While most lower back pain can be treated without surgery; we help guide patients when surgical care becomes necessary.
SPEAK TO OUR TEAM ABOUT YOUR OPTIONSOur Approach: Non-Surgical First
Back pain can be a debilitating condition that causes anxiety and fear of paralysis and dysfunction. It is extremely rare that a condition causing back pain will lead to paralysis or dysfunction. It is also important to remember that in chronic pain the symptoms of pain that an individual experiences may be more severe than the underlying problem suggests. The nature of chronic pain is that it steadily increases over time, usually without any increase in the severity of the condition causing the pain. This can be confusing to patients who may think that their condition is rapidly deteriorating.
At the Pain Collective, our doctors and therapists specialise in managing patients with lower back pain in a multi-modal, non-surgical manner. We are, however, equally adept at recognising when surgery is indicated and have the benefit of knowledge of which surgeons are the best trained to manage which conditions.
When Might Surgery Be Considered?
The following can be considered absolute indications for back surgery:
Cancer or growths of the spine or close to the spine,
Infections of the spine,
Fractures of the spine with instability or fractures that are not uniting,
Pressure on the spinal cord and nerves that will lead to paralysis. The indicator that there is pressure on nerves is the presence of specific pain or dysfunction in the legs, dysfunction of the bladder or bowel, and not back pain.
Back pain per se, is not an indication for spinal surgery. Unfortunately, patients who have severe pain are anxious and vulnerable, and frequently opt for a surgical solution when it is not indicated.
The decision to perform surgery is based on the history of the pain, the physical examination and relevant imaging and other specialist investigation results. It is extremely rare that back pain requires spinal surgery.
Common Surgical Procedures for Lower Back Pain
The following is a list of the most common surgical procedures.
Discectomy / Microdiscectomy/Endoscopic discectomy – removal of part of a herniated disc through small incision(s). This is performed when there is a herniated disc pressing on a nerve root or the spinal cord, causing symptoms in the legs, and when it is thought that the disc herniation, which usually spontaneously resolves, will cause nerve damage before resolving.
Spinal Fusion (Lumbar) – joining two or more vertebrae to stabilize the spine. This is frequently performed by using metal instrumentation such as screws and rods. It is primarily performed when there is spinal instability or deformity.
Laminectomy / Decompression Surgery – removal of bone to relieve nerve pressure. This operation creates a larger spinal canal in conditions where there is compression of a bundle of nerves and the condition causing the pressure cannot spontaneously resolve. It is commonly performed for spinal stenosis. The word spinal stenosis merely means a narrow spinal canal.
Lumbar Disc Replacement – replacing a damaged disc with an artificial one is a procedure that has very narrow spinal indications and is performed very rarely. There are many potential complications in this procedure and the surgeon offering it must be experienced and have access to an approach surgeon to assist in performing this procedure.
Minimally Invasive Spine Surgery (MISS) – advanced techniques that reduce recovery time and are performed with image guidance equipment. The indications are narrow for this procedure and the surgeon must be experienced and preferably have additional fellowship training.
What Happens if You Need Surgery?
Our interventional pain doctors and therapists will assess your condition thoroughly and if we ascertain that surgery is indicated, we will liaise with the correct surgical team to arrange the referral. We have our own neurosurgeons in the Pain Collective with extensive spinal surgical experience, and they have created a database of shared knowledge. We will guide you in selecting your surgeon, when to obtain further opinions and how to navigate the path into and out of surgery.
Rehabilitation and Recovery
Spinal surgery is mostly aimed towards reducing the risk of nerve damage and stabilising the spine. It is not a cure for lower back pain, and you will in most cases still need on-going management of your back pain. Your team at the Pain Collective will continue to assist you with your maintenance of your underlying disease and your pain management in a life-long commitment towards helping you live a normal life, despite your condition.
Have Questions About Surgery?
The team at the Pain Collective understand that in your decision to consider surgery, there are many variables that you must consider and that you may feel overwhelmed. You may have been told by a friend or a family member that you should consider surgery, or even by a trusted therapist or even your G.P. You may have already visited a surgeon for an opinion. No matter where you are in your journey, we are available to help you understand better about why surgery may be indicated, whether there are any non-surgical solutions you could consider, and what to expect.