When is Surgery Appropriate for Chronic Back Pain
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Synopsis and Key Points:
Back surgery is typically an option only when treatments like pain relievers and physical therapy have not worked and pain is persistent and disabling.
According to Dr. Praveen Kadimcherla back surgery is typically an option only when more conservative treatments such as pain relievers and physical therapy haven't worked and the patient's pain is persistent and disabling. Dr. Kadimcherla offers tips to seniors with back issues.
With national statistics indicating nearly one-quarter of doctor visits for low back pain take place among patients over age 65, it's clear that seniors - who often cope with co-existing health issues - are heavily impacted by this highly common problem. But what factors influence treatment for seniors with chronic back pain and when is surgery appropriate? The answer lies in each individual's overall health and how well their back pain responds to various treatments, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.
U.S. Census figures indicate that more than 37 million Americans are over age 65, and that number is expected to exceed 54 million by 2020. This will translate into even greater numbers of seniors who will need to determine the best approach to addressing chronic low back pain, which affects 8 in 10 Americans at some point in their lives.
"The risk of experiencing low back pain from disc disease or spinal degeneration rises with age," explains Dr. Kadimcherla, who is fellowship-trained in orthopedic and spine neurosurgery. "Back pain itself is partly due to the aging process, which includes the development of arthritis but can also stem from injury and sedentary lifestyles marked by bursts of activity that compromise weakened back muscles."
Tips to address lower back pain in seniors
According to the Agency for Healthcare Research and Quality, 23% of physician visits for low back pain are comprised by patients over age 65, which may equate to more than 7 million visits annually among this age group.
But a host of other chronic health problems associated with aging, including arthritis, high blood pressure, diabetes and heart disease, can make it difficult for clinicians to assess the best approach for back pain relief. Additionally, changes in metabolism leave older adults more vulnerable to side effects - or even overdosing - on pain relievers used for lower back pain, Dr. Kadimcherla notes. All of these factors influence the tactics used to treat back pain, he says, and whether that includes surgery.
"Back surgery is typically an option only when more conservative treatments such as pain relievers and physical therapy haven't worked and the patient's pain is persistent and disabling," Dr. Kadimcherla says. "Specifically, surgery can predictably relieve pain and numbness caused by compressed nerves in the spine caused by disc problems or bone spurs on the spine."
Considerations influencing decision for surgery
Back surgery is a common choice to treat unrelenting back pain. According to the U.S. Office of Disease Prevention and Health Promotion, lower back pain is the third most common reason to undergo a surgical procedure.
Various types of back surgery include discectomy, which removes a bulging or ruptured disc to relieve nerve irritation; laminectomy, which enlarges the spinal canal to relieve nerve pressure; and spinal fusion, which permanently connects two or more bones to stabilize the spine and relieve pain. A huge bonus is that many back surgeries can now be performed using minimally invasive techniques that require just tiny incisions and promote quick healing.
Since two 60, 70 or 80 year olds can be remarkably different in terms of overall physical condition and chronic illnesses, age itself is not the only consideration when deciding if surgery for lower back pain is appropriate, Dr. Kadimcherla says.
Other factors older patients should discuss with their doctor include:
- Risks and benefits of surgery: How will your life be impacted? Will several weeks of rehabilitation or other discomfort be required to improve your overall quality of life
- Goals for surgery: Can complete lower back pain relief be expected from the type of surgery needed
- Recovery time: How long will it take to recover from the procedure? Older patients often take longer to recover from surgery, which should be considered.
- Current medications: What prescription and over-the-counter drugs do you take regularly for other health conditions
- Overall functional status: Doctors should evaluate the strength or frailty of the patient before operating, including how well they perform daily activities such as walking, climbing stairs and getting up from a chair. Those who are already physically robust will recover better after surgery.
But there are other considerations as well.
"Few people think about how the costs of unrelieved pain - in this case, in the spine - can lead to longer hospital stays, higher rates of re-entering the hospital, more outpatient visits and lower ability to fully participate in everyday life," Dr. Kadimcherla says. "Surgery - even when minimally invasive - can take a toll on older adults, but it's satisfying when it leads them back to pain-free living. However, each case is unique and seniors should talk with their spine specialist to determine the best treatment for their individual circumstance to get relief from chronic back pain."
Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with three locations in New Jersey in West Orange, Edison and North Bergen. www.atlanticspinecenter.com Praveen Kadimcherla, MD, is a board-certified orthopedic spine surgeon at Atlantic Spine Center.
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