Updated 12 February 2013

When is back surgery an option?

The decision to undergo back surgery will and should never be taken lightly. Back surgery is a last resort and will only be considered conservative treatment options had failed.


The decision to undergo back surgery should never be taken lightly. Back surgery is a last resort and will only be considered when conservative treatment options have failed.

The only absolute indications for back surgery are:

  • When a nerve is pinched;
  • When the spinal cord is compressed;
  • When there's too much movement between the vertebrae,
  • When your neck or back pain is accompanied by nerve involvement. Watch out for the following signs and symptoms: pain radiating down your legs or arms; a tingling, numb or weak feeling in your arms and legs; no or little bladder or bowel control.

The following back problems may be helped by surgery:

  • Herniated or slipped disc: Wear and tear may cause the pads of cartilage (discs) between your vertebrae to bulge or rupture (herniate). Parts of the herniated disc can protrude onto the nerve running adjacent to the disc. This pressure can cause pain, numbness, tingling or weakness of the arms or legs.
  • Back pain caused by disc degeneration. This surgery is only performed when conservative options have failed to improve the pain.
  • Spinal stenosis. This occurs when there is narrowing of the spinal canal and/or its openings (foramina) through which nerves exit the canal. The bony growths/spurs and thickened ligaments compress the spinal nerves. In the case of spinal stenosis, a surgeon will remove the bone or ligament that pinches nerves or the spinal cord. Spinal stenosis is a common condition, but in many cases it has no symptoms. Patients born with a narrow canal are more prone to developing symptoms.
  • Fractures. Spinal fractures require surgery if the spine is unstable or if the spinal cord or nerve roots are compressed.
  • Osteoporosis can weaken vertebrae, causing them to fracture or collapse. Doctors will perform surgery only if an osteoporotic compression fracture threatens the stability of the spine or if the pain has persisted despite pain medication and bed rest. In elderly patients who battle to be mobile, the fracture could be injected with bone cement (vertebroplasty or kyphoplasty).
  • Infections and tumours. Surgery may be needed to remove a tumour or an abscess.
  • Spinal deformity. Scoliosis (S-shaped spine), kyphosis (humpback) and spondylolisthesis (spine segment slipping forward) may be treated surgically if they are causing pain, deformity or nerve and/or cord compression.

Reviewed by Dr Pradeep Makan, orthopaedic surgeon, Melomed Gatesville and Life Vincent Pallotti Hospital in Cape Town and part-time lecturer in the department of orthopaedic surgery at the University of Cape Town, 2010.

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