Back Pain Surgery Not Recommended As First Line Treatment

More than 26 million Americans between the ages of 20-64 experience low back pain.  Globally, an estimated 22-65% of adults suffer from it every year.  Treatment recommendations can vary significantly, from relative rest to surgery.  Despite the medical literature not recommending and clinical guidelines discouraging the use of spine surgery in routine cases of acute low back pain, rates of spinal surgeries and fusions have increased exponentially in recent years.

new article in the July issue of the British Medical Journal highlights the complexity of treating spinal conditions.  The importance of understanding the cause of one’s back pain cannot be overstated, particularly if more invasive treatment options are being considered.  One of the article’s key points is that low back pain itself is not a specific diagnosis but rather simply a symptom.  Based on the available medical literature, success rates of surgeries in cases without a clear cause of spinal pain are low and should not be performed.  As a result of, authors of the study recommend against back pain surgery for acute, non-specific cases.  

Spinal imaging such as an MRI is frequently performed to clarify a diagnosis but often times can add more confusion, particularly with non-spine specialists.  Such studies can often be misleading with the presence of “abnormal” findings that are in fact not consistent with a patient’s symptoms.

Treatment of back pain should be diagnosis specific and evidenced based.  Most cases can be successfully treated with conservative care.  Surgery can offer a significant degree of pain relief in cases that have a specific spinal etiology that can be successfully treated with surgical decompression.  It should not be an option, as the authors of the article note, for treating the symptom of acute, non-specific back pain.