After months of back and leg pain, all of a sudden it seems I need surgery. The decision seems a bit rushed, so I'm wondering if it's really necessary. How do I weigh the pros and cons of this decision?

There are many possible causes of low back pain (LBP). But LBP along with pain down the leg is frequently a signal of neurologic involvement. This is usually from pressure on the spinal nerve root.

Narrowing of the spinal canal and/or the opening for the nerve root can cause these kinds of symptoms. This condition is called spinal stenosis. This narrowing can be the result of bone spurs, tumors, or thickening of the spinal ligaments.

Degenerative disc disease (DDD) can also cause the type of symptoms you have described. A degenerated or herniated disc can press against the nerve root. A damaged disc can also release chemicals that irritate the nerve endings. The result is back and/or leg pain.

When neurologic symptoms do not improve with conservative care, then surgery is considered. Numbness in the groin area called saddle anesthesia is a red flag. Without surgery to remove pressure from the nerves, permanent paralysis is possible.

Studies show that early intervention improves your chances for a good recovery. The longer you wait, the more risk there is for a slow recovery rate and recurrence of the problem.

If you are having doubts, ask your surgeon to review your case with you. Answering any questions you have may help point you in the right direction. Surgery is a big step and should be considered carefully. But the right operation at the right time can make a difference in your symptoms and function.

Kate Haswell, BSc, MHSc (Hons), PGDipHSc, et al. Clinical Decision Rules for Identification of Low Back Pain Patients with Neurologic Involvement in Primary Care. In Spine. January 2008. Vol. 33. No. 1. Pp. 68-73.



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