Ask these five questions before agreeing to surgery for back pain

December 8, 2020 in Disease Management  •  By Miles Varn, MD
back pain

Back pain is a more common problem than you may realize. It’s one of the most common reasons people see their doctor and also one of the most common causes people miss work. About 60% to 80% of adults experience low back pain during their lives, and for 10% of them the pain continues for more than three months.

Although nearly 500,000 adults in the U.S. have surgery for back pain each year, in most cases surgery shouldn’t be the first treatment you try. In fact, according to specialists at Johns Hopkins Medicine, fewer than 5% of people living with back pain are actually good candidates for surgery. Another issue to consider before agreeing to surgery for back pain is the relatively high failure rate of lumbar spine surgery for back pain, which one study estimated is between 10% and 46%.

Before saying yes to surgery, get answers to these questions

If a doctor has recommended surgery for your back pain, get a second opinion to help you determine if surgery is the most appropriate treatment or if there are other options you should try first. A health advisor can quickly connect you with experienced specialists for an in-person or virtual second opinion.

These five questions can help you get the information you need to make an informed decision about surgery.

  1. Do I have other treatment options? Depending on what’s causing your back pain, over-the-counter anti-inflammatory medicines like ibuprofen and naproxen and pain relievers that contain acetaminophen, steroid injections, heat and/or cold therapy, and therapeutic massage may lessen your pain. Physical therapy is another option to consider. One recent study found that physical therapy can decrease both disability and pain for people with back problems. Your doctor may also recommend losing weight, taking part in regular, low impact exercise like walking and swimming, and quitting if you smoke.
  2. What type of surgery are you recommending and how will it help me? Ask which type of surgery your doctor is proposing. Will a disc be removed? Will hardware be implanted? Will vertebrae be fused? Will a bone graft be needed? Find out how long the surgery takes and what recovery is typically like. Will you need rehabilitation? How long will you be out of work or restricted in terms of your activities? Discuss the procedure’s potential risks and benefits. You should ask why the physician recommends this specific surgery. Is the goal relieving pain, improving function, correction of an anatomical problem, or a combination of these goals?
  3. Will surgery fix my problem permanently? Find out how long you can expect the results of your procedure to last. Could you need another surgery in the future to maintain the result? Does having this surgery mean that you can’t have other types of treatments if the problem comes back? It’s also important to discuss whether surgery could increase your risk of other types of back problems, like degenerated discs or arthritis, in the future.
  4. How often do you perform this surgery? What are your success and complication rates? Finding an experienced surgeon and a hospital where a larger number of the type of surgery your doctor has recommended are performed is important. Studies have found an association between the volume of a given surgery performed and the risk of complications and death. As the volume increases, the risk decreases. The surgeon should have a high level of experience with the specific surgery and should be both board certified and fellowship-trained in spine surgery.
  5. Where will you do my surgery? Some types of back surgery can be performed on an outpatient basis at the hospital or at an ambulatory surgery center. If that’s your doctor’s plan, find out how the results compare with the same procedure performed in the hospital and why the doctor recommends outpatient surgery. Also ask for the success and complication rates for the hospital or facility where your surgery will be performed.


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