My Aching Back: Dr. Tim Answers Your Questions

Nov. 22, 2006 — -- If you're one of the 80 percent of adults who has experienced back pain at some point in your life, you know it can get so bad that you'll try anything to fix it. But how do you know when it's bad enough for surgery? Or what kind of surgery is appropriate?

Our Medical Editor, Dr. Tim Johnson, provides some answers.

Question: So how does back pain get to the point that you actually need surgery?

Answer: Your doctor may recommend surgery if your neck or back pain is accompanied by signs of nerve damage. Those signs include pain that radiates down your legs, numbness, weakness or tingling in your legs, and loss of bowel or bladder control.

The latter means that the situation has gotten quite serious. Most often, the pain will be caused by a bulging spinal disk that is pressing on a nerve in your lower back.

Q: If you have a bulging disk, do you necessarily need surgery?

A: If you do an MRI on 100 people, 20 of them will have bulging disks that don't cause symptoms. The majority of bulging disks get better with time and conservative treatment. Surgery should not be your first choice.

You need to make sure, through an MRI, that the bulge is pressing on the very nerve that corresponds to your symptom. So you can have a bulging disk, but you really need to make sure that it's actually the culprit in the pain.

Q: Who is surgery most appropriate for?

A: Surgery is most appropriate for people who have had severe pain for six months or more after trying conservative treatment like physical therapy.

It can also be for younger patients who might have to live with back pain for a long time -- and by young, I mean under 60. You're not going to do this on an 80-year-old.

Surgery may also be the best option for anyone with a real emergency, like loss of bladder or bowel control.

Q: I read a new study out that looked at the results of surgery versus conventional treatment. Was one more successful than the other at treating back pain?