Back Surgery Not Necessarily Next Step

Dear Dr. Roach: I am a 60-year-old female who has been diagnosed with spondylolisthesis and stenosis. My pain is severe in both buttocks and the backs of my upper thighs. I also have some lower-back tightness. Pain is relieved upon sitting or lying down.

My orthopedic surgeon recommends a lumbar laminectomy and fusion. I’ve never had surgery and don’t want to have this.

I am a diabetic, and this adds to my concerns about recovery from surgery.

I’m doing strengthening exercises, and I’ve been getting epidurals, with varying degrees of relief. I cannot take anti-inflammatories due to bleeding issues. Extra-strength Tylenol gives some relief.

Are there other treatments available? My surgeon says no. Would losing weight help? I’m about 40 pounds overweight. What about following an anti-inflammatory diet? — M.S.

Answer: Spondylolisthesis is when the vertebrae are not lined up properly, and one is moved forward compared with another. This causes stretching and sometimes compression of the spinal cord. Stenosis is narrowing, which means that the nerve roots, coming off the spinal cord to form the nerves, are being pressed on.

I don’t like to send people to surgeons for back pain, since most people get better without surgery. However, there are some times when surgery clearly is the best treatment, and a few times when surgery is needed quickly. If the nerve is being compressed severely, then there will be not only pain, but loss of reflexes, numbness and weakness. The major concern is weakness. Progressive weakness means surgery is needed urgently.

If you have no weakness, then surgery probably is not your only option. Losing weight, in my experience, always helps. Strengthening exercises, preferably supervised by a physical therapist, likewise can be very helpful.

There are medication options for people with bleeding issues, if you need something stronger than Tylenol.

Because the problem is largely anatomical, I don’t think an anti-inflammatory diet will cure the problem, but eating healthy foods will make you feel better and will help you lose the weight. You are quite right that because of your long-standing diabetes, the healing from surgery may take longer.

But you should not let that stop you if you have an urgent need for surgery. Fortunately, it doesn’t sound like you are there yet.