Will I need spine surgery?
Progressive nerve deficits are one of the few indications for spine surgery. Most people with back pain do not need surgery. More research shows the long term benefit of surgery is not much different than non surgery options. In conditions such as spinal stenosis people do not benefit from surgery such as fusion in the long term. If you have severe muscle weakness, complete loss of sensation, or loss of bladder function you should consult a physician to determine if you need surgery. If you are no longer able to urinate you should go to hospital quickly as it is an emergency situation. There are many surgical options but most people with back pain do not need surgery.
What are the risks of surgery?
There are a number of risks for spine surgery. Risks include reaction to anesthesia or other drugs, bleeding, infection, blood clots, heart attack, stroke, herniated disc, and nerve damage. Nerve damage can result in weakness, paralysis, pain, sexual dysfunction, or loss of bowel or bladder control. Each surgery has different risks. If you consider surgery you should not only know the potential benefit but also the risks.
Can I just have a minor surgery?
In regards to spine surgery there is not a minor surgery. Each surgery has risks and minimally invasive does not mean the surgery is less. The fancier the surgery the more complex it is which could lead to some misses or errors. Spine surgery in non emergency situations should not be taken lightly. This is a major consideration and is always a major surgery. When it comes to back pain their is no easy quick fix when it comes to surgery.
What questions should I ask about surgery?
With any surgery you should ask what will happen if you do not have surgery. You should also ask what the expected outcome is for you and ask for the available research and if you have any hesitation you should get a second opinion. There has been numerous patients who have been told they need surgery and with a second opinion were told that was not true. With nonoperative treatment their issues later resolved.
What is the cost of spine surgery?
The cost of spine surgery varies by region. The price ranges from $50,000 to over $150,000 per procedure. In a cost benefit analysis the results were not good for spine surgery. Over a 2 year period it was found the cost was $77,000 to $115,000 for quality adjusted life year. Procedures over $100,000 in the US are not cost effective. A quality adjusted life year is how you can measure the value of an intervention. With such a high cost spine surgery is one of the most expensive purchases someone will ever make.
Is minimally invasive surgery better?
Research shows that there is an increase in certain side effects with minimally invasive surgery. There may be a lower chance of overall infection however. Since the surgeon has to visualize the area they expose you to radiation which carries its own risk. Like all surgeries there is minimal trials that compare interventions. This means that you have to weigh the risks and benefits of each surgery by themselves since there is no direct comparison of benefit and risk.
What is an epidural steroid injection?
An epidural injection is injection by needle of steroids into the epidural space around the spinal cord and nerves. This is outermost point in the spinal canal. In a 2014 report the FDA notes that this surgery has been in use for decades while there has been a lack of established effectiveness and safety. The FDA had not approved corticosteroids for this use in 2014. Some people report short term relief with this surgery but you will need to consider the risks in comparison to the short term benefit. Risks include tingling, weakness, severe headache, stroke, paralysis, and death.
What is a spinal fusion?
Spinal fusion is the addition of a bone graft to a part of the spine and the goal is to have the body fix two vertebral elements to create a fusion between the two. This will stop the movement between those segments. This results in a loss of motion. As more research comes out spinal fusion is becoming less popular for people with spinal stenosis as the long term benefit is under question. With 5 to 15 degrees of motion per segment you can lose a significant amount of motion with spinal fusion. Also a second spine surgery occurs in 19% of people after initial spinal fusion within 2 years.
What is a microdiscectomy?
Microdiscectomy is a surgery to remove herniated disc material that is pressing on a nerve root or the spinal cord. In the lumbar spine this is usually done to the lower levels as herniation is more common. With the surgery they use a special scope to see the disc and nerves. The surgeon may or may not remove a small piece of the bone to see the area. People appear to benefit from this surgery in all aspects apart from work status. This means that a change in how much you work is not likely after this surgery.
What is a disc replacement?
Disc replacement is a newer surgery. It is the placement of an artificial disc in place of your normal disc between the bones in your spine. The surgery is done through the abdomen and they remove your normal disc and place an artificial disc in its place. This is not as popular as spinal fusion and most studies lack the numbers to determine if this surgical intervention is effective.
What is a laminotomy?
A laminotomy is the removal of a small part of the lamina and ligaments on one or both sides. The goal of this surgery is to leave enough of the bone to decrease the chance of instability. This surgery can be a scope procedure which is less invasive than open surgery. The goal of this surgery is to increase the space the nerves have to move. This surgery hopes to remove pressure on the nerves and is typically used for people with weakness or numbness in the lower leg due to nerve compression. Recovery rate in 37 patients who had bilateral laminotomy was 63% which should be kept in perspective when you consider this option.
What is a laminectomy?
Laminectomy is similar to the above surgery but it removes the entire bony area and the enlarged joint and ligaments are also removed. This surgery is a greater removal of bone and places people at a greater risk for spine instability. Research found 16 patients who had a laminectomy had a 43.7% recovery rate, because it may have a low rate of recovery you will need to consider it to other options.
What is a foraminotomy?
A foraminotomy is the removal of the bone around the space between the bones of the spine where the nerves exit. The goal is to increase the space lost from disc degeneration which results in the loss of space. This loss of space is normal as we age and not everyone has pain. This surgery can be done with a laminectomy or a laminotomy and is part of spinal decompression which is a common surgery when a person has nerve compression. If you have nerve problems you might have a physician tell you that you need a spinal decompression. These issues include loss of strength and loss of sensation.
What is vertebral augmentation?
Vertebral augmentation is a surgery to stabilize a fracture in the spine. The common fracture is compression which occurs in people with osteoporosis. The goal is to reduce pain and stabilize the fracture which should prevent the fracture from becoming worse.. The two common forms are vertebroplasty which is the injection of bone cement into the vertebra and balloon kyphoplasty which uses a thicker cement. This surgery is very specific to a specific problem in the spine.