When is surgery needed for back pain?

The first thing that we must do when we have severe back pain is to obtain a thorough evaluation by our local doctor or even better, an orthopedic surgeon. This will include a detailed medical history, clinical examination and possibly investigations such as a blood test, X-ray, CT or MRI scan. These investigations may show that the back pain:

  1. Is due to a serious spinal or other disorder that requires surgical management. These are known as “Red Flags.” Remember that ONLY 1% of all back pains come under this category
  2. Is due to a spinal or other disorder but can be managed with conservative treatments. It accounts for 10 – 15% of back pain cases.
  3. Does not have an identifiable spinal or other cause. Most back pains (85 – 90%) fall in this category.

Back pain does not mean surgery

Just because you see your physician or orthopedic surgeon does not mean surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In fact, surgery may do more harm than good.

This is why we need some strong indicators for surgery. These indicators are known as “Red Flags” and tell us that surgery must definitely be done if permanent damage is to be avoided and that the benefits of surgery far outweigh the complications that may arise due to the procedure.

Red Flags

So what are these Red Flags?

  1. Difficulty in urination or loss of bladder and/ or bowel control
  2. Saddle anesthesia – numbness around the genital area and buttocks
  3. Numbness/ tingling in one or both feet/ toes
  4. Difficulty in moving the ankle upward or downward or raising the great toe
  5. Gait disturbance – difficulty in walking
  6. Changes in reflexes in the legs (this can be detected by the physician).

If you have one or more of the above symptoms you definitely have a condition that may need surgery. The timing of surgery will depend on how severe the symptoms are.


  • Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at http://www.amazon.in/Say-Goodbye-Back-Pain-Ranjan-ebook/dp/B004S7BAO6

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