Back Pain: When is Surgery Necessary?

Why Does Back Pain Occur?

Chronic lower back pain, commonly known as "back pain," is a debilitating condition and a leading cause of work absences in the Western world.

This pain is a symptom resulting from the aging spine and, particularly, the intervertebral disc, which is mainly composed of water. Over time, the disc gradually dehydrates and thins. This causes excessive movement of the vertebrae, and the articular facets – the joints enabling spine mobility – begin to rub, leading to inflammation and pain.

What Happens When Back Pain Worsens?

Patients with chronic lower back pain experience episodes of intense, sometimes paralyzing pain, potentially causing bed rest for weeks. These episodes can occur two or three times yearly, significantly impacting quality of life. A classic example is a thinning and collapsing vertebral disc due to dehydration. This inflames vertebral structures, producing fluid that stimulates nerves and causes pain. Therefore, chronic lower back pain can be associated with spinal instability.

Back Pain and Surgery

When is Surgery Necessary?

Surgical intervention is considered if conservative therapies (physical therapy, postural exercises, etc.) fail. These techniques strengthen and lengthen abdominal and lumbar muscles, contributing to spinal stability. Surgery aims to fuse vertebrae and correct spinal curvature defects (like scoliosis) or sagittal plane imbalance. The spine should have an anterior convex curvature in the lumbar region to best distribute body weight. Loss of this curvature and straightening increases stress on vertebral structures, potentially causing pain.

Back Pain: When to Use Minimally Invasive Surgery?

Identifying the underlying pathology is crucial for choosing the best treatment. Discopaties and herniated discs typically affect younger patients (20-40 years old). Microsurgery is often preferred. Minimally invasive refers less to incision size and more to the smaller area of bone and ligamentous tissue operated on. This is preferred over endoscopic surgery whenever possible due to less neural damage and postoperative pain. Arthrodesis, necessary in spondylolisthesis, differs. Patients are typically 65-70 or older. Decompression with instrumented fixation might be used. This stabilizes the spine and decompresses nervous structures. Percutaneous screw insertion, guided by intraoperative CT scans and a neuronavigator (a "GPS" using precise anatomical mapping), restores alignment.

Fracture-related back pain requires different solutions. Depending on severity, the specialist may recommend conservative approaches (splints or collars) or minimally invasive surgery with instrumented fixation.

Why Undergo Surgery?

Surgery can definitively address back pain. Minimally invasive techniques avoid open incisions, allowing for quicker return to daily activities. Many with chronic lower back pain report a heavy, tense, and stiff feeling. Fear of increased stiffness from screws or rods is common, but spinal instability and degenerative disc disease actually cause the increased muscle tension. Patients often feel significantly less stiff post-operation.

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Preventing Back Pain

While tissue degeneration contributing to lower back pain is a natural aging process, certain measures can help prevent and mitigate chronic pain.

Scoliosis, lumbar hyperlordosis, lower limb dysmetria, and poor posture can worsen back pain. These factors should be addressed promptly with medical guidance.

Prevention begins in childhood with appropriately sized desks, chairs, and backpacks. Similar precautions apply in adulthood with ergonomic workstations. Regular physical activity is crucial for supporting spinal muscles and maintaining a healthy weight, as being overweight increases back pain risk.