Spinal Surgery Best Option for Spinal Stenosis, Spondylolisthesis, and Instability
Orthopedic surgery, particularly on the back, can be tricky and cause complications. However, when surgery is done, it usually improves a person's quality of life considerably. This is important to note because it could be tempting to not do surgery sometimes but studies have shown that people with spinal problems may have a lower quality of life than even those who have cancer or heart failure. The authors of this study wanted to see how surgery affected quality of life, so they performed a study by following 777 patients with different orthopedic (bone) problems, not just of the back.

The patients were divided into 12 groups. One group included those who had cancer in the bone in an arm, another had artificial shoulders that had come loose, another had knee problems, and so on. During the study, 184 patients didn't complete the questionnaires and were considered lost to follow up. All patients completed a questionnaire before surgery and then completed it again one year after surgery. The researchers used the EuroQol (European Quality of Life scale) and the SF-36 (36-Item Short Form Health Survey, version 1) as the questionnaires.

The results of the questionnaires showed that patients who underwent spinal surgery for spinal stenosis (narrowing of the spine), spondylolisthesis (stress fractures in the spine that have shifted), instability, or chronic lower back pain, had a poorer quality of life than any of the other patient groups. Among all the patients who had surgery in all groups, it was those who had surgery for spinal stenosis who had the best quality of life improvement, followed by those who had ankle surgery because of osteoarthritis.

Other surgeries, such as disc surgery, did improve quality of life, but not to the high level that it did for spondylolisthesis. Those who had surgery for chronic low back pain didn't see big changes in quality of life.

These were the results of a few of the groups:

Total hip replacement: Physical functioning and quality of life improved, and pain decreased significantly.
Total knee replacement: Similar to the hip surgery but a not as significant difference in change of quality of life.
Revision hip surgery: Didn't have as big an impact as the original hip replacement.
Spinal stenosis with laminectomy: When the back surgery involved removing part of the damaged bone, there was a great improvement in the quality of life, as with the total hip replacement.
Chronic lower back pain: Not much difference in quality of life before and after one year but the physical functioning was improved.

The authors of this study concluded that back surgery for some issues is beneficial to the point that it definitely improves the quality of life in many patients. However, this isn't so for all surgeries, particularly for chronic back pain that doesn't have such a distinct and identifiable cause.
Tommy Hansson, MD, PhD, Elisabeth Hansson, PhD, and Henrik Malchau, MD, PhD. Utility of Spine Surgery. In Spine. December 1, 2008. Vol. 33. No. 25. Pp.2819-2830.