What Is the Surgical Management for Lower Back Pain?
Orthopedic Health Data Verified

Lower Back Pain Surgical Management - Indications, Types, and Risks

Published on Jun 08, 2023   -  4 min read


Lower back pain is a common condition that can be treated both non-surgically and surgically. Keep reading below for more insights.


Back pain, especially lower back pain, is a very common condition. Most lower back pain can be treated without surgery. People experience back pain at least once in their lifetime. Most of them recover on their own. A few percent of such individuals develop chronic pain and require surgical intervention. Musculoskeletal injuries or nerve compressions require surgery as a viable option.

What Is Chronic Lower Back Pain?

Chronic lower back pain is defined as continuous lumbar, sacral, or lumbosacral spinal pain that occurs for 12 weeks or due to low-level pain caused by acute pain exacerbations. Back pain is diagnosed after a thorough physical examination to assess the factors leading to the pain. The evaluation aims to identify the causes of lower back pain and individuals at risk of developing delayed improvement because of neurological impairment. A physical examination is usually required for individuals without any other grave disorders. All other organs are also thoroughly examined in others with a systemic or visceral cause of lower back pain.

What Are the Indications of Back Surgery?

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has laid down the following indications for surgical intervention for lower back pain:

Ruptured or herniated disks, in which one or a few disks are damaged.

What Are the Different Types of Lower Back Surgeries?

Vertebroplasty and Kyphoplasty:

These are minimally invasive surgical procedures that are used to repair vertebral fractures due to osteoporosis. During the procedure, a hollow needle known as a trocar is inserted through the skin into the vertebra, guided with the help of an X-ray (fluoroscopy). After the trocar is in place, either cement (vertebroplasty) or a balloon-like device (kyphoplasty) is inserted into the vertebra via the trocar. As the balloon is inflated, it creates a space that can be filled with bone cement, thus strengthening the bone.

Spinal Laminectomy or Spinal Decompression:

This procedure is performed in cases of spinal stenosis. Spinal stenosis leads to spinal canal narrowing, resulting in pain, numbness, or weakness. In this procedure, a part of the lamina or a piece of the back of the vertebra is removed. Laminectomy enlarges the spinal canal to relieve pressure on the nerves.


This procedure surgically removes the disk when some part of the soft part of the disk bulges out through an opening, causing pressure on the nerve root or spinal cord. This leads to compression of the nearby nerves, causing pain, numbness, and weakness. Laminectomy and discectomy are generally carried out together.


This procedure involves the enlargement of the hole (foramen) where the nerve exits the spinal cord to prevent the bulging of the disks or joints from pressing on the nerve.


Nucleoplasty is also known as plasma disk decompression. This laser surgery uses radiofrequency to treat back pain associated with a mildly herniated disk. A needle is inserted into the disk along with a plasma laser device. The needle's tip is heated, vaporizing the disk tissue, reducing its size, and thus relieving the pressure on the nerves.

Spinal Fusion:

This procedure removes the spinal disk between two or more vertebrae. The adjacent vertebra is then fused with bone grafts or metal devices with the help of screws. This procedure may lead to some loss of flexibility in the spine. The recovery takes longer for the bone grafts to grow and fuse the vertebra.

Artificial Disk Replacement:

This is an alternative procedure used in place of spinal fusion for the treatment of individuals with damaged disks. In this procedure, the disk is removed and replaced by a synthetic disk.

Injection Therapy:

Injection therapy is used when painkillers and physiotherapy fail to curb the symptoms. In this therapy, local anesthesia and steroids are inserted in and around the joint with the help of a needle. This leads to a momentary suppression of the inflammation, thus reducing the pain. Injection therapy is a temporary measure and can be used to manage acute pain exacerbations.

This temporary pain management gives time for the patient to undergo physiotherapy. However, injection therapy is not meant for individuals with a progressive degenerative process. The area, level, and type of injection therapy depend on the symptoms and the area of pain. Injection therapy is not carried out more than three times a year.

Non-Fusion Stabilization:

This procedure is an alternative to traditional fusion. In this procedure, an artificial ligament is attached to the spine with the help of screws to stabilize the spine, limiting only the flexion movement. However, a study found a higher recurrence rate post-surgery. The device was then modified, limiting both flexion and extension. This led to removing the load from the intervertebral disc. The recurrence rate was low with such devices, but they had their share of limitations.

What Are the Risks Involved With Lower Back Surgery?

Lower back surgery has associated risks, like any other surgery. Being closer to the nervous system involves greater risk. Paralysis (loss of one's ability to move any body part) and infection are the two major risks of lower back surgery.


Chronic lower back pain is common and can be managed with or without surgery. The non-surgical approach includes physiotherapy, medications, or alternate hot and cold fomentations. Surgery comes into the picture only if these procedures have yielded no positive results.

Various procedures, from steroid injections to decompressions, remove pain by preventing movement between the two vertebrae. Like any other surgery, lower back surgery has its share of complications. No treatment is completely error-free. Further research is required in this field for a better understanding of the physiology and pathology of the disc and the development of a universal treatment strategy.

Article Resources

Last reviewed at:
08 Jun 2023  -  4 min read




Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers

Intramural Fibroids - Causes, Symptoms, Diagnosis, and Treatment

Article Overview: An intramural fibroid is a benign tumor that develops in the space between the uterine muscles. Read to know details about its causes, symptoms, and treatment. Read Article

Sunita Kothari
Sunita Kothari
Obstetrics And Gynecology

What Are Uterine Fibroids? Uterine fibroids are benign tumors that grow in and on the uterus. Although not all fibroids cause symptoms, when they do, those symptoms may include painful sex, frequent urination, back pain, and heavy menstrual bleeding. Larger fibroids can be treated with medication or...  Read Article

Fibromuscular Dysplasia - Symptoms, Causes, Diagnosis, and Treatment

Article Overview: Fibromuscular dysplasia is a rare condition that causes narrowing or stenosis and enlargement of the arteries. Read Article

Prashant Valecha
Prashant Valecha

Introduction Fibromuscular dysplasia is a medical condition that leads to the narrowing as well as enlargement of the arteries in the body. Fibromuscular dysplasia generally affects the medium-sized arteries. The narrowing of such arteries is referred to as stenosis, and their enlargement is called ...  Read Article

Spondylolisthesis in Athletes - Causes, Symptoms, and Treatment

Article Overview: This article is about spondylolisthesis in young athletes who can return to sports following proper diagnosis and treatment. Read Article

Atul Prakash
Atul Prakash
Orthopedician And Traumatology

Introduction: Kids and teens who play sports like football, weight-lifting, gymnastics, volleyball, ballet, wrestling, and golf can strain their lower back and have a high risk for spondylolisthesis. Young athletes are at more risk because of their growing bones, especially during the growth spurt. ...  Read Article

Popular Articles Most Popular Articles

Do you have a question on Lower Back Pain Surgical Management or ?

Ask a Doctor Online

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.