Back and Spine; Orthopaedics and Rehab

Just 10% of back pain requires surgery – and minimally invasive procedures work for many

Some spinal conditions can be managed with medication or injections such as epidurals, facet blocks, and selective nerve root blocks.

There are a lot of potential pain generators in the spine: discs, bones, nerves, muscle, and arthritis. Not all of these sensitive areas and progressive problems can be fixed with surgery. In fact, more than 90 percent of back pain is successfully treated nonsurgically.

As a physical medicine and rehabilitation (PM&R) specialist, part of my role is to help treat patients with spine disorders without surgery. But an equally important responsibility is knowing who can benefit from back surgery and when is the best time to make that referral.

In complex cases and for certain conditions, surgery is the most appropriate and effective treatment.

Unfortunately, there are a lot of misconceptions that back surgery is always a major procedure with an extended hospital stay and long recovery period. In fact, many patients can be treated with minimally invasive surgery, while only the most complex cases require open surgery. Even then, our approach is to get you moving as quickly as possible to aid in your recovery.

At the UT Southwestern Spine Center, we participate in national surgical and nonsurgical spine registries so we can analyze trends and data to improve our patients’ care. Staying current on the latest research, and most importantly, listening to our patients, we can recommend the safest, most effective, and least invasive treatments to manage your pain.

The longer the pain goes unchecked, the more nerve and tissue damage, as well as compensating issues in other parts of the body, are likely to occur and the harder it is to treat.

Bottom line: If you have back pain it does not automatically mean you’ll need complex spinal surgery. Let’s take a look at the range of treatment options.

What to Know About Back and Muscle Pain

COVID-19 is challenging our health in many indirect ways, from nagging back and neck pain due to working from home to more severe orthopaedic injuries as we return to sports. UT Southwestern specialists Kavita Trivedi, D.O., and Jay Shah, M.D., discuss the trends, trouble spots, and treatment options.

Watch more episodes

Nonsurgical treatments to try first

At the start of the COVID-19 pandemic, patients were hesitant to visit the clinic for neck and back pain relief out of fear of the virus (although the hospital has always been safe). But as the pandemic dragged on and their symptoms got worse from poor ergonomics while working from home or being too sedentary during shelter in place, more patients have become open to trying nonsurgical treatment options.

These are often the best choice for patients with spine pain:

Studies show that getting at least 30 minutes of moderate exercise three to four times a week can help prevent and reduce back pain.
  • Exercise: When your back hurts, sometimes the best thing you can do is move more. Ample research shows that getting at least 30 minutes of moderate exercise three to four times a week is an excellent way to prevent and reduce back pain. For example, preliminary data from one of my ongoing research studies shows that doctors who move more during the workday tend to have less back pain. Bonus: achieving and maintaining a healthy weight can also relieve back pain symptoms.
  • Medications and injections: Anti-inflammatory medications or injections such as epidurals, facet blocks, and selective nerve root blocks can help manage pain for conditions such as arthritis or sciatica.
  • Physical therapy (PT): Expert-guided strengthening, stretching, and conditioning of the muscles, tendons, and ligaments that support your spine and adjacent body structures. PT is not a way to “postpone” surgery – it’s a way to get relief when surgery may not be beneficial. That said, almost all patients who have spine surgery will do PT to regain strength and flexibility.

Virtual spine care can make a big difference for your spine health. Seeing a doctor or physical therapist through telehealth means you don’t have to make travel arrangements or significantly rearrange your schedule to attend your appointments. Keeping your visits can mean better adherence to your care plan and quicker pivots if something isn’t working.

Related reading: Can a standing desk help my back pain?

However, some conditions require in-person visits and more extensive treatment. Before recommending surgery, we try all other treatments we know could work, such as injections and medications.

It's important to know which alternative therapies may help back pain, and which ones probably won't.

Alternative therapies to try (or avoid)

While there is no miracle cure for back pain, some alternative or complementary treatments can help ease symptoms and make you feel better. There are also some we strongly recommend avoiding.

Safe to try

  • Electrical stimulation: When performed by a spine specialist or sports medicine chiropractor, this therapy can help release tight muscles that support the abdominal core and spine, potentially relieving pain.
  • Myofascial release: Physical therapy or chiropractic treatment that involves deep soft tissue massage can complement more permanent treatments. While myofascial release can’t cure nerve damage, it can help release tense muscles trying to protect the spine that may be impinging or compressing nerves.

Avoid

  • High velocity, low amplitude (HVLA) treatments: These adjustments result in popping and cracking of the neck and back. HVLA might temporarily reduce pain symptoms, but it cannot cure your spine condition and is not proven to provide lasting benefits.
  • Laser spine surgery: There is no solid evidence that laser spine surgery can effectively treat spine conditions, and UT Southwestern does not perform these procedures.
  • Regenerative medicine: Current research shows a risk of transplanted cells regenerating in unexpected places. This can make existing problems worse or create new complications, such as paralysis. The data are more solid for joints, such as the knees, but we currently do not recommend spine regeneration therapy.

When you might need back surgery

Get a close-up look at UT Southwestern's Spine Center and its team approach to patient care.

If nonsurgical treatments don’t work, or if you are dealing with extreme pain or a spine-related medical emergency (sudden leg weakness, lack of reflexes, or inability to hold your bladder or bowel), you may need minimally invasive or traditional open surgery.

Minimally invasive spine surgery, which uses small incisions and tools to treat mild to moderate spine conditions, can effectively stabilize your spine and address the problem causing your pain. It also reduces the risk of infection and recovery time.

Many minimally invasive procedures use an endoscope – a small, lighted tube with a camera in its tip – to enter the spine with less damage to the surrounding skin and muscle. Back problems that often can be treated with minimally invasive surgery include:

  • Herniated discs: We may be able to remove just the damaged part through a small tube (endoscope).
  • Spinal stenosis (lower back): Removing bone and tissue that crowds nerves to increase the space between.
  • Scoliosis (mild to moderate): Using small incisions to fuse affected areas of the spine together to straighten it.
  • Spinal fractures (mild to moderate): Options include using a small balloon to “inflate” the vertebrae parts to their original place and using “bone cement,” a body-safe adhesive, to help with back pain from the fracture.
  • Spondylolisthesis (shifted vertebrae): Using small incisions to fuse affected areas of the spine together to keep vertebrae in their proper spaces.
  • Small spinal column tumors: Removing just the tumor and nearby affected tissue using small incisions.

Related reading: Back in action: Updated treatment recommendations for lower back pain

Traditional open surgery is usually appropriate for very complex conditions and patients who have had previous back surgeries that resulted in scar tissue or required a lot of permanent hardware, such as rods and screws, to be left in the spine.

Conditions often treated with open spine surgery include:

  • Certain spinal deformities
  • Disc degeneration (severe)
  • Scoliosis (severe)
  • Spinal fractures (severe)
  • Spinal instability
  • Spinal trauma, such as after a vehicle accident
  • Spinal tumors (large or complex)

Related reading: Get help for back, neck, and leg pain caused by spinal stenosis

Physical therapy rehabilitation can be crucial to effective recovery from spine surgery. After an open procedure, our goal is to get you up and moving as quickly as possible to start the healing process.

Not all spinal conditions can be fixed with surgery. But if you do need spine surgery, it might not be a major, open procedure. You don’t have to live with back pain. If surgery is the best choice, we’ll do everything we can to make sure you get the safest, least invasive procedure to relieve your symptoms and treat the root cause of your pain.