Surgery for back pain may be necessary for those patients who do not respond to less invasive treatment, and is particularly important in certain rare emergent situations, such as patients with cauda equina syndrome. Prior to surgery patients require diagnostic imaging studies, which usually will include MRI imaging studies. Newer surgical techniques, such as microdiscectomy are considerably less invasive than previous spinal surgery, yet still entail risk. Other surgical procedures for patients with back pain include laminectomy, laminotomy, and spinal fusion.

The risks of surgical intervention include not only the risks of the surgical procedure itself but also the risks of anesthesia. Anesthetic risks include the risk of allergic reactions to the anesthetic agent; hypotension and/or hypoxia leading to brain damage or damage to other organ systems; bleeding, and death. Surgical risks include infection, bleeding, nerve damage, paralysis, or death. Fortunately all of these complications are rare due to the advancements of modern surgery and modern anesthetic practice.

Patients choosing surgery are advised to carefully select their surgeon. There are many highly qualified spinal surgeons who fall into two main groups: Board-Certified Orthopedic Surgeons, and Board-Certified Neurological Surgeons. Surgeons specializing in spinal surgery are recommended. Prior to consulting your surgeon it may be helpful to consult the AHCPR document, "Questions to ask your doctor before you have surgery".

The authors of this website do support surgery as a proven and established treatment modality for the appropriate patient with certain types of back pain, which generally are predominantly those involving compression of neural elements.

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