Patients need to weigh risks, benefits of lumbar spine surgery

Oct 4 2011
A study from the University of Washington (UW) Department of Orthopedics and Sports Medicine suggests that candidates for lumbar spine surgery need to consider the risks for complications from an operation.

The spinal cord that links the brain to the rest of the body is protected by the vertebrae, the facet joints connecting these bones and the intervertebral discs that act as shock absorbers and stabilize movement of the spinal column. According to the American Academy of Orthopaedic Surgeons (AAOS), back pain can be caused by several conditions affecting these structures.

Over-activity can strain the surrounding muscles and ligaments. The intervertebral discs may degenerate over time because of mechanical wear and tear, or because of injury. A resulting herniated disc may put pressure on the surrounding nerves, causing back pain which could radiate to other parts of the body.

Age-related degeneration of the facet joints may cause the vertebrae to slip and slide against the nerves, leading to conditions such as spondylolisthesis. Osteoarthritis may cause parts of the spinal column to narrow on the spinal cord due to thickening ligaments or abnormal bone spurs, a condition known as spinal stenosis, according to the AAOS.

Back pain is the leading neurological condition afflicting Americans, second only to headache. More than 28 percent of adults reported lower back pain within three months prior to being surveyed by the Centers for Disease Control and Prevention.

Conservative approaches to back pain are best. This may include anti-inflammatories, or alternative pain therapies, such as acupuncture, hypnotherapy, physical therapy, yoga or chiropractic medicine. Some patients with lower back pain cannot avoid surgical procedures, such as discectomy to remove a herniated disc. However, new research details the various risks that may come with lumbar spine surgery.

A team from UW reviewed data tracking 767 patients who had surgery on their lower back and were monitored for two years. About 13 percent of complications from lumbar spine surgery were in the cardiovascular system, while more than 17 percent were in the blood systems, making these two categories the most common complications. Patients who experienced post-surgical problems to their heart and lung systems were at greater risk of dying within two years. The leading cause of these complications appeared to be surgical invasiveness, according to the researchers.

Further studies to determine who is most at risk for developing problems after lumbar spine surgery could be helpful to both patients and doctors, the team said.