When Is Surgery the Right Choice for Chronic Back Pain? (video/podcast)

The spine is a complicated body part that is involved in every movement you make. As Dr. Eastlack demonstrates in the video, the spine itself is made up of 28 bones called vertebrae and cartilage discs between the vertebrae that cushion the bones. The spine is surrounded by muscles and nerves.

There are different types of back pain. Injury or aging can cause problems with any of these and cause back pain. While spasms, strained muscles and other types of back pain can be quite severe, most will go away on their own within four to six weeks. Ice, heat, anti-inflammatory medications and physical therapy can often help relieve pain.

However, in cases where the spinal discs have collapsed or degenerated, or the spine itself has shifted and is pinching nerves, surgery may be recommended.

Back surgery is usually performed for one of two reasons. Surgery may be done to take pressure off nerves or spinal cord nerve tissue that is being squeezed and causing pain and mobility issues. Spinal reconstruction surgery corrects problems with the structure of the spine by replacing damaged discs or connecting the vertebrae that have lost support, allowing them to fuse or grow together. Minimally invasive techniques can be used in both types of surgery.

“Decades ago, spine surgeries were major open surgeries with large incisions and a lot of blood loss that really made it untenable, particularly in the aged population,” says Dr. Eastlack. “With minimally invasive techniques, we’re working through very small holes and using image guidance to see the underlying anatomy, so we can do surgery without disrupting all the muscle tissue that surrounds the spine. And we can do that with less risk for our elderly patients.”

Downtime after surgery depends on the specific procedure, but minimally invasive back surgery can have significantly less downtime than open surgery. Generally, open surgery meant five to seven days in the hospital, followed by a lengthy stay in a rehabilitation or skilled nursing facility.

“With minimally invasive approaches, patients are up and walking a few hours after surgery. If we’re taking pressure off nerves, we can get people home the same day, so they’re mostly outpatient surgeries,” says Dr. Eastlack. “When we do reconstructive or fusion surgeries, people can go home the same day or the next day. And even with the bigger deformity surgeries, which historically have been very big open surgeries and patients might be hospitalized from 10 to 14 days, those people can go home in two to three days.”

Return to activities after minimally invasive back surgery comes in phases. Most patients can walk and do light, low-impact activities right away as long as they don’t require rotating, bending, twisting or lifting.

“These movements are still restricted because we’re still intending, for example, to fuse a segment of the spine. And that biologic process has a timeline that is still going to require several months to be accomplished,” explains Dr. Eastlack. “The minimally invasive part of it doesn’t accelerate the healing of the bone-to-bone connection. It simply allows the surrounding envelope to feel better faster.”

Dr. Eastlack says that maintaining the muscle structural support of the back is the most important factor in keeping the back as healthy as it can be. While it’s normal for muscles to atrophy with age, core strengthening is key. Core means the abdomen and back muscles that support the spine and torso; yoga, Pilates and core-focused exercises can all work these muscles. Try to do core workouts a few days a week.

Other preventive approaches include maintaining a healthy body weight and eating a mostly anti-inflammatory diet. Avoid smoking or using nicotine, which can have disastrous effects on blood flow to tissues in the spine; the discs have poor blood flow in general and struggle with nutritional support.

“If you have a back problem that persists or you have weakness or numbness or something more concerning, make an appointment to get it checked out,” says Dr. Eastman. “We have a great team at Scripps with wonderful technology to help you in a variety of ways.”

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