BOSTON, MA — Low back pain is an extremely common condition: 80% of Americans experience at least one bout of it some time during their lives. Usually, rest, some pain relievers, and perhaps some exercises help it go away. But for many millions, the pain lingers and may become severe and debilitating. How do you know when back pain warrants surgery? The February 2007 issue of the Harvard Health Letter investigates.

Deciding to have surgery is never simple, but it’s especially difficult when the back is involved. Many studies of back surgery have been small. Popular procedures have been questioned, and new ones get introduced before we really know how well they’ll work over the long haul. It’s hard enough for doctors to figure out what to do about surgery for back pain. Patients are often even more confused.

Back surgery is an option for people with long-lasting pain due to herniated disks, spinal stenosis, or degenerative disease. Studies have shown good results from spinal stenosis surgery, with any lingering pain controlled with medication. On the other hand, doctors are beginning to question whether too many surgeries are performed to treat degenerative disease. As for herniated disks, a recent study found that surgical and nonsurgical treatments worked equally well. An editorial accompanying the study said toss-up results show that the decision whether to have surgery is a matter of patient preference more than anything else.

Ideally, your primary care physician can walk you through your options—surgical and non—to get you to an effective treatment.