You can remember the precise moment. You bent over to pick up the newspaper and bam! Your lower back lit up in pain. Weeks later, you still have pain. A friend had back surgery and it helped. You wonder, will surgery take care of my back pain too?

Consider this first. Most people who seek medical care for lower back pain improve with conservative treatment within one month. This may include a combination of pain or anti-inflammatory medication, heat and physical therapy.

Back surgery is an aggressive approach to back pain that is only needed in a few cases.

When may neck or back surgery be necessary?
You may be a candidate for surgery if your back pain does not improve with conservative treatment. Surgery may also be an option if there are symptoms involving damage to a spinal nerve, such as:

• Loss of bladder or bowel control
• Pain that radiates down arm or leg (sciatica)
• Numbness or weakness in the arm or leg

You may also need surgery if you have symptoms of infection or tumor:

• Unrelenting pain or night pain
• Fever
• Night sweats
• Unexplained weight loss

Back injury basics
The spinal cord runs through a column of bones called vertebrae. Nerves enter and leave the vertebral column. If you are injured from a car accident or fall, a vertebra may fracture and tear the spinal cord or a major nerve root leaving the spine. This could cause permanent damage, but usually only if the spine is unstable. Most vertebral fractures heal on their own without surgery to stabilize the spine.

Back pain, even if the spinal cord is not in danger, can still cause serious disability. Surgery may relieve pain in conditions that pinch or compress the spine. This may involve a herniated disc or other anatomical structure causing the pain, such as:

• Deformities. This may include scoliosis (a curvature of the spine), kyphosis or a humpback deformity.
• Disc problems. Intervertebral discs act as shock absorbers between vertebrae. As you age, the center portion of the disc shrinks and the disc fails to cushion movement. A disc may also push out of the space between vertebrae and pinch a nearby nerve. This is called a herniated disc.
• Spondylolysis and spondylolisthesis. This is the most common cause of low back pain in young athletes. An inherited weak back bone breaks (spondylolysis), often from a sports injury. The unstable spine then slips forward (spondylolisthesis).
• Spinal stenosis. Narrowing of the spinal canal that can come with age.

Types of back surgery

• Diskectomy. Removes the herniated disc to ease pressure on nerves leaving the spine.
• Laminectomy. Removes one or more laminae, part of the vertebral bone beside the spinal canal, so that there is more room for spinal nerves.
• Fusion. Two or more portions of the spine are fused together with bone grafts in areas where excess movement causes pain.

Newer procedures use smaller incisions to reach the disc, but there are still risks.

Consider the risks of surgery
Risks of back surgery include infection, bleeding or reaction to anesthesia. The spine could be injured during the procedure, leading to paralysis, loss of bladder or bowel control or other permanent disability. Even after you and your doctor agree that surgery is an option, you must weigh these risks.