In most people low back pain has a favorable outcome. There is usually good resolution within a month (acute). In a few months the pain persists and becomes chronic (before the chronic phase there is a subacute phase; four to twelve weeks). The pain is considered chronic if it lasts more than twelve weeks.
There are symptoms that would require urgent surgery include:
- If there is significant weakness in the leg(s).
- Cauda equine syndrome, a compression of nerves that may lead to permanent paralysis of the legs.
In patients with mild symptoms or weakness, urgent surgery is not required, and the symptoms may respond to conservative approaches such as physiotherapy. There is still debate on which patients would benefit from this surgery. The current recommendation is to consider surgery if the pain is persistent for more than one year (American Pain Society).
The most common surgery is spinal fusion; part of the spine is fused using either a bone graft (a piece of bone from elsewhere in the body like the hip) or mechanical hardware (small metallic implants). The area with the pain will be fused. This procedure is not without its problems as the fusion alters the normal spine and can hasten the degeneration in the parts nearest the fusion
In lumbar disc prolapse, the surgeon's aim is to relieve symptoms caused by a disc that is either causing inflammation or pressure on nerves near it. There are various techniques for doing this from large operations to tiny operations with small cuts.
There is still debate if there is much of a difference in outcomes in the long-term in the conservative approach versus the surgical approach, but surgery has been noted to offer faster pain relief.
In addition to the surgery, there are different regimes that have been tried to help improve outcomes such as physiotherapy and acupuncture with varying results.
Non Responsive Back Pain
Unfortunately in some individuals the pain persists - "failed back surgery syndrome." Such patients require a transfer to doctors with experience in dealing with these type of cases. There may use chronic opioids and other drugs to control the pain. Other newer therapies are being developed:
- Spinal cord stimulation, where small electric probes are placed near the area of pain and a little current is used to stimulate that part of the cord to try and suppress pain.
Most people will not need to wear a brace after surgery. During the days following surgery, physical and occupational therapists will work with the patient while they are still in the hospital. It will usually 2 to 3 weeks after a laminectomy and discectomy and 4 to 6 weeks after a lumbar fusion to get back to normal activities entirely. There will be an elaborate and extensive program of what exercises and what not to do. Most patients will be use pain medication that will be weaned off over a few months. The first visit to the surgeon is usually in six weeks if there are no issues prior.
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