You’ve probably heard of a friend or loved one whose back pain resulted in a spinal fusion surgery, but you may not understand what prompted surgery over non-surgical approaches, including chiropractic care.

Simply put, spinal fusion is a surgical technique that aims to eliminate excessive motion (instability) in the spine by fusing two or more vertebrae together. Fractures related to trauma are a common reason for spinal instability, but excessive motion can also be caused by conditions such as spondylolisthesis (when one vertebra slides forward on another) and age-related disk degeneration.

When is a fusion necessary? The short answer is after every non-surgical option fails to result in a satisfactory outcome. The long answer is when there is progressive neurological loss or deficit, cauda equina syndrome, failed non-surgical care, failed prior surgical care, x-ray evidence of instability with neurological signs, and unremitting pain that affects one’s quality of life. Treatment guidelines are not always followed, as many patients consult with a doctor of chiropractic only after they’ve already been advised that their lower back condition requires surgery.

The good news is that most conditions of the lower back can be managed with non-surgical chiropractic care, especially early on. With any musculoskeletal injury, it’s almost always best to seek care right away when the symptoms may be milder. Ignoring an injury may cause it to worsen and/or lead to the formation of scar tissue in the affected area and secondary problems elsewhere as the body attempts to compensate for mobility impairments. Conditions like chronic back pain can still respond well to chiropractic care, but keep in mind, it may take longer to achieve a successful outcome.

However, there are times when surgery is necessary. Surgery may include decompression of the nerve without fusion, but in cases of spinal instability, fusion may be needed, which is determined on a case-by-case basis. There are always risks associated with surgery, which is why it’s so important to exhaust non-surgical options first. When appropriate, your doctor of chiropractic can help facilitate in the referral process for a surgical consultation.