Spinal Surgery: What You Need to Know

The Myth: … the only solution a spine surgeon can offer is surgery. If you believe the myth you will be interested to learn that out of 100 patients with a back or neck disorder, fewer than 5% require surgery. This means that 95% are treated without surgery. If a spinal problem falls into the 95% group, the course of treatment may include anti-inflammatory and pain medication, physical therapy, or injection therapy. Certain spinal disorders may require surgical consideration. These include bladder or bowel dysfunction, structural instability, tumor, infection, deformity, progressive neurological deficit, and unrelenting pain that cannot be controlled non-surgically. In the 5% group, certain spinal disorders arouse more concern. Notably, incapacitating back pain, inability to move an extremity, leg pain, or loss of bladder or bowel control may be signs of progressive and serious neurological dysfunction. In some cases, surgery may be the immediate treatment.

Spine surgery is not the perfect answer or a cure. This type of surgery has its own risks and is quite different from other operations. Not every patient is a candidate for spine surgery. This may relate to the patient's general health. For example, a patient with a cardiac disorder may be at risk during any surgical procedure. If one spine surgery fails, the patient may be advised against additional spine surgery because one failure may lead to another. Smoking and diabetes contributes to the risk for failed spine surgery. Patients who use tobacco are advised to stop at least one month prior to surgery. Nicotine constricts blood vessels slowing circulation, which can inhibit healing. Further, bone does not grow or mend well when nicotine is consumed. People who smoke or use tobacco are apt to have more spine and general health problems.

At one time spine surgery was reserved for younger to middle-aged patients. Today, attitudes have changed, the risks are more controllable, and research has shown that the success rate for elderly patients is as high, or higher, than some younger patients. Sometimes older patients are more motivated to get better. Younger patients may have more underlying problems such as those related to family, employment, stress, and depression. Of course older people share similar problems, but they often have fewer difficulties. During the next 25 years physicians anticipate treating a growing number of elderly patients. Research reveals that the population as a whole is increasing in age.

The Goal of Spine Surgery
The goal of any surgery is to restore the patient's health. Spine surgery is no exception. Spine specialists want to return each patient to his pre- disease or injury functional level quickly. This usually involves relieving the patient's symptoms. In general, the success rates are very good.

Patient Fear When Surgery is Recommended
The thought of spine surgery or any type of operation can frighten some patients. Fear is normal. No one wants to have spine surgery. Fortunately, most spine surgeries are not needed as emergency treatment. Therefore, the patient has the time to learn more about their disorder and the procedure. The patient has the right to decline surgery or obtain a second opinion. These rights are always respected. When spine surgery is recommended, the spine surgeon discusses the case and proposed surgical plan with the patient's primary care provider (and other specialists, such as the patient's cardiologist). The primary care physician's involvement is important as he is responsible for granting surgical medical clearance.

Patient Surgical Conference
The surgical conference is a meeting between the patient, the surgeon and/or his surgical assistance. The patient is encouraged to bring a family member or friend and to ask questions. Psychologically, a well-informed patient is less anxious about their surgery.

During the meeting, the patient's medical history, test findings, treatments, allergies, and medications are reviewed. The surgeon explains in detail the risks, possible complications, how the surgery is performed, and the patient's expected outcome. The patient is asked to sign an Informed Consent. This document outlines in writing the surgical procedure, associated risks and complications, and includes other issues discussed with the surgeon.

Some types of spine surgery can be performed using minimally invasive procedures. These types of procedures appeal to patients because in some cases, the patient may be allowed to go home the same day as their surgery or be released the following day.

Another myth about spine surgery is that a long recuperative period in bed is necessary. This simply is not true. Often the patient is up, out of bed and walking the day after surgery. Even following a complex surgical procedure the patient is up, seated in a chair and walking the next day. Rehabilitation or physical therapy may be started the day after surgery to help the patient become mobile. Many patients are quite independent a short time after spine surgery.

This article is an excerpt from Dr. Stewart G. Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A Patient's Guide (March 2005).