7 The role of surgery in the management of low back pain

The main challenge of surgery in the treatment of low back pain lies with the poor knowledge of the aetio-pathogenesis of this symptom. Surgical treatment requires the precise diagnosis of a surgically curable lesion. In low back disorders this research of a precise source of nociception remains elusive even in the presence of radiological abnormalities. Indeed, surgery may not be performed to treat a symptom (low back pain), but an objective condition or disease. Surgical treatment for low back pain is the subject of many controversies, but a certain numbers of attitudes can be (generally) agreed upon in a variety of low back disorders: (i) intervertebral disc herniation; (ii) degenerative spinal disease; (iii) spinal stenosis; (iv) lytic spondylolisthesis. However, there is a wide choice of attitudes, techniques and procedures for each of those indications and numerous conflicting result reports have been published. This chapter will try to present the best available consensus regarding the indications and results of different surgical procedures in spinal disorders.

Most of all, physicians should bear in mind that, in spine surgery perhaps more than in other fields, unreasonable patient (and surgeon) expectations will most likely lead to poor outcomes.