We get asked quite regularly when it’s necessary to have surgery for back pain, and this is quite a difficult question to answer as it is entirely dependent on that person’s set of circumstances. It’s also dependent on the specialist they choose to see – different practitioners in different parts of the world have varying approaches and attraction to surgery. We see people who come in for the first time to the clinic and say that they’re quite willing to have surgery if they need to, but often the problem doesn’t warrant the need for such invasive action. Equally, we also see patients with spines in a very bad condition, and it can be difficult to provide them with much in the way of long-lasting stability without them doing some element of treatment and ongoing therapeutic intervention.

In the lower back, the most immediate form of intervention that needs to be done is when the patient presents with red flag symptoms. These include saddle anaesthesia (numbness in the area of your body that would be in contact with a saddle on a horse), loss of bladder or bowel control. If you have any of those symptoms, it’s vital you go to A&E very swiftly, as these are signs of Cauda Equina Syndrome. We don’t generally see these sorts of patients, as generally they will have recognised these are unusual symptoms and would have most likely called emergency services to ask what is happening to them.

The first thing we advise patients who are considering surgery, is to of course talk to your surgeon. Rather than speaking to other people about their experiences, ask the surgeon how they can help you and the likelihood of success – as some surgeries can actually have success rates that are relatively low. The surgeon is the person doing this type of surgery day-in-day-out, they know the results, they know what they’re doing and they know if you’re a suitable candidate for it. One thing we find in this country, in England, is that there seems to be a growing tendency of surgeons not wanting to do surgery, which – as a specialist believing most of the time it is unnecessary – is always pleasant to hear! The surgeon will try their very best, in most cases, to direct you to other means or methods to provide relief of the problem before going down the surgical route. It’s best to exhaust all other options and try your best to adhere to a treatment program, before opting into surgery, as like other methods of treatment it is not a guaranteed ‘cure-all’.

If you’ve got some lower back pain, or recurring lower back pain, and all you’ve tried is painkillers and a little bit of exercise – then go and see someone who can actually perform some treatment. A lot of patients come in and say they’ve been using painkillers for the last six months or so, their problem hasn’t gotten any better, but hasn’t gotten worse. Often that is because they haven’t sought treatment to help.

If there’s some damage to your lower back – I.e. you have a disc bulge, there are arthritis changes and degeneration – then it’s really vital that you have someone examine your spine thoroughly to give you an understanding of the alignment of your spine. Does it have a normal lordosis? Are you leaning off to one side? Do you have any leg length discrepancy? A lot of the time, a patient doesn’t take the time to go through this and it’s definitely something you should tick the box on before going down the line of surgery. Quantifying the angles of your spine will give you an accurate reading as to what exactly is wrong with your spine, and why you’re experiencing the problem – it can also indicate what you need to be focusing on in terms of your rehabilitation. If you have a normal lumbar spine, legs are perfectly level, you’ve got good muscular support, are not overweight, you take care of yourself by exercising regularly and leading a healthy lifestyle, and you don’t spend too much time working at a desk, and you still have back pain that is severe and debilitating – then you might want to consider surgical intervention at that point.

So what questions are useful to ask a surgeon regarding your particular case? Firstly, ask and understand exactly what they are going to do, and what the purpose of it is. Are they addressing some of the challenges your spine faces on a daily basis? Are they putting any emphasis on rehabilitation after the surgical procedure? How long will you be recuperating afterwards? Are your muscles going to suffer as a consequence and waste due to a long recovery time? In the case a patient is seeking surgical intervention due to a problem that has been brewing away for a number of years, and not due to an accident, it’s likely that problem has occurred due to long-term bad spinal habits such as poor posture, that has taken its toll on your spine. Your spine is naturally aligned in a way that allows it to effectively distribute the force of gravity. If your spine deviates from this alignment, it is no longer able to do this and so places more pressure on other areas of the spine. Due to increased pressure, discs end up bulging and eventually pressing against nerves – and this can cause quite a considerable amount of pain not just in your back, but also in the area that nerve controls. The issue with a lot of approaches is that the posture and alignment is not taken into consideration, which only means that treatment will work temporarily but not be resolved completely.

Following these few steps we’re sure you’ll be able to get the right answers, giving you the best possible prognosis and getting you better in the right way. We hope you found this article helpful! If you’d like to reach out to us about your specific case, feel free to get in touch with us through our social channels, or speak to a member of the team by calling the clinic on 0203 947 3222 or emailing at info@themayfairclinic.com.

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