Back surgery: What to realistically expect

Your doctor may suggest that you see a surgeon if your back pain is unrelenting and no form of treatment seems to work, or if serious neurological deficits set in, such as foot drop, an inability to raise the front part of the foot due to a weakness or even paralysis of the muscles.

The information provided by surgeons was a key aspect of decision-making for the people we surveyed as they contemplated back surgery. Nine in 10 patients told us they relied on information from their surgeon "a lot" before agreeing to an operation, according to a survey of almost 1,000 ConsumerReports.org subscribers who said they had a lower-back operation in the last five years.

But how consistent are the recommendations of back surgeons? The evidence shows they can vary widely by the individual surgeon, the type of operation proposed, and the extent of counseling provided before surgery.

In our survey, 60 percent of the back-surgery respondents said they were completely or very satisfied with the results of their surgery. In comparison, 82 percent of the people who had hip or knee replacement surgery in our 2006 survey said they were completely or very satisfied with the results.

But satisfaction levels varied according to the diagnosis given and the type of back surgery. Those with a diagnosis of degenerative disk disease (arthritic changes or osteoarthritis of the spine) were far less likely to be highly satisfied with surgery (54 percent) than those who were told they had a herniated disk (73 percent) or spinal stenosis (71 percent). Those who underwent discectomies were significantly more satisfied (69 percent) than those who underwent spinal fusions (56 percent). Those who said back surgery was strongly recommended by their doctor were the least satisfied, and those who broached the idea of surgery themselves were the most satisfied.

Alfonso Sanchez, 38, a state senatorial aide from Sacramento, Calif., was highly satisfied with his lumbar discectomy. His back pain turned excruciating when he went canvassing in the hills of San Francisco last June. When his doctor diagnosed herniated disks, he tried everything from acupuncture to physical therapy and chiropractic treatments, but nothing seemed to work. He decided to undergo a microdiscectomy in August. "The moment I woke up from surgery I realized that my pain was gone," he said. He recovered quickly, and his doctor let him go back to work after three months. He is now back to riding his bicycle to work and tending his garden.

But not everyone does so well. More than 50 percent of the respondents reported at least one problem. The most common was finding that recovery was lengthier and more debilitating than they had expected. Indeed, 16 percent of the back-surgery respondents said their back pain did not improve, and half of them said it became worse after surgery. Overall, 20 percent said they were dissatisfied with the outcome.

Other findings from our back-surgery survey:

• The single most expressed regret (offered by 1 in 10 respondents) was that they didn't receive enough postsurgery rehabilitation.
  
  
• More than 25 percent of the respondents said they had not been informed about the risks of surgery, such as nerve injury, bleeding, and infection, and 33 percent said their doctors did not discuss the consequences of not having surgery.
  
  
• Thirty-eight percent of respondents reported having had one or more previous back surgeries; over half of the spinal-fusion patients reported a previous back operation.
  
  
• Compared with more than 14,000 subscribers with lower-back pain who did not have surgery, those who had surgery described their back pain before surgery as much more impairing in terms of activities such as sleep (79 percent compared with 47 percent), mobility (95 percent vs. 66 percent), and sex life (60 percent vs. 24 percent).
  
  
• In addition, 95 percent of those who had surgery described having back pain with neurological symptoms—such as weakness, numbness, or pain radiating down a leg—as opposed to those who did not have surgery and reported back pain alone.
  
  
• The amount of time individuals spent living with pain before surgery varied widely. Ten percent had surgery for back pain that had been present for less than three months, while more than 25 percent of the sample had lived with pain for more than six years before having surgery.
  
  
• The most common surgery type was spinal fusion (25 percent), followed by lumbar discectomy (20 percent), laminectomy (16 percent), and laminotomy (15 percent). About a third of all surgeries required some type of hardware or device, such as a screw or artificial disk.
  
  
• Having conversations with professionals other than doctors or surgeons (i.e., chiropractors and physical therapists) was related to being more highly satisfied with the outcome.