If you have pain in your lumbar spine — or low back — you may be worried you need to have surgery. Many times, back pain can be treated using non-surgical methods, such as rest, nonsteroidal anti-inflammatory (NSAID) medication, walking or exercise and physical therapy. In some cases, steroid injections can help.
Typically your orthopedic doctor will assign a course of non-surgical treatment before considering lumbar spine surgery. If after a period of time that might last up to several months there is no improvement, surgery may be the next step. In some cases, the need for surgery may be urgent.
Cauda Equina Syndrome
Cauda equina syndrome is the result of a central disc herniation and one of the instances in which surgical intervention is usually urgent.
Cauda equina syndrome symptoms include:
- Leg pain that affects both sides of the body
- Loss of feeling in the perianal area
- Bladder paralysis
- Anal sphincter weakness
Contact an orthopedic doctor ASAP if you have these symptoms. Other conditions are less likely to need surgery, at least right away.
Herniated Nucleus Pulposus
The progressive degeneration of a disc or degeneration due to traumatic event can cause a condition of herniated nucleus pulposus (HNP). The degree of herniation of discs can vary. Symptoms of HNP in the lumbar spine include:
- Back or leg pain
- Abnormal sensations
- Loss of sensation
When symptoms are mild, nonoperative treatment usually helps and surgery is rarely needed. Nonoperative care would likely be tried for at least six weeks to several months. In cases where nonoperative treatment fails, lumbar spine surgery may be considered.
Spinal stenosis is an umbrella term for several conditions:
- Central stenosis, which occurs when the central part of the spinal canal narrows
- Foraminal stenosis, in which the foramen narrows and puts pressure on the exiting nerve root
- Far lateral recess stenosis, which involves the lateral part of the spinal canal becoming narrower
Symptoms of spinal stenosis — which can affect one or both sides of the body — can include pain, abnormal sensations or numbness in the:
If symptoms persist after three to six months of non-surgical treatment, lumbar spine surgery may be needed.
Spondylolisthesis and Spondylolysis
Spondylolisthesis is a condition that is characterize by the following symptoms:
- Low back pain
- Buttock or thigh pain may accompany back pain
- Pain that worsens when you stand or walk
- Pain that improves when you lay down
- Legs that feel tired or numb, or have abnormal sensations
- Pain that improves by leaning forward or sitting
Spondylolysis occurs when a vertebra is fractured or has a defect. Symptoms include:
- Pain or stiffness in the low back
- Pain that increases when you bend forward
- Symptoms that worsen with activity
Both conditions may need surgery if a course of nonoperative treatment does not produce results.
Degenerative Disc Disease (DDD)
This condition, which often occurs with age, is characterized by pain in the low back or buttocks, or both. If no improvement occurs after a minimum of six weeks, surgical care may be considered, including lumbar fusion surgery or arthroplasty.
If you are experiencing pain of the lumbar spine, talk to an orthopedic expert. A doctor who specializes in treating the spine can help determine whether nonoperative treatment or spine surgery is needed for your condition. If you need surgical treatment, read our posts about how to prepare for spinal surgery and the most frequently asked questions about spine surgery.
If you're going to have spinal surgery, there are steps you can take to be prepared for a successful procedure and recovery.