When Might It Be Time to Consider Back Surgery? It’s a Matter of Quality of Life…

Dr. Sandro LaRocca MD of New Jersey Neck & Back Institute, P.C.

The most important question someone faces as they live with back pain is whether its time for surgery. While there are many criteria that can help shape this decision, whether surgery is the right choice is still a highly subjective matter that each individual patient must ultimately navigate themselves.

Neurological symptoms such as leg pain, tingling, or numbness are indicators that you may be a good candidate for surgery. Physical therapy, medications and rest will sometimes be a great first line of defense much of the time but symptoms can persist from a variety of conditions that lessen the quality of life and limit activities and even employment.

These common conditions such as disc herniation, spondylolisthesis, stenosis and scoliosis are can all be treated with non-surgical methods as well as surgery. Imaging from X-rays, MRI and CT diagnostics combined with the patient’s description of symptoms are the factors that determine whether surgery is a possible solution when these techniques fail to improve symptoms. The trouble is that while surgery often CAN help these conditions, whether it’s the right treatment plan is a matter of WHEN.

Traditionally, surgery was seen as a “last resort” solution. That was before many modern minimally invasive techniques were available that lessen convalescence, before modern imaging allowed surgeons to be hyper-precise in their techniques. As surgical techniques were improving in leaps and bounds, technology and the internet made gathering, sharing and studying long term longitudinal data about outcomes. This allowed surgeons and patients to make evidenced based decisions gathered from tens of thousands of cases around the world – assisting in prognosis and protocol selection. A major study shows that basic surgeries for common conditions had the same outcomes as non surgical methods five years out from diagnosis. However, the quality of life in those five years was drastically better for patients who had surgery compared to those who chose non-surgical treatment. The bottom line is as science is giving us more and more facts to work with surrounding back surgery the “when” remains a moving target. Here are some steps you can take to determine that elusive question of “when”.

First – have a consultation with a surgeon. It’s likely your diagnosis will come from imaging ordered by a doctor that isn’t a surgeon such as a chiropractor or pain management physician, orthopedist or neurologist, or primary care doctor. Once you have a definitive diagnosis, such as a herniation or stenosis, its important you get an opinion from a surgeon. A surgeon will discuss what the possible prognoses of outcomes may be and whether you are a candidate. Ideally, your surgeon is communicating and working with your other doctors that have diagnosed or are familiar with your case. Often, a patient may be candidate for continued conservative techniques as well as surgery. This grey area is where the decision becomes very personal and other factors must be weighed leading to the second factor: quality of life.

While non-surgical treatments may work they may take a considerable longer amount of time, during which you are refraining from activities that at the very least limit recreation such as skiing or weight lifting and at the most limit essential day to day tasks like housework, parenting tasks, driving or jobs involving physical labor. Quality of life is the single most important factor that a patient must assess when deciding on the “when”.  If your prognosis is good and you fit the guidelines of the long established evidence based protocols you may be able to return to work, parenting responsibilities and the things you love doing more quickly with surgery.

The third reason it may be time for surgery is as an alternative and solution to pain relieving medications. Keep in mind that pain medications are effective and medically necessary for short term use in alleviating symptoms and for post-operative pain but are not a long term management plan for chronic conditions in those that qualify for surgery. Medications carry significant risks such as tolerance, addiction, overdose and diversion and must be viewed with respect and caution. If you have responded well to medications but are developing a tolerance and requiring a higher dose, surgery may be the better option.

Lastly, it’s time for surgery when you have found a medical home. This is the least scientific element in decision making and measures whether you can communicate well with your surgeon and staff. You may qualify for surgery but you still have to pick the right one. This means someone who listens to you, explains things well, has a supportive and empathetic demeanor and will be an advocate for you in the insurance and billing process. Don’t hesitate to speak to more than one surgeon and go with your gut feeling about where you will get the best care.

It’s time for surgery when it time to reclaim your quality of life, and a good surgeon will help you reach that decision.

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*We are located in New Jersey, USA and do not provide medical advice via email or phone. We do not accept Medicare or Medicaid, however we do participate with commercial insurance as an out of network provider.

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