Editing Back pain (section)

===Surgery===
Surgery for back pain is typically used as a last resort, when serious neurological deficit is evident.<ref name=":2" /> A 2009 systematic review of back surgery studies found that, for certain diagnoses, surgery is moderately better than other common treatments, but the benefits of surgery often decline in the long term.<ref name="pmid19363455">{{cite journal | vauthors = Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD | title = Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline | journal = Spine | volume = 34 | issue = 10 | pages = 1094–109 | date = May 2009 | pmid = 19363455 | doi = 10.1097/BRS.0b013e3181a105fc | s2cid = 1504909 }}</ref>

Surgery may sometimes be appropriate for people with severe [[myelopathy]] or [[cauda equina syndrome]].<ref name=":2" /> Causes of neurological deficits can include [[spinal disc herniation]], [[spinal stenosis]], [[degenerative disc disease]], [[Neoplasm|tumor]], infection, and spinal [[hematoma]]s, all of which can impinge on the nerve roots around the spinal cord.<ref name=":2" /> There are multiple surgical options to treat back pain, and these options vary depending on the cause of the pain.

When a herniated disc is compressing the nerve roots, hemi- or partial-[[laminectomy]] or [[discectomy]] may be performed, in which the material compressing on the nerve is removed.<ref name=":2" /> A multi-level laminectomy can be done to widen the spinal canal in the case of spinal stenosis. A [[foraminotomy]] or foraminectomy may also be necessary, if the vertebrae are causing significant nerve root compression.<ref name=":2" /> A discectomy is performed when the intervertebral disc has herniated or torn. It involves removing the protruding disc, either a portion of it or all of it, that is placing [[pressure]] on the [[nerve root]].<ref>{{cite web|url=http://www.ehealthmd.com/library/backpain/BAK_surgery.html|title=Surgery For Back Pain|access-date=June 18, 2010|archive-url=https://web.archive.org/web/20080517135512/http://www.ehealthmd.com/library/backpain/BAK_surgery.html|archive-date=May 17, 2008|url-status=dead}}</ref> [[Total Disc Replacement|Total disc replacement]] can also be performed, in which the source of the pain (the damaged disc) is removed and replaced, while maintaining spinal mobility.<ref>{{Cite book|title=Benzel's spine surgery : techniques, complication avoidance, and management| vauthors = Steinmetz MP, Benzel EC |isbn=978-0323400305|edition=Fourth|publisher=Elsevier Health Sciences|location=Saint Louis|oclc=953660061|date=2016|page= }}{{page needed|date=February 2021}}</ref> When an entire disc is removed (as in discectomy), or when the vertebrae are unstable, spinal fusion surgery may be performed. [[Spinal fusion]] is a procedure in which [[Bone grafting|bone grafts]] and metal hardware is used to fix together two or more vertebrae, thus preventing the bones of the spinal column from compressing on the spinal cord or nerve roots.<ref name="Burke22">{{cite book | vauthors = Burke GL | title = Backache from Occiput to Coccyx | chapter-url = https://www.macdonaldpublishing.com/Chapter_9.html | archive-url = https://web.archive.org/web/20160820105826/https://www.macdonaldpublishing.com/Chapter_9.html | archive-date = 20 August 2016| chapter = Chapter 9: The Surgical Treatment }}</ref>

If infection, such as a [[spinal epidural abscess]], is the source of the back pain, surgery may be indicated when a trial of antibiotics is ineffective.<ref name=":2" /> Surgical evacuation of spinal [[hematoma]] can also be attempted, if the blood products fail to break down on their own.<ref name=":2" />