Back and neck pain are extremely common, affecting millions of people worldwide. While most back and neck pain can be managed with conservative treatments like rest, ice/heat, medication, physical therapy, chiropractic care, massage, etc., sometimes surgery is necessary. Spine surgery is a big decision and requires careful consideration of the potential risks and benefits. Here is an overview of how you can evaluate if spine surgery may be right for you.
When should I consider spine surgery?
In general, spine surgery is only recommended when conservative treatments have not provided sufficient relief of your symptoms after several months. Red flags that it may be time to discuss surgical options with your doctor include:
- Persistent or progressive neurologic deficits (e.g. weakness, numbness, loss of coordination or bowel/bladder function)
- Unrelenting pain that significantly impacts quality of life
- Spine instability or severe deformity
- Compression of the spinal cord or nerves
Seeking surgical treatment earlier may be warranted in cases of trauma, tumors, infection, or rapidly progressive neurological decline. Your physician will determine if you meet the criteria for surgery based on your symptoms, exam findings, duration of the problem, and results of imaging tests like X-rays, CT scans or MRIs.
What are the most common reasons for spine surgery?
Some of the most frequent indications for spine surgery include:
- Herniated disc – Rupture of the jelly-like disc between vertebrae allows disc material to irritate nearby nerves. This often causes sciatica or arm/neck pain depending on the location of the herniation.
- Spinal stenosis – Narrowing of the spinal canal compresses the spinal cord and nerve roots. This typically produces neurogenic claudication (leg pain with walking that improves with sitting down).
- Degenerative disc disease – Loss of disc height due to aging and wear-and-tear can cause instability, pinched nerves, and arthritis.
- Spondylolisthesis – Vertebral slippage places stress on nearby tissues. Symptoms include back stiffness and radiculopathy (leg pain).
- Spine fracture – An acute traumatic fracture or collapse of a vertebra due to weakening from osteoporosis.
- Spinal deformity – Abnormal curvatures like severe scoliosis or kyphosis can cause pain, neurologic issues, and impaired posture/mobility.
- Spinal tumors – Both malignant and benign spinal tumors can require surgery if causing intractable pain or neurological deficits.
What types of spine surgery procedures are performed?
Common spine operations include:
- Discectomy – Removal of herniated disc material pressing on a nerve root.
- Laminectomy – Elimination of the lamina bone and ligaments to decompress pinched nerves.
- Foraminotomy – Enlarging of the neural foramen opening to relieve nerve root impingement.
- Spinal fusion – Permanently joining vertebrae together for stability using bone grafts and instrumentation.
- Artificial disc replacement – Removing a damaged disc and inserting an artificial prosthesis.
- Vertebroplasty/Kyphoplasty – Injecting bone cement to stabilize fractures and reduce pain.
- Spinal instrumentation – Utilizing rods, screws, wires, or plates to correct deformity or facilitate fusion.
The specific operation recommended will depend on factors like location of compression, number of levels affected, presence of instability, and surgeon preference.
What are the potential risks of spine surgery?
Spine surgery is highly effective when appropriately indicated, but does come with risks including:
- Infection
- Bleeding
- Nerve injury
- Paralysis
- CSF leak
- Need for reoperation
- Adverse reaction to anesthesia
- Chronic pain or numbness
- Implant complications
Be sure to discuss the specifics of your procedure with your surgeon, including likelihood of risks. For many operations, the risks are small when performed by an experienced spinal surgeon.
What questions should I ask my doctor about spine surgery?
Important questions to ask when considering spinal surgery include:
- What exactly is wrong with my spine?
- What approach/procedure do you recommend and why?
- How soon does surgery need to be done?
- What are my alternatives to surgery?
- What are the potential risks and benefits of this surgery?
- What will rehabilitation involve after surgery?
- How long is the recovery period?
- Will surgery completely resolve my symptoms?
- What outcomes can I expect in terms of pain relief and function?
Understanding the answers to these questions will help you make an informed decision if spine surgery is the right choice for your particular situation.
How can I determine if a spine surgeon is highly qualified?
Tips for finding a skilled, experienced spine surgeon include:
- Choose a board-certified orthopedic surgeon or neurosurgeon who specializes in spine procedures.
- Select someone fellowship-trained in spine surgery.
- Find a surgeon who is highly experienced in your specific spinal diagnosis.
- Look for a surgeon with privileges at a major hospital.
- Confirm they have low complication and infection rates.
- Ask how frequently they perform the procedure you need.
- Check their malpractice history.
- Read online reviews, but take negative reviews with a grain of salt.
- Make sure you feel comfortable communicating with the surgeon.
Conclusion
Undergoing spinal surgery is a major decision that should not be taken lightly, but it can also provide immense relief of pain and neurological symptoms when conservative treatment fails. By understanding when surgery may be appropriate, the common procedures, associated risks, and questions to ask your surgeon, you can make the most informed choice. Finding an experienced, trusted spine specialist is also key to achieving the best outcome from surgery.