Undergoing back surgery is a big decision. If you are considering this treatment, chances are you have lots of questions. Back surgery techniques have changed significantly over the years so it is important to get the most recent information and to be able to separate what is true about spine surgery and what is not. Here’s what you should know:

• Back surgery is very specific and is aimed at correcting a clear mechanical problem located in a defined part of the spine. It isn’t helpful in treating systemic problems affecting the back, such as widespread “wear-and-tear” changes caused by aging or by being in poor physical condition.
• Most people with back and back-related leg pain try many kinds of treatment with varying degrees of success. It’s important to understand that just because you have tried lots of things that haven’t worked does not mean you are automatically ready for back surgery.
• Surgery done to relieve leg pain (and occasionally back pain) has two goals: first to remove pressure on a nerve, and second, to stabilize the spine so it stops moving in abnormal ways that can produce the pain.
• The decision about whether or not to have surgery should be based, in part, on the degree or length of your disability, rather than on just how severe the pain is. It is not how long you have had the pain; it is when the pain starts to change your life that surgery (if there is a surgical solution) is most effective.
• Even if you have back surgery, this rarely eliminates all symptoms. To gain the most benefit, people must pursue physical rehabilitation and make every effort to return to normal activity after their operations.
• While some kinds of back surgery are clearly indicated – for example to treat a major injury, a tumour or an infection – and one is urgent – surgery to address the loss of normal bowel and bladder function – surgery for mechanical problems is almost always “elective.” That means it’s up to the patient as well as the surgeon to decide whether this is right thing to do.
• Except in those rare cases where urgent intervention is necessary, patients’ preferences for treatment should always be taken into account. You should never feel forced to undergo back surgery—especially since the rate of natural recovery from all back problems is so high. It may be reasonable for you to delay recommended surgery while you continue trying other treatments. But putting off needed surgery for too long can create problems too, like developing a pattern of complex pain. This is an important conversation to have with your doctor.

 
You and your surgeon
The back surgery procedures described here are preferably done by a spine surgeon, usually an orthopaedic surgeon or by a neurosurgeon with specific interest and expertise. The first goal of the surgical “consult” is to determine whether or not back surgery is the right option for you. If you feel anxious about meeting with a surgeon for any reason, it’s a good idea to bring along a trusted family member or friend who can help you ask questions, listen to the answers and take notes.

There are many factors to consider when choosing a surgeon. If you live in a smaller town or in a rural area, the choice may be limited. If possible, find a surgeon who specializes in spine surgery. In recent years, spine surgery has started to become a separate specialty. All recently graduated spine surgeons will have received added training in back surgery techniques.

A few words about “informed consent”
No surgery can be performed without the patient’s consent. It’s expected that such consent is “informed”—that is, you understand the process and agree to the risks. Here are some questions you may want to ask your surgeon before signing a consent form:

• What is the operation called?
• Why is the surgery being recommended?
• What specific symptom(s) will the operation address?
• How much can I expect my symptoms to improve?
• How long will it be before I see a change in my symptoms?
• How long will I have to wait for surgery?
• What will happen during the surgery?
• How long will the operation take?
• What type of anaesthesia will be used (regional, general or a combination)?
• What are the risks during and after surgery?
• Will I need a blood transfusion?
• Will I need to go to another hospital for rehabilitation? If so, for how long?