Spine Surgery: How Surgeons and Patients Make Decisions Together

Doctor speaking with elderly female patientAccording to the SpineUniverse Chronic Back Pain in America 2015 Survey Results; 67% of people who were polled that underwent lower back pain spine surgery reported their spine surgeon involved them in the decision-making process. Patients are more involved in their healthcare plan than ever before; more information is available to patients, and they often become their own healthcare advocates. Surgeons have felt this shift and are now including patients in the decision-making process.

Spine surgery is needed for severe cases when pain is infiltrating all aspects of a patient’s life.  Discussing a plan of care is now a two-way conversation. Even a decade ago patients did not have the same access to information as they have now. When a patient has to undergo spine surgery, especially for chronic pain, they have to be informed.

Many spine practices use ancillary services and nonoperative spine specialists to promote conservative treatments. In cases where conservative treatments fail and surgery is the only option, patients want to feel like they are a part of the decision-making process. Surgery is a big step and scary for most patients; while no one may want to have surgery, living with chronic pain is not the better option. Surgery might be the best option if your pain is persistent and disabling.

Some surgical options for patients with chronic back pain include:

A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. At its most minimally invasive, the procedure requires only small incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact. A laminectomy is usual done to relieve symptoms of spinal stenosis.

Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root causing pain, weakness or numbness.

Spinal fusion
Spinal fusion is a permanent joining of two or more vertebrae made to grow, or "fuse" together.

Many questions exist regarding fusion:

  • Should the fusion be performed as an entity, in and of itself, or with instrumentation?
  • Should the fusion be anterior (front) or posterior (back) in location?
  • Should cages or screws be used to supplement the fusion?
  • How many levels long (or short) should a fusion be?
  • Should fusion incorporate one motion segment (disc), or two or three motion segments?

Informing and involving patients improves the quality of their medical decisions. Sometimes patients are intimidated by surgeons and are afraid to ask questions. You might be wondering what are the risks? What is the recovery time? And why is surgery a viable option for me? When you don’t ask questions, your plan of care becomes a one-way street.

If we’re moving towards collaborative care between patients and surgeons, there should be equal amounts of communication. Your healthcare choices should feel like they are made with input from both, you and your surgeon to be able to move toward a lifestyle that is productive and without pain.