Back pain and the realities of surgical recovery

Statistics show that 80% of us will have at least one episode of low back pain during our lifetime. This is especially important when you consider these factors will increase your risk: obesity, smoking, age, female, physically strenuous work, sedentary work, stress, job dissatisfaction, anxiety or depression.

There are four main regions of the back: Neck: seven cervical vertebrae (C1-C7), Upper back: 12 thoracic vertebrae (T1- T12), Lower back: five lumbar vertebrae (L1-L5), and Base of spine: sacrum, coccyx (S1- S4). Low back pain is most commonly found in the L4, L5 and S1 areas. However, most people (>85%) have “nonspecific low back pain,” which means there isn’t a specific disease or abnormality in the spine clearly causing the pain.

Causes of low back pain include: degenerative disc disease (wear and tear causing breakdown of spinal discs or loss of fluid in the discs), facet joint arthropathy (arthritis in joints connecting the vertebrae to one another), spondylolisthesis (one of the vertebrae of lower spine slips forward), herniated disc (outer covering of disc is torn, soft inner tissue extrudes), lumbar spinal stenosis (open space inside the vertebrae is narrowed), and spinal compression fractures.

Symptoms include: radiculopathy (nerve root becomes irritated, causing radiating pain, numbness, etc.), sciatica (one of the five branches of the sciatic nerve becomes irritated), neurogenic claudication (pain runs down the back to buttocks, thighs and lower legs, often on both sides and may cause weakness and limping).

Diagnosis: Imaging studies including X-rays, MRI, CT scan. It’s interesting to note that a patient may have an abnormality on imaging and actually experience no symptoms.

Treatment: Remaining active helps to relieve muscle spasms and prevents loss of muscle strength. Also helpful: heat, pain meds, exercise to increase back flexibility and strengthen core muscles, physical therapy, chiropractic manipulation, acupuncture, massage, trigger point injections into the soft tissues of back or epidural injections, traction, ultrasound, electrical nerve stimulation, low level laser therapy.

Surgery is only recommended if more conservative treatments fail. Options include spinal fusion (fusing two or more vertebral bodies together), lumbar disc replacement (may help preserve normal range of motion), discectomy (removes part of/entire disc to relieve pressure on the nerve roots), open discectomy (standard surgical incision), micro discectomy (smaller incision to remove of disc fragment).

Spinal fusion recovery. Pain should decrease gradually. Usually the worst is over by four weeks. However, some patients have pain for three to six months after surgery. Avoid bending, twisting or lifting anything over 10-15 lbs. If a back brace is recommended, wear it for six weeks to three months after surgery. Driving may be allowed after four to six weeks. Outpatient physical therapy may be started at six weeks.

At three to six months’ post-surgery, exercise is the central component of the recovery process. Focus should be on strengthening your back and core muscles for support. Complete recovery may take up to eight months. Bone continues to evolve for 12-18 months.

SUSAN LOCKE, MD is Healthnetwork Foundation’s medical director.

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