Lumbar Spine Surgery Alternatives

If surgery is not desired or not possible, surgical alternatives may be considered. Alternatives to spine surgeries include injection treatments, specialized forms of physical therapy and exercises, and complementary and alternative medicine (CAM).

Surgical alternatives to manage back pain and specific low back conditions are described below. This list does not cover all the potential surgical alternatives, and it is advisable for patients to consult with a pain management specialist, another surgeon, and/or other qualified healthcare practitioners to stay current on additional treatment options for their individual situation.

A process of trial and error is often necessary to find the right combination of treatments. 

Surgical Alternatives to Treat Back Pain and Reduced Function

Most treatments that aim to relieve back pain focus on the specific anatomic area that is the cause of pain. However, some therapies such as mind-body techniques focus on training the mind to cope with pain by reducing overall stress and promoting relaxation.

Spinal injections

A variety of spinal injection options are available to treat spinal pain.

Spinal injections work in one of the following ways:

• Deliver a steroid or pain-relieving medication into the area that is the source of pain to reduce inflammation and numb the pain. Common examples include:
  • Epidural steroid injections
  • Selective nerve root block injections
  • Facet joint injections and medial branch blocks
  • Sacroiliac (SI) joint injections
  • Costotransverse and costovertebral joint injections
• Create a heat lesion on a pain-transmitting nerve to prevent it from sending pain signals to the brain. This treatment is commonly known as radiofrequency ablation or basivertebral nerve ablation.
• Injecting a medicated solution (osmotic agents or irritants) into the target musculoskeletal tissue(s) over a period of several weeks with the goal of inducing tissue regeneration, promoting healing, and reducing pain. This treatment is commonly called prolotherapy but may also be referred to as ligament sclerotherapy or regenerative injection therapy.¹Rabago D, Nourani B. Prolotherapy for osteoarthritis and tendinopathy: a descriptive review. Curr Rheumatol Rep. 2017;19(6):34. doi: 10.1007/s11926-017-0659-3^,2Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med. 2021;16(1):81-95. doi: 10.17085/apm.20078

Injections directly target the anatomic location that generates pain, which may provide more effective pain relief than oral medications.

Success rates of spinal injections vary depending on the type of injection and the condition being treated.

Physical therapy

Physical therapy and exercise aim to improve the functioning of soft tissue and joints to build tissue resilience, muscle strength, and endurance and reduce pain. In some cases, a spinal injection may be given to provide adequate pain relief for participation in physical therapy. 

Practitioners may try more targeted, high-intensity exercise treatments based on the level of spinal impairment, with longer sessions lasting between 1 to 2.5 hours 2 to 3 times per week.³Thapa P, Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. Korean J Pain. 2018;31(3):155-173. doi:10.3344/kjp.2018.31.3.155^,4Delitto A, George SZ, Van Dillen L, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-A57. doi:10.2519/jospt.2012.42.4.A1^,5Cohen I, Rainville J. Aggressive exercise as treatment for chronic low back pain: Sports Medicine. 2002;32(1):75-82. doi:10.2165/00007256-200232010-00004

Spinal manipulation or manual manipulation

Spinal manipulation is a technique that treats back pain through the application of controlled force to the spinal joints.

The goal of spinal manipulation is to restore the spine’s structural integrity, reduce pain, and initiate the body’s natural healing processes.

Mind-body therapy

This therapy focuses on training the mind to become more in tune with its surroundings and experiences and how they may be affecting the body’s pain levels. Mind-body therapy works by relaxing the muscles and, to an extent, increasing one’s sense of control over the pain.

Mind-body techniques include deep breathing exercises, meditation, guided imagery, cognitive behavioral therapy, and more.

A physician trained in musculoskeletal and spinal pain can suggest the best surgical alternative for a given condition. Treatments are considered based on the patient’s general health, the results of diagnostic and imaging tests, and the types of non-surgical treatments that have already been tried.