Back Surgery: what are the odds of success?

Simply put, lets say a disk in your lumbar is very badly damaged & you need surgery. What are the odds of true success & recovery? Odds of still walking? Odds of walking w/o a cane? Odds of winning the wheelchair seat? I’ve always heard that only a fool lets someone near their back with a knife…

Depends on your definition of success. There is something known as Failed Back Surgery Syndrome, and then there’s the question of whether you consider resolution of neurological deficits such as bladder or rectal incontinence or foot drop a success, or if you extend the parameters to also include relief of pain. (And for how long post-op?)

As for what you’ve always heard, I’d like to update that to “only a fool lets someone other than a neurosurgeon near their back with a knife.” Almost every spinal horror story I’ve heard involved the efforts of orthopedic surgeons. Not saying that orthos are up to no good, but for my money, I’ll go with a neurosurgeon.

Also, are you considering disk replacement or fusion? For an ADR, a US doc or someone overseas?

Depends on a few things:
-Is life manageable right now without treatment?

  • Have less invasive interventions been tried?
  • Any other chronic illnesses that could hinder recovery?
  • Do they have someone at home to take care of them if they are bed ridden for three months?
  • Financial situation

Surgery is never certain. Sometimes you just have to take an educated chance. Every situation and person is different. To say that “putting a knife in” is always a bad idea is generalizing. There are very well educated people who know what they are doing when they do the procedure. Also, I think that we hear more often about the “bad” cases than the good ones.

What kind of surgery? Fusion surgery for example has a low success rate (where success is pain improvement), and also leads to a lower probability of returning to work than physical therapy.

Are you in a lot of pain?

I had a two-level Cervical Spine Fusion in 2005 (when I was only 30) and it was a total success. C-spine surgeries are usually successful to some degree and I have only met one person who had a bad experience.

Unfortunately, the success rate for similar surgeries on the Lumbar Spine are quite a bit lower. The most common (and logical) explanation I’ve heard to explain that is that the lumbar spine bears a much heavier load that the cervical spine. It is also common for someone suffering from lumbar spine pain to be less active, which often results in weight gain (in the mid-section, particularly). In turn, the additional weight puts additional stress on the lumbar spine.

Cervical spine surgery’s high success rate can be attributed to how severe and debilitating a c-spine injury can be. In my situation, I had one ruptured and one herniated disc pressing on my spinal cord. My right arm was either in agony lor completely numb and immobile all the time! The relief when the pressure on my spinal cord was removed was instantaneous. I had the use of my arm the day following surgery. The pain prior to surgery was gone almost instantly.

Of course, there was a bit of post-operative pain from the incision made in my throat and the retraction of my esophagus and trachea to access the cervical spine! I ate yogurt and mashed potatoes for three weeks because I couldn’t swallow! The MOST painful thing was my right hip, which had a quarter-size hole cut thru the bone to access the marrow inside. They scooped out bone material to mix with some sort of protein powder to place between the vertebrae where the two discs had been. Then they covered it all with a titanium plate and screws and the three vertebrae grew into one mass (the ‘fusion’ part of the surgery). They could have used cadaver bone, but my own my own bone material had a higher success rate and less chance of complications. I also didn’t want some dead person’s stuff inside me unless it was my only option! :dubious:

The surgeon told me that my hip would take the longest time to heal, be the most painful part of the surgery and it would likely irritate me at times for the rest of my life. Seven years later and I still can’t stand to sleep laying on my right side because it hurts…but it was a tiny price to pay overall.

Back to the actual topic of the lumbar spine- Inversion therapy has been very successful for a significant number of people suffering from lumbar spine pain and/or damage. It is non-invasive and certainly can’t hurt to try prior to surgery if you haven’t done so already.

Another option is epidural spinal injections to help reduce the pressure point(s) causing the pain. It is rarely (if ever) a permanent solution or total fix, but it often can reduce pain to varying degrees or potentially elimate pain for a period of time. If effective, it is usually used as a way to delay surgery as long as possible and restoring or improving quality of life during that delay. I had weekly injections right into my spinal column (hurt like a sonofabitch!) and got NO relief. So I had surgery a few weeks later.

Researching the surgeon who will perform the surgery is probably the MOST IMPORTANT thing that almost no one does! I was diagnosed by an orthopedic surgeon and got a second opinion from a neurosurgeon. My regular orthopedic surgeon is a very close friend who I trust implicitly. But he does not work with the spine at all. He referred me to another orthopedic surgeon who he said he would trust with the lives of his wife and kids. After I researched that surgeon and even spoken online with two of his patients, I felt that he was the surgeon I trusted and felt most comfortable with. I have since referred countless others with c-spine injuries to him and all have been very pleased. I also strongly encouraged second opinions from a neurosurgeon, just as a matter of due diligence before allowing anyone to cut open your spine!!!

Whatever you choose, I wish you the absolute best outcome!!!

It depends, what surgery are we talking? I had a lumbar microdiscectomy in February, I seem to remember the ‘successful’ rate (no discernable damage) being around 95%, with less than 1% change of major problems- though the clinic I visited claimed they had a higher success rate, as they specialised in the procedure, but were only able to give the overall NHS rates. It was rushed through as a ‘next available slot’ emergency case, so I wasn’t actually told who my surgeon was going to be before I was already admitted and halfway prepped; in theory I think I had a choice of clinics, but it was a bit of a no-brainer given they were the only neuro specialists in the area.

Obviously what I had was one of the simpler procedures so far as back surgery goes, and the chances of nerve damage from leaving the disc as it was weren’t much different than the chances of damage from the surgery, so pretty good odds in my view.

I’d been in constant severe pain, unable to walk or even lie flat for over a month at that point, and have so far had a pretty much perfect recovery - I can walk fine, and even hula hoop, I didn’t even get any pain from the surgery, or any wound pain, which is more than a bit odd, but I ain’t complaining.

I do still get occasional sciatica if I stand still too long, but nothing like what it was, and I’m not at all sure if it’d due to the same disc, as I had 3 in varying degrees of deterioration. I try not to lift anything heavy, or stand still for more than about 15 minutes, but I can live with that.

Hope you get a good outcome, whatever you choose.

Here’s the most recent study on lumbar fusions I could find:

Also beware as you research that the success rate quoted is sometimes technical (fusion achieved) rather than clinical (condition improved).

And back to the comments of Beelzebubba (who, I imagine, is born to love volcanoes):

The size of the sample is IMO way too small, but it does suggest inversion therapy is well worth a try.

Good luck, I know back pain can take over one’s life.

Rule of thumb for lumbar disk surgery, as of ten years ago: success is 85% if the goal is to fix radicular pain (leg or foot pain caused by the disk crushing the nerve that serves the leg or foot), 50% if the goal is to fix pain in the lumbar spine per se. This is from the surgeon who fixed mine.

I had L4/L5/S1 fusion in 1991 to correct spondylolisthesis. Age 28.
Removed one disk, and opened up the pars opening for some nerves so they weren’t compressed any more.

While I don’t bowl or golf as well as before, and I have trouble reaching my shoelaces, I’ve been pain-free and mobile since then. So I’m thankful for that I suppose!

It was a joint effort between my neurosurgeon and his ortho partner.

In my experience as a Rad Tech as well as someone with a L5/S1 grade 2/3 spondylisthesis, the patients’ satisfation rate following lumbar fusion is just below 50% with quite a few of them saying “Don’t ever do it.”

Well, now, there is another side to being cautious about the knife. I blew out my L5S1 disk, massively extruding the pulp, and partly paralyzed my lower right leg, and followed the conservative advice for 6 months before changing orthopedic practices. The new guy said I should have had surgery right away, which would probably have restored motor control, but too late now. He said that by operating he’d give me a lot of pain relief (which he did) but the paralysis had become permanent (which it had). I wish I’d had that advice from the start!

I had a spinal fusion with instrumentation for scoliosis back in 1992. In my case it worked out well; there were some complications but they’ve all been dealt with now.

I don’t think I’d recommend it if there are alternatives available. And you want to have a lot of confidence in your surgeon.

Thank you all, for this information. I’m not free to say more publicly other than thank you at this time for either medical or legal reasons. If I’m very lucky, this may well be a bullet dodged, but the information people have shared will help a great many more people
than just me and for far longer, thanks to Google. This is the kind of thread that I wouldn’t mind seeing as a zombie thread 10 years from now, for it shows that we are all human, we all suffer pain, and that we truly do want to help each other.

I’d rather be known for it than for some snarky opinion I had in 2003 about a person I didn’t know in a position that I’ve never been in based on reported circumstances that I honestly knew nothing first-hand about.

an update: the MRI shows 2 disks are black. The specialist is not recommending surgery & I’m glad. I’ve been managing the pain with PT (so far). He told me that he feels it may get better over time. There’s still other stuff, but the MRI is proof that the pain I felt & still feel has a basis in reality.

As you probably guessed, black disks are “dead” - more technically, the doc would probably say you have DDD (degenerative disk disease) at those levels.

The success rates for fusion vs conservative therapy to yield back pain relief are just about the same, so the longer you can go without surgery, the better. PT and weight loss are probably more successful over the long run.

That recent study linked above is really discouraging.

(bolding mine)

I don’t know what the overall success rates are, but when they are successful, the results can be spectacular.

My dad, who has apparently had a ruptured and bulging lumbar disc for some time, was having trouble walking, trouble controlling one of his legs, and in fairly constant pain. We all sort of assumed that a lot of it had to do with his Parkinson’s Disease, but came to find out that it was lumbar disc trouble.

He had a laminotomy and discectomy, and the results were astounding. Prior to the surgery, getting out of a chair was a big production- he had a hard time getting from sitting to standing, and was very slow at it. Plus he had a hard time walking and balancing.

A week after surgery, my wife and I went to Houston, and visited him in the hospital. About halfway through the visit he says “I have to go to the bathroom- be right back.” and proceeds to sit up in the hospital bed, and just stand straight up, and walked over there with a walker.

My jaw dropped- he couldn’t do that months before his surgery, and he just did it like it was no big deal afterward.

I had chronic pain throughout most of my childhood, but wasn’t diagnosed with Grade III Spondylolisthesis until I was in my 20s. It was a complication of Spina Bifida Occulta. A neurosurgeon and an orthopedic surgeon performed my laminectomy and lumbar fusion as a team. I healed well and was able to return to work without any problems.

Unfortunately, over time the fusion became unstable. I had to have another one done ten years later. At that time I was forced to change careers because it was very physical.

Fast forward almost 20 years I think I’m doing OK. I live a full life. I’m usually able to manage the pain without taking medication. If I accidentally overdo it the pain usually is worst the next day and will last anywhere from several days to a week.

I avoid heavy lifting, bending at the waist or sitting without good lumbar support. I have no problem walking, but I’m unable to stand in one spot for long periods of time without being in pain. I tend to pace and fidget to keep things from “settling down” too much and start hurting. I do not wear shoes with high heels.

If I had to do it over again, I would still have had the surgery.

I’m a witness to that! :slight_smile: Before my surgery I had lost a lot of my ability to get around and was in constant pain. I could feel the bones clicking in my back whenever I moved. I couldn’t get out of bed without pulling up on something to support myself. I was walking with a cane. In the grocery store, I had to lean over on cart to hold myself up. This was back before they had those little electric carts.

The difference is like daylight and dark.

I believe one reason the study showed such POOR results for those opting for surgery vs. those opting for “conservative” therapy is that those in the former group were probably suffering much worse to begin with, thus forcing them to make the decision to have surgery.

In my case, I had herniated disks at L4/L5 and L5/S1, and constant sciatica all the way down to my foot for about a year, when I finally decided I should have surgery. Luckily I didn’t need fusion surgery, and had microdiskectomy on both disks, and now, four years later, I am in the best physical shape of my life–at age 47. I would recommend my Surgeon, Jeffrey Goldstein in NYC, to anyone.