Eighty percent of the adult population will be required to take time off from work for short duration due to significant back pain sometime during their adult life. The causes of back pain are many. Wear and tear conditions such as degenerative arthritis as well as degenerative discs are some of the most common causes that orthopaedic spine doctors see on a regular basis. Muscle pulls and tears are also frequent, but they are usually very short lived. When the pain lasts for longer than a week, it may means that there is more involvement and underlying degenerative problems and or persisting arthritis are the culprit.

Back pain can be caused by injury or damage to muscles and tendons, discs, bones, joints, nerves, or any other structures of the back. Strain-sprains are the most common problems associated with the back, and typically involve the damage to the muscles and tendons. Still, the other structures of the spine can also be involved, leading to more serious forms of back pain. The two most common mechanisms of development of back pain are injury or degeneration. Injury, often referred to as "trauma", damages the back by causing a stretch, tear, or break in a tissue due to abnormal positions or usage of the spine. They can also be due to subjecting the spine to harmful forces such as in a fall, car accident, or sporting injuries. Improper lifting or twisting of the spine may also commence low back pain and leg pain. Degeneration is the "wear and tear" changes of the spine that usually result in aging. This may have nothing to do with subjecting the spine to abnormal usage. The end result would be impaired function of the spine in both cases and causing pain. Fortunately most of the low back pain is not too serious, they will go away in a few weeks if there is no structural damage done to the spine.

In the trauma or spine injuries, there is a wide variation of clinical symptoms. This ranges from simple muscle spasm to out right fracture and dislocation of the spine. Not all fractured spine are serious, even though most of them can be potentially dangerous. In a many cases, when the spine is broken or fractured, if clinically the spinal structure remains stable, no surgery would be necessary. Over the course of a few weeks, the patient would have a very good recovery. However in situations that the spinal structure is unstable, and that there are other associated injuries, most likely this would require surgical treatment to stabilize the spine and to prevent further injury. Unfortunately if the injury is associated with dislocations, there will be a much higher chances of damages done to the nerves or the spinal cord. This type of injury would require a much more aggressive approach in order to give the patient the chance to recover.

In the degenerative spine, that is the one secondary to wear and tear. As an early sign of degenerative changes, most likely the material inside the disc [nucleus propolsus] would become hardened as it loses it water content. This would set up a whole set of secondary changes in the spine as the disc is not functioning as it should in terms of acting as a shock absorber. The disk may begin to protrude or collapse and therefore putting pressure on the nerve root leading to a leg or foot either by direct pressure on the nerve root, causing pain in its distribution (sciatica). The problem can be aggravated by narrowing of the neural foramen and therefore also putting pressure to the existing nerve roots. With hypertrophy or enlargement of the facet joints and the thickeining of the inner lining or the ligamentum flavum, this can result in a significant narrowing of the spinal canal (spinal stenosis), resulting with the inability to tolerate upright activities. They cannot walk or stand for any substantial amount of time, but once they sit down, the symptoms tend to disappear quickly. This can further develop into shifting or sliding of the vertebral body anterior, therefore ends up with an unstable spine (spondylolisthesis).

Not all spine conditions would require surgery. In fact 85-90% of the cases, surgery is not necessary. In majority of the cases, the patient would experience some relief with conservative management. Non-surgical treatment options are extensive. Treatment may include medications; muscle relaxants, anti-inflammatory or pain medicaitons. Treatment may also include physical therapy, activity modification, bracing, therapeutic massage, or chiropractic manipulation. Other treatments may involve pain management specialists utilizing injections or transcutaneous muscle stimulation. The treatment option selected for you will depend on your condition and your response to other treatments. However, depends on the cause of the spine problem, some of these cases would plateau, and the patients would not be able to function as the same level as before the incidence.

The pros and cons of surgery would be thoroughly discussed with the surgeon. If the surgeon cannot identify a good mechanical reason and the source of the pain, then surgical results would be doubtful. Ultimately, the decision to recommend surgery means that the surgeon feels that the potential benefits outweigh the potential risks.

It should be understood that even though a lot of times we have the impression that surgery should be the last resort, the surgery should be considered only if everything fails, if the cause of the back pain is well defined, and is a correctable situation, then a timely surgery would allow the patient to be back to their normal life without prolong the suffering.

To consider such a question, one should understand that there are two general categories of risks. One is in general associated with any type of surgery. These risks are related to anesthesia, poor general health, medical complications associated with hypertension, diabetes, and possible risks of transfusion. There is always the possible of infection and bleeding. It can be said that if the patient is healthy and in good physical shape, or their medical conditions are well under control, then all these risks would be less. There is one more factor that will determine the success of healing and therefore the surgery. Smoking seems to be a negative factor in the process of healing.

There are risks or complications that are specific to spine surgery. There is the fear that one would become "paralyzed" from any spine surgery. But if the surgery is planned and done properly, this is not the likely outcome. There is remote possibility of technical failure such as failure of the implants, failure to do a complete decompression, and therefore failure to relieve pain. There is always the possibility of recurrent pain secondary to recurrent disc or scaring or fibrosis of the nerve roots. One has to discuss with his or her surgeon so that the patient should have a full understanding of the risks and benefits of the proposed surgery. Surgery should be recommended only when there is a clear indication and a predictable benefit.

Joint replacement is considered to be major surgery. It is important that you are aware of potential risks and complications. These include problems from anesthesia, infection, surgical bleeding, blood clots, and damage to nerves or blood vessels, dislocation with hip replacement, and very rarely, death. Although these complications are rare, they are possible. Every precaution is taken by your healthcare team to avoid these complications. Over time, an artificial joint may become loose or wear out, and could require further surgery and repair.

We do not recommend surgery unless the pain and symptoms prevent the patient to participate in his and her normal activities and lifestyle. After a reasonable trial of conservative treatment, if there is no real clinical response, and if the pain and symptoms still persist, the one can consider the role and surgery and think of it as an important step in the healing and recovery process. It can help to relieve pressure on the spinal nerve(s) and thereby relieving pain to the extremities. It can improve tolerance of physical activities and help to regain some of the lost functions of the extremities.
Our surgeons have the training and expertise to correct physical problems by performing the operation. However our patients do need to know that the surgery is an important but not all in the healing process. Post operative management includes diligent work by the patient with physiotherapy, back education as to what one can or cannot do, or what one should or should not do. Life style change is a very important part of the post operative course. Your chance of having a successful outcome is good, but an understanding of the surgery, a strong and positive attitude, setting appropriate and realistic goals for improvement with the supporting team, you would be on the way to accomplish each goal and enjoy the new found freedom as a result of the surgery.