When is surgery needed?
Although much low back and lower extremity pain can be
treated conservatively, there are times at which surgical intervention is
required on an elective, urgent, or emergent basis.
When pain radiating from the back down the lower
extremities persists for more than 6 weeks, and when the pain is in the
characteristic distribution of a nerve, if imaging studies confirm a
herniated disk pressing on the appropriate nerve, then a discectomy may be
In addition, there are cases in which the herniated
fragments of disk are very large, and if conservative measures are felt to
unlikely to result in pain improvement, the patient and physician may
jointly elect to proceed with surgery.
When a progressive motor deficit is present, such as a progressive foot
drop, then an urgent decompression is indicated to attempt to halt the
progression of the weakness.
Cauda equina syndrome, caused
by severe pressure on the nerves in the lumbar spine, may result in severe
low back pain as well as retention of urine, numbness around the rectal and
genital region, lower extremity weakness, and sexual dysfunction. If
caused by mechanical pressure, such as a large herniated disk, then
urgent/emergent decompression is indicated to try to arrest the progression
of symptoms, and hopefully reverse them.