Only a small minority of people with low back pain will require surgery. Surgery is often necessary if there is evidence of cauda equina syndrome (problems with the nerves at the base of the spinal cord), another serious back condition like a tumor or infection, or severe weakness due to spinal stenosis or compression of a nerve root.
Surgery may also be considered for people with persistent radiculopathy due to herniated disc or spinal stenosis that has not responded to other (non-surgical) therapies. There is controversy about whether surgery is beneficial for people with degenerative disc disease alone.
Referral to an orthopedic surgeon or neurosurgeon is recommended under the following circumstances:
- Increasing neurologic problems (measurable weakness)
- Loss of sensation (eg, numbness) or bladder and bowel symptoms
- Failure to improve after four to six weeks of non-surgical management, with persistent and severe sciatica and evidence of nerve root involvement
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