Back surgery is a substantial investment of time, energy, and resources. Not surprisingly, most people with acute low back pain would like to avoid back surgery if at all possible. Avoiding back surgery is not only reasonable, but it also advisable when the pain will likely resolve with conservative treatments alone. But how do you know when back surgery is necessary and when it can be avoided? In this article, we review alternatives to back surgery, when they are likely to work, and when it is time to be evaluated by a spine surgeon.

It is time to call a spine surgeon when back pain hasn’t gone away within four weeks or is an emergency.


Can back pain be cured without surgery?

Yes. Fortunately, 90% of the time, back pain goes away without surgery. So, if you are experiencing low back for the first time and it has lasted less than two weeks, nine times out of 10, the pain will go away without surgery.


Why you should avoid back surgery

The biggest reason to avoid back surgery is because, 90% of the time, the pain will go away on its own or with conservative treatment. It would be costly and wasteful to have back surgery for something that could be treated conservatively.


Why you should NOT avoid back surgery

Unfortunately, in 10% of cases, back pain does not go away on its own or after conservative treatments. In these cases, the longer you wait to have back surgery, the worse the condition can get. People who need back surgery but avoid it are at risk for developing permanent weakness, permanent numbness, and intractable low back pain. The longer these patients avoid back surgery, the greater the risk becomes.


Back Surgery Alternatives

The good news is that there are many alternatives to back surgery that can be helpful in treating back pain. The back surgery alternatives listed here are those that are most likely to resolve the issue, i.e., these back pain surgery alternatives have at least some evidence to support their use.

  • Superficial heat
  • Spinal manipulation
  • Massage therapy
  • Acupuncture
  • Exercise
  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Muscle relaxants
  • Duloxetine
  • Benzodiazepines
  • Steroid injections
  • Weight loss
  • Transcutaneous electrical nerve stimulation (TENS)
  • Mindfulness meditation


Causes of Low Back Pain You Can’t Afford to Ignore

Some causes of low back pain are emergencies and require immediate medical attention. Cauda equina syndrome can lead to permanent paralysis if not treated promptly. Signs of cauda equina syndrome include severe low back pain and loss of bladder and/or bowel function. If low back pain is caused by infection, cancer, or a spinal fracture, then it should not be ignored. Lastly, back pain lasting four weeks or longer should not be ignored. Rather, sub-acute or chronic back pain, as it is called, should be evaluated by a spine surgeon.


Conclusion: Which Back Pain Treatment is Right For You?

Unfortunately, there is no single back pain treatment that is right for every person. Moreover, a treatment that once worked for your back pain may not work the next time. As long as you do not have “red flag” signs or symptoms that would suggest spinal cord compression, cancer, infection, or fracture, conservative treatments will likely relieve your back pain without the need for back surgery. A heating pad, ibuprofen, mindfulness meditation, and some low-impact exercises like walking are something every patient with acute low back pain can try to relieve their pain. If these do not relieve the pain, consider physical therapy, spinal manipulation, steroid injections, electrical stimulation, or acupuncture. If your back pain persists for four weeks or more, schedule an appointment with Dr. Lanman or Dr. Cuéllar, who are experts in both surgical and non-surgical back pain treatment.


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