Back pain is one of the most common reasons people see their physician and one of the most common causes of missed days at work. Approximately 60% to 80% of adults experience low back pain during their lives, and for 10% of them, the pain lasts for more than three months. And although nearly 500,000 Americans have surgery for back pain each year, in most cases, surgery should not be the first treatment you undergo. In fact, a white paper by Johns Hopkins physicians asserted that fewer than 5% of people living with back pain are good candidates for surgery. Another issue to bear in mind is the relatively high failure rate of lumbar spine surgery for back pain, which one study estimated to be between 10% and 46%.
If a physician has recommended surgery for your back pain, your first step should be to seek a second opinion to help you determine if surgery is the most appropriate treatment. These questions can help you get the information you need to make an informed decision about whether to undergo surgery and provide you with information about non-surgical treatment options you may want to try first.
1. Are there effective, safe, non-surgical treatments that may help relieve my pain? Depending on what the underlying cause of your back pain is over-the-counter anti-inflammatory medications like ibuprofen and naproxen and pain relievers that contain acetaminophen, steroid injections, heat and/or cold therapy, and therapeutic massage may decrease your discomfort. One recent study also found that physical therapy can help manage back pain, decreasing both disability and pain. Your physician may also recommend lifestyle changes, especially losing weight and regular, low-impact exercise.
2. What surgical procedure are you recommending? Why? Ask which type of surgery your physician is proposing and have him or her explain what the surgery involves. Will a disc be removed? Will hardware be implanted? Will vertebrae be fused? Will a bone graft be needed? Find out how long the surgery takes and what you can expect during recovery. Will you need rehabilitation? How long will you be out of work or restricted in terms of your activities? Discuss the procedure’s potential risks and benefits. You should ask why the physician recommends this specific surgery. Is the goal relieving pain, improving function, the correction of an anatomical problem or a combination of these outcomes?
3. Will this surgery solve my problem permanently? Talk with the surgeon about how long you can expect the results of your procedure to last. Will you potentially need to undergo surgery again in the future to maintain the result? Does having this surgery mean that you cannot undergo other types of treatments if the problem recurs? It’s also important to discuss whether the surgery could increase the likelihood of other types of back problems, like degenerated discs or arthritis, in the future.
4. How frequently do you perform this surgery? What are your success and complication rates for this procedure? Finding an experienced surgeon and a hospital where a larger number of the type of surgery your physician has recommended is important. Studies have found an association between the volume of a given surgery performed and the risk of complications and death. As the volume increases, the risk decreases. The physician should have a high level of experience with the specific surgery and should be both board-certified and fellowship-trained in spine surgery. If your surgeon has recommended minimally invasive surgery, he or she should be trained in the technique and experienced with it.
5. Where will my surgery be performed? There are some types of back surgery that can now be performed on an outpatient basis at the hospital or at an ambulatory surgery center. If that’s the plan for your surgery, find out how the results compare with the same procedure performed in the hospital and why the physician recommends an outpatient setting. You should also ask for the success and complication rates for the hospital or facility where your surgery will be performed.
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