Back Surgery: A Patient’s Perspective

“I know. I’ll get right in the middle of the dance floor where everybody can see me and impress Monica Banner with my amazingly limber and athletic dance moves.”

Those were the thoughts of my 17 year old, awkward, girl-crazy self right before I leapt in the air, arched my back, felt a pop, and came down right near Monica’s feet. Suffice to say the excruciating physical pain didn’t compare to the embarrassment. I lay on the ground for about three minutes as classmates gathered and eventually helped me off to the side where I lay motionless for my parents to arrive.

Ouch, my pride.

One of the guys who helped me off would later date and marry lovely Monica. He was better looking, more athletic, and a pretty decent guy by most accounts. I still don’t know what she saw in him..

An orthopedic surgeon soon informed me that I had a herniated disc in my lower back between the L-4 and L-5 vertebrae. And while it would periodically flair up for a week or two (or five) at a time over the next 20 years, I never came close to having surgery. The costs and potential costs just never stacked up to the potential benefits for me – especially considering the available alternatives.

Of course, that’s my experience and if you’re battling debilitating back pain, maybe surgery is the right course for you. As with anything in life though, there are costs and benefits. And while surgery may indeed be the answer in some cases, there are some drawbacks and alternatives you may wish to consider before diving in. And, of course, a reliable second opinion will always help give you the perspective and professional insight you need to make the right decision.

Five Major Types of Spinal Surgery

There are five major types of spinal surgery: spinal fusion, laminectomy, foraminotomy, discectomy, and disc replacement. Each one carries its own risks and potential benefits.

• Spinal Fusion: The surgeon permanently joins vertebrae together. The fused bones can result in reduced nerve impact but also reduce range of motion.
• Laminectomy: The surgeon removes ligaments, parts of bone, or bones spurs that may be pressing on spinal nerves. The downside is that the spine may be less stable. As a result, spinal fusion is sometimes also performed.
• Foramintomy: Similar to a laminectomy, the surgeon shaves bone at the sides of the vertebrae to widen the space for nerves exiting the spine. Much like a laminectomy, this can also cause instability and may be accompanied by spinal fusion.
• Discectomy or Microdiscectomy: The surgeon removes part (or all) of a bulging or herniated disc that may be pressing on spinal nerves. This is often accompanied by one or more of the aforementioned procedures.
• Disc Replacement: The corollary to the discectomy, in this procedure, the surgeon removes the entire disc and replaces it with an artificial version. The new disc allows continued full motion of the spine as opposed to spinal fusion.

Recovery time for these procedures can extend anywhere from three months to a full year before one can resume normal activities and there is no guarantee that future surgeries will not be required.

Alternatives to Spinal Surgery

The overwhelming majority of doctors will tell you that surgery should be a last resort. So for those whose back pain is relatively manageable, there are alternatives.

• Fitness: It sounds so simple but the act of changing one’s diet, getting a little exercise, and dropping a few pounds can make a remarkable difference when it comes to back pain – especially lower back pain caused by herniated discs. With less weigh to support there’s less pressure on the discs to push out into the nerves. Getting in shape made a significant difference for me. Until seven years ago, I drove to work every day and sat behind a desk. It was a decidedly sedentary lifestyle. It showed in my belly and I definitely felt it in my back. At some points, the pain was so bad that I had to use a cane. Then I moved to New York and worked in a more active job. The combination of less sitting and more walking was the greatest gift I could have given my spine. I still have the occasional flare up and I do have to be careful about undertaking certain activities but it’s nowhere near as bad as it was before. Of course, office jobs are extremely common and not everybody has the option (or inclination) to simply pick up and change careers. And that’s why it’s important to understand posture.
• Posture: Posture can play a major role in back health. And it’s not just how you stand and walk but also how you sit. If you’re going to be sitting for hours on end, one of the best things you can do for your back is make sure you have an ergonomically supportive chair. But that alone, isn’t enough. The act of sitting itself, no matter how comfortable the chair, will eventually shorten and tighten your hamstrings and hip-flexors. The tightened ligaments can pull on the spine, distorting its natural shape. This can become increasingly problematic as one ages and the ligaments become less flexible. If you do have to sit for extended periods, take a break every 45 minutes to an hour. Get up, walk around, and try to loosen up if you can. Also, for the guys out there, don’t sit on your wallet. It makes a difference. Seriously.
• Stretching: Simply taking the occasional break at work isn’t enough. Stretching both in the morning before work and at night after you get home can make a big difference. Before undertaking a stretching regimen, you may want to consult a doctor or physical therapist to learn proper technique. Stretching the wrong way may actually do more harm than good.
• Yoga: I’ve only tried it once in my life and I was quickly reminded why I was never much of an athlete. But my friends who do it, swear by it. While certainly worth considering, I don’t recommend trying yoga (or any other strenuous activity) while battling a flare-up. Make sure your back is in relatively decent condition and take it slow. You can always pick up the intensity down the road if you find it helpful.
• Physical Therapy: I’ve been down this road three different times when the pain was simply too much to bear and it definitely helped. The physical therapists I’ve seen not only helped relieve the immediate pain, but educated me on how my specific problem is impacting my life, and designed a daily regimen for me to help reduce the duration and intensity of future flare ups. Just be aware that a good physical therapist can be a little pricey. It was worth it for me and—if you can get insurance to cover it—all the better.
• Acupuncture: I’ve never tried it and frankly remain skeptical, but some people enthusiastically declare the wonders it does for their health. Does it actually help physiologically? Is it merely psychosomatic? At the end of the day, does it really matter as long as you’re feeling better and no actual harm is being done? If you are having difficulty finding relief via other methods, then acupuncture may be worth pursuing.
• Chiropractor: And, finally, there’s the chiropractor. I’ve been to many and I’ve always left feeling better to some degree or another… at least for a few days. If you’re dealing with debilitating back pain, I strongly recommend seeing an orthopedist first—before going down the chiropractic road. If your doctor says that trying it won’t do any additional damage, and you need immediate—albeit temporary—relief, give it a try.

Like most health issues, there is no one-size-fits-all formula here. Everybody is different with different bodies, different ages, different ailments, different lifestyles, different budgets, and different responsibilities. They key is to find what works for you.

Before you do anything, be sure to consult a physician and ask questions. Then seek out another physician to get a second opinion that ensures you’re exploring all of your options and only undergoing surgery if and when it’s truly necessary.

There’s no shame in asking questions—lots of questions! And it certainly can’t be any more shameful than getting helped off the dance floor by the future husband of your high school crush.