feb. 2, 2017, by Annals of the Rheumatic Diseases suggested that only one in six people treated with NSAIDs achieve any significant reduction in pain.

Spinal manipulation. A meta-analysis in the April 11, 2017, Journal of the American Medical Association found that spinal manipulation could offer modest relief from back pain. Spinal manipulation, which is typically done by chiropractors, physical therapists, osteopaths, massage therapists, and some other health providers, involves applying pressure and moving joints in the spine.

Researchers analyzed 26 studies involving more than 1,700 patients with lower back pain. They found that those who underwent spinal manipulation experienced a decline of one point on a zero-to-10 pain scale. That’s about the same amount of pain relief as from NSAIDs. The study also found that spinal manipulation modestly improved function. On average, the patients reported they had less difficulty turning over in bed, and they slept better. It’s not clear how spinal manipulation relieves back pain. But it may reposition the small joints in the spine in a way that causes less pain.

Steroid injections: Are they an option?

Initial research has suggested that steroid injections offer little relief for back pain. However, a 2015 study in the journal Pain Medicine found that patients with spinal stenosis (narrowing of the spine) experienced significant relief that lasted from many weeks to a few months after receiving epidural steroid injections. “Injections are often reserved for severe pain when over-the-counter medicine and exercise do not help,” says Dr. Atlas. “People also need to weigh their possible side effects, like bleeding, infection, and sometimes even worsening pain.”

Image: © lisafx/Thinkstock

Posted by: Dr.Health

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