I’m stuck between a rock and a hard place. I had spinal fusion four years ago at the L45 level for a large herniated disc. After the operation, I had much more back pain than before the surgery. It lasted months and months before finally going away. Now I need another level fused. I hate the thought of facing the surgery and postoperative back pain. Any suggestions?

Most experts suggest a course of conservative care for back pain before surgery. This is true even if there has been known injury or disc protrusion. Antiinflammatories, exercise, and physical therapy should be given a fair trial before turning to surgery.

If it’s been at least six months with nonoperative care and you’re still no better, then surgery may be an option. But any back surgery has its risks. With open back surgery, a large incision is made through the skin and soft tissues. Special tools called retractors are used to pull the muscles and soft tissue aside. This gives the surgeon a clear view and access to the spine.

Studies now show that using the retractors for too long can contribute to the increased back pain some patients reported after spinal fusion. A new method of releasing the retractors for five minutes every hour is being tried with animals. So far the resuls have been good.

With periodic retraction release, there is less pressure on the muscle. The result is less muscle injury and fewer problems with back pain afterwards. Talk to your surgeon about your concerns. Bring up your pain experience from the last surgery. Ask about possible alternatives to help keep this from happening again.