Surgery is an option for many conditions that cause chronic back pain, but not everyone has to go that route for symptom relief. In fact, there are plenty of reasons why back surgery should be avoided when possible.

Back surgery is an umbrella term for surgical procedures involving the muscles, bones, nerves, and connective tissues of your back. They’re procedures performed for a variety of reasons, including spinal stabilization, nerve decompression, tumor removal, and correction of conditions such as scoliosis.

Having an operation on your back isn’t a light decision. Your back is a major component in your overall functionality, and surgery comes with its own risks.

For some people, back surgery may not be the best or most effective option for pain relief.

Back surgery may seem like the shortest road to recovery when you’re dealing with chronic pain, but there’s more to this decision than surgical recovery time.

Side effects from surgery and the chance that your symptoms won’t get better — or may even get worse — are important considerations.

According to Bryan Hathaway, owner of Peak Performance Physical Therapy and a physical therapist certified in mechanical diagnosis and treatment, in Owego, New York, most surgeons will inform people that any surgery is usually the last option.

“It does not matter the [type of] surgery because there are risks involved, the most serious being, although rare, loss of life,” he explains, referring to the known mortality risks associated with anesthesia and major surgical complications.

“Lesser risks are infections, delayed healing, internal bleeding, deep vein thrombosis (DVT), nerve damage, and poor outcomes.”

According to the American Society of Anesthesiologists, back surgery is considered higher risk compared with other surgeries due to how closely surgeons work to the central nervous system.

The close proximity to your spinal cord and major nerves increases the risk for paralysis and other side effects from nerve damage, such as:

  • muscle weakness or atrophy
  • cramping or muscle twitches
  • loss of feeling
  • poor motor function control
  • tingling or prickling sensations

Can surgery make symptoms worse?

Any time you disrupt the natural state of your body, there’s a chance to cause secondary harm.

Back surgery involves the manipulation of soft tissue, blood vessels, nerves, and bone. Additional trauma to any of these body parts may worsen your pain or bring on new symptoms.

Individual factors also matter. Not everyone responds to back surgery in the same way, for many different reasons.

“There are a multitude of factors that influence the outcome following any treatment, including surgery,” says Hathaway. “Factors such as fitness, nutrition, physical health, mental health, age, expectations, duration of the pathology, and environment [can all play a role].”

While each individual type of back surgery has its own success rate, as many as 40% of back surgeries aren’t successful, overall.

Failed back surgery is so common that the cluster of symptoms experienced after operation is referred to as “failed back surgery syndrome.”

Surgical candidacy is determined by your doctors. It involves a review of individual factors such as your overall health, pre-existing health conditions, and if you’re able to make the lifestyle changes necessary for the best outcome.

According to Hathaway, certain pre-existing conditions may rule you out as a surgical candidate.

Living with a bleeding disorder, severe osteoporosis, or having an increased infection risk, for example, may be factors that prevent you from having back surgery.

“Also, patients need to be willing to change their lifestyle if needed after surgery,” he states. This may involve quitting smoking, losing weight, and making dietary changes.

If you’re unable to make the changes necessary for a back operation to be successful, you may not be a good candidate for surgery.

Who is a good candidate for back surgery?

Common conditions that may qualify for surgical treatment include:

Having surgery as an option for your diagnosis doesn’t mean it’s always the preferred method. Most back pain improves with noninvasive therapy after a few weeks.

As with any surgery, you’re considered a good candidate when your overall surgical risks are low.

Age, body weight, lifestyle habits, and general health are taken into account. Your doctor will also consider factors related to your recovery, such as ability to follow rehabilitation steps, ability to travel to appointments, and level of at-home support.

When is back surgery necessary?

Sometimes back surgery is necessary. Your doctor may recommend this route if you’re:

  • experiencing unmanageable, debilitating, burning pain
  • unable to function enough for daily tasks
  • living with a potentially life threatening condition
  • noticing bladder or bowel incontinence
  • in an emergency situation from an accident
  • diagnosed with severe spinal instability
  • experiencing significant spinal cord compression and injury
  • seeing little to no response from noninvasive treatments
  • experiencing lower extremity weakness

How you approach treating back pain depends on its underlying causes.

As a general rule, Hathaway recommends focusing on healthy living practices that can improve your well-being regardless of your diagnosis.

“Change your lifestyle first,” he says. “Great nutrition and fitness create an internal environment most conducive to healing.”

Next, he suggests seeking out conservative care such as:

“If these treatments and lifestyle changes do not positively affect your symptoms then consider surgery,” says Hathaway. “Surgery outcomes will be better due to the changes you have already made in your lifestyle.”

Back surgery isn’t an inherently negative thing. It can be an important, necessary, or lifesaving procedure for many people.

Just because you can have surgery for back pain, though, doesn’t always mean you should.

The risk of surgical complications, a low rate of success, and the potential for worse or additional symptoms are a few reasons why back surgery should be avoided when possible.

Healthy lifestyle modifications, as well as alternative treatments such as physical therapy, acupuncture, or massage therapy, may help provide symptom relief while your back heals naturally.