Surgery Vs PT For Chronic Low Back Pain
It is estimated that around 600,000 to 700,000 people in the United States undergo surgery for chronic low back pain each year. The number of people who use physical therapy for this condition runs into the millions.
Surgery and physical therapy are two common treatment options for managing chronic low back pain. Both approaches have their own advantages and disadvantages, and the decision of which to use really comes down to the specific circumstances that patients are facing.
Pros of Surgery for Low Back Pain:
Can provide quick relief from pain
Can improve mobility and functionality
Can correct structural issues causing pain
Can provide permanent relief from pain, if successful
Cons of Surgery for Low Back Pain:
Invasive procedure with associated risks and complications
Long recovery time
May not be effective for all patients
Can lead to new pain or problems
Often very expensive
Who Is Not A Good Candidate For Back Surgery?
Back surgery isn’t for everyone, and knowing who is a good candidate and who is not before you take your decision further can help you avoid disappointment in the future. Here are some instances when surgery might not be appropriate for you:
When the underlying cause of the back pain isn’t a treatable, structural issue.
When you have a medical condition that would make surgery risky or if it is completely contraindicated for your condition.
When you have a history of failed back surgery syndrome.
More Considerations For Back Surgery
If you don’t tolerate anesthesia well.
When the expected results may not justify the risks and cost of surgery.
If you haven’t been fully informed about the surgery and completely understand what the results might be, and you are not satisfied with the range of results you may receive.
If you aren’t completely motivated to have the surgery and agree to the post operative care and rehabilitation plan.
Who Is A Good Candidate For Back Surgery?
There are definitely cases where back surgery is necessary and will potentially produce the best outcomes for a patient. You may be a good candidate for low back surgery if you have experienced any of the following:
You have tried nonsurgical treatments without experiencing any meaningful relief.
When the pain severely impacts your quality of life and interferes with your daily activities.
When you have had an in-depth conversation with your surgeon and you fully understand the risks, expected outcomes, and costs of your surgery.
When you are willing, and able, to fully participate in a post-operative care plan.
When the benefits of the surgery outweigh the risks.
Understanding What Surgery Involves
It is important to understand that the decision to have surgery for low back pain should be made only after you have received a comprehensive evaluation by a qualified healthcare provider and you have considered all available non-surgical options.
Although spinal surgery has a role in the management of back pain - especially when it is related to significant instability, particularly in the context of cancer, infection or previous surgery, its role in the management of non‐specific LBP still doesn't have a lot of evidence to support it.
Clinical Trials To Support Surgery
So what does the evidence say about surgery for low back pain? A 2009 study published in the journal, Spine, reviewed the evidence for the American Pain Society Clinical Practice Guidelines.
After looking at many different clinical trials that researched surgical interventions for those suffering from low back pain the results showed that “for nonradicular low back pain with common degenerative changes, we found fair evidence that fusion is no better than intensive rehabilitation with a cognitive-behavioral emphasis for improvement in pain or function”.
Essentially what they found was that spinal fusion produced the same results for low back pain patients as cognitive behavioral therapy, particularly when it came to pain levels, and getting people moving again.
The researchers also reported that “less than half of patients experience optimal outcomes (defined as no more than sporadic pain, slight restriction of function, and occasional analgesics) following fusion”.
The Risks Of Persistent Post-Surgical Pain (PPSP)
Chronic pain is a relatively frequent surgical complication with estimates suggesting that between 10 - 40% of low back pain patients will experience this after surgery.
The International Association for the Study of Pain defines persistent postsurgical pain as, “a clinical discomfort that lasts more than 2 months post surgery without other causes of pain such as chronic infection or pain from a chronic condition preceding the surgery”.
Persistent postsurgical pain not only brings emotional distress to patients, but it also brings additional healthcare costs and a lack of quality of life. It is important to understand that PPSP is a major risk that comes with low back surgery.
Failed Back Surgery
Failed back surgery is another complication that patients should be informed about before having low back surgery.
Failed back surgery syndrome is defined as “lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location”.
With failed back surgery syndrome, the you might find that your pain starts right after surgery, that the surgery makes your original pain worse, or you might find that surgery just didn’t help fix the pain at all.
When a patient is fully screened and informed about their chances to have a successful surgery, with agreed upon outcomes, it can reduce the incidence of failed back surgery syndrome. For a surgeon, a successful surgery might be that the patient doesn’t die or that some degree of mobility is restored.
The patient, on the other hand, may have the expectation that they will go back to how they were before their back pain started. Having realistic expectations, and being on the same page with your surgeon about results can make a big difference to how you view the results of your surgery, or if you even decide to go ahead with the procedure at all.
Physical Therapy For Low Back Pain
Physical therapy is recommended as first line treatment for low back pain by physicians and healthcare providers around the world.
Pros of Physical Therapy for Low Back Pain:
When it comes to the benefits of physical therapy for managing low back pain, these include things like:
Non-invasive and low risk
Can improve mobility, strength, and functionality
Can target specific issues causing pain
Can help prevent future back pain or injury
Cons Of Physical Therapy For Low Back Pain:
Physical therapy isn’t going to work for every case of low back pain, although it is generally the best place to start and the first thing experts recommend to try. Some of the drawbacks to physical therapy include:
It often takes longer to see results compared to surgery.
It can take a lot of motivation and commitment.
You may not get complete relief from your low back pain.
It is not suitable for all low back patients, especially if you have severe or complex back problems.
May not always work for neuropathic, or structural spine issues.
The Growing Number Of Spine Surgeries
These days it seems as if spine surgery centers are everywhere. Indeed, the US does more than double the number of spine surgeries than countries like the United Kingdom or Australia.
Per person, there are still twice as many spine surgeries performed in the US as many other countries. This number even takes into account the differences in population numbers.
One positive of this is that due to privatization of healthcare compared to a national healthcare system, patients are generally able to get the surgeries they want, when they want, and they don’t have to jump through hundreds of hoops, or wait a ridiculously long time for their surgery as they do in some other countries.
Many countries are encouraging patients to try all of the nonsurgical treatments before undergoing surgery. It has been suggested that patients in the US often receive surgery a little too quickly, and sometimes before the other treatment options have really been exhausted.
Some patients may see surgery as a “quick fix” option, but the reality is that it can be quite the opposite. Patients still need to adhere to their post-operative care program, and they also need to make sure that they have addressed any underlying psychological conditions that may be playing a role in their low back pain.
In conclusion, both surgery and physical therapy have their advantages and disadvantages when it comes to treating chronic low back pain. The decision of which treatment option to use should ideally be made on a case-by-case basis, taking into consideration the specific circumstances of each person individual and the underlying cause of their pain.
To really get the best results from your surgery it is vital to speak candidly with your surgeon to make sure that you fully understand the risks, have a good idea of the work you will have to put in, understand what recovery will look like, and discuss what results you can realistically expect.
If you are unsure about whether to try surgery or physical therapy to relieve your pain, you should know that international guidelines recommend exhausting nonsurgical treatments first, and if those don't work then possibly moving on to more risky treatments, like surgery.
It is important to consult with a qualified healthcare professional that you trust, like your doctor or physical therapist, to determine the best course of treatment.