Spine Surgery Often Unnecessary in Treating Back Pain

/ Thomas Cohn, MD

spine surgeryA recent presentation at the North American Spine Society (NASS) meeting, points to the fact that a third of spine surgery patients are still using narcotic/opioid medications one year after surgery.

Further, the study indicates that of those patients using opioids before surgery, 51% continued a to use them a year later.  The article goes on to discuss the concern that too much opioid prescribing is occurring.  This is the wrong concern. The real concern should be whether spine surgery should have been done in the first place.

Reasons for Spine Surgery

The United States has one of the highest rates of spine surgery.  Compared to most other countries, the spine surgery being done is mostly unnecessary.  There are appropriate reasons for spine surgery, such as:

  • Trauma
  • Scoliosis
  • Changes in the spine causing nerve damage with loss of muscle or organ function

Pain alone is a poor reason for spine surgery.  Most spine pain is caused by degenerative discs and joints. Treating this surgically most often only changes the location of pain, and does not resolve pain.  Nonsurgical management of most spine conditions has been shown to be much more successful in numerous studies.  Ask a group of surgeons, the answer of course is that the surgery works.

Pain management experts will usually have a more conservative view with regards to surgery. Spinal fusion surgery has at most a 30% success rate for helping with pain.  Spinal surgery in general also has a 20% rate of significant surgical complication.  The above statistics highlight the real issues with spine surgery – that it often causes more problems than solutions.

Alternative Treatment Options

Treatment for spine pain involves many different options, including a variety of medications and possibly opioids.  Every person has different needs, and a Pain Medicine physician can evaluate you and help determine an appropriate treatment program.  Surgery should only be considered if neurologic compromise is occurring and without intervention, loss of motor control or organ function may result.

Opioid medication use in the United States may be out of control, but so is spine surgery.  Surgery and opioid use are truly independent problems.  Pain and opioid use after surgery is not a surprising issue.  The problem is too much surgery and not enough good pain management of spine problems by qualified experts.