Lower Back Pain and Back Surgery

Lower back pain can take over your day. It can make it hard to sit through a meeting, stand at the stove, sleep through the night or bend down to tie your shoes. When the pain shoots down your leg, or your legs feel heavy and tired after a short walk, it’s natural to wonder whether something more serious is going on.

Most causes of back pain can be found and treated. Dr. Betsy Grunch, a board-certified, Duke-trained neurosurgeon, has spent more than 13 years helping adults with back problems, from herniated discs and sciatica to spinal stenosis and instability. This guide explains the most common causes, the warning signs to watch for, and the treatment options available, including minimally invasive surgery and lumbar disc replacement.

Most lower back problems start in the discs, joints and bones of the lumbar spine, the five large bones in your lower back. These are the conditions Dr. Grunch treats most often:

• Herniated disc: the soft center of a disc pushes out and presses on a nerve.
• Sciatica (lumbar radiculopathy): a pinched nerve that sends pain, numbness or tingling down the buttock and leg.
• Degenerative disc disease and discogenic back pain: worn discs that become a source of pain themselves.
• Lumbar spinal stenosis and foraminal stenosis: narrowing that squeezes the nerves and often causes leg pain or heaviness when you walk or stand.
• Spondylolisthesis: one bone slips forward on the one below it.
• Facet joint disease and spinal arthritis: wear and tear in the small joints at the back of the spine.
• Spinal instability: too much movement between bones, which can cause pain and pressure on nerves.
• Sacroiliac (SI) joint dysfunction: pain from the joint where the spine meets the pelvis.
• Adjacent segment disease: wear at the levels next to an earlier fusion.
• Chronic low back pain: back pain that lasts longer than three months.

Problems in the middle back, such as a thoracic disc herniation, are less common but are treated in a similar way.

Many people with back pain start with their primary care doctor, a chiropractor or physical therapy. It’s time to see a spine surgeon if you have:

• Pain, numbness or tingling that travels down your buttock or leg
• Leg or foot weakness, such as tripping or a foot that slaps when you walk
• Leg pain or heaviness that makes you stop and rest after walking a short distance
• Pain that keeps you up at night or keeps getting worse
• Back pain that hasn’t improved after several weeks of treatment
• Back pain after a fall or accident
• An MRI that shows a herniated disc, stenosis or a slipped vertebra

Call 911 or go to the nearest emergency room if you have new loss of bladder or bowel control, numbness in the groin or inner thighs, or sudden weakness in both legs. These can be signs of cauda equina syndrome, which needs emergency surgery.

Treatment starts with an exam and a careful look at your imaging. When the source of pain isn’t clear, Dr. Grunch may use tests such as discography or Nociscan, an MRI-based test that helps show which discs are causing pain. Many patients begin with physical therapy, medicine or injections, and Dr. Grunch will talk with you about what makes sense for you. When pain keeps coming back, gets worse, or causes weakness, surgery can often correct the problem.

Dr. Grunch performs the full range of lower back surgery:

• Microdiscectomy: removes the piece of herniated disc pressing on a nerve, often with annular closure to help prevent another herniation.
• Laminotomy, lumbar laminectomy and foraminotomy: make more room for squeezed nerves without a fusion.
• Synovial cyst removal: removes a fluid-filled cyst that is pressing on a nerve.
• Lumbar artificial disc replacement: replaces a painful disc with a motion-preserving implant for carefully selected patients.
• Lumbar fusion, including TLIF, ALIF, LLIF and OptiLIF: stabilizes the spine for slipped or unstable bones, often through minimally invasive incisions.
• SI joint fusion: a minimally invasive, outpatient surgery for sacroiliac joint pain.
• Revision fusion: for patients who still have problems after an earlier back surgery.

Many patients go home the same day after a microdiscectomy, laminectomy or SI joint fusion. Lumbar disc replacement usually means one night in the hospital, and fusion surgery may need a short hospital stay.

• Duke-trained and board-certified by the American Board of Neurological Surgery, and a Fellow of the AANS, ACS and CNS
• Experience: more than 5,000 procedures, with 400 to 600 surgeries a year
• Minimally invasive spine surgery, including transforaminal approaches through Kambin’s triangle, a natural corridor that reaches the spine with less disruption of muscle and bone
• Motion-preserving options: lumbar artificial disc replacement for carefully selected patients who want to avoid a fusion
• Finding the true pain source: discography and Nociscan when it isn’t clear which disc is causing pain
• Second opinions and revisions: Dr. Grunch often sees patients who were told they need back surgery, or who still have pain after surgery somewhere else
• Close to home: offices in Gainesville, Sandy Springs and Riverdale

Learn more about Dr. Grunch’s training and credentials.

Is my lower back pain serious?

Most lower back pain comes from strained muscles or wear and tear and gets better with time and treatment. Back pain is more serious when it comes with leg pain, numbness, weakness, or trouble walking, because those can mean a pinched nerve. Loss of bladder or bowel control or numbness in the groin is an emergency, so call 911.

When should I see a surgeon for back pain?

See a spine surgeon if pain travels down your leg, if you have numbness or weakness, if your legs get heavy or painful when you walk, or if pain keeps coming back despite physical therapy or other treatment. You should also be seen if an MRI shows a herniated disc, stenosis or a slipped vertebra.

Do I need surgery for a herniated disc or sciatica?

Not always right away. Many people start with physical therapy, medicine or injections. If leg pain, numbness or weakness continues or gets worse, a minimally invasive microdiscectomy can often correct the problem, and many patients go home the same day.

What is the difference between a back fusion and a disc replacement?

Both treat a damaged, painful disc. A fusion joins two bones so they heal as one, while a lumbar disc replacement uses a moving implant so that level keeps its motion. Disc replacement is only a good fit for certain patients, and Dr. Grunch will explain which option fits your spine and your goals.

How long is recovery from back surgery?

It depends on the surgery. Many patients go home the same day after a microdiscectomy or laminectomy, lumbar disc replacement usually means one night in the hospital, and fusion may need a short hospital stay. Most people can drive once they are off narcotic pain medicine, and Dr. Grunch or one of her physician assistants will give you a recovery plan for your surgery.

If back pain, sciatica or leg numbness is getting in the way of your life, Dr. Grunch can help you understand what’s causing it and what your options are. Call 470-293-9800 or contact us to schedule a visit at our Gainesville, Sandy Springs or South Atlanta (Riverdale) office. You can also ask general questions any time through our “Ask Us Anything” chat.

Related: All back conditions · All back procedures · Neck pain and neck surgery · Pinched nerves and sciatica · Chronic pain and spinal cord stimulation · Choosing a spine surgeon

This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms.