If you suffer from severe neck or back pain, you may have wondered whether or not surgery is the answer for you. Naturally, you probably have a long list of questions, including:
- When is the right time for you to look into surgery?
- If you do choose surgery as an option, what risks are involved?
- How long will recovery take?
- And most importantly, will it relieve your back pain?
Unfortunately, there are no simple answers. Whether or not you go forward with spine surgery depends a lot upon your individual situation and what other treatments you may have explored. Even with surgery, there are no guarantees of 100% success.
As with any other medical treatment you seek, before you make a decision do your research on the procedures and the doctors and surgeons who are available. When considering surgery, it is probably a good idea to get input from a few experts before moving forward with any type of surgery.
I have been practicing NUCCA Chiropractic in Chesapeake, Virginia, since 2002. I am board-certified in NUCCA (National Upper Cervical Chiropractic Association), which is a safe and painless, evidence-based approach to correct spinal problems.
I also am credentialed in spinal biomechanical engineering through SUNY Buffalo, Jacobs School of Medicine. I am a fellow in spinal biomechanics and spinal trauma through SUNY Buffalo, having studied and done practical rotations in spine surgery, pain management, neuroradiology, family and emergency medicine. I also serve on the Foundation Board for Chesapeake Regional Hospital.
When looking for a spinal surgeon, make sure you do some research. It’s important to know their credentials and experience in various procedures. This article will give you some of the basics of what you need to know as an informed consumer and some of the most commonly asked questions.
Proper Evaluation
Remember, there is no one size fits all in healthcare. Being informed and an active participant in your healthcare is vital to the success of any treatment option you pursue. Therefore, make sure you discuss your options with the professionals most qualified to help you relieve your pain.
For example, I always encourage my patients to take an active role in their healthcare. After a thorough evaluation, if the evidence suggests that you should consider surgery, I will discuss your options for surgery and refer you to the medical professionals with whom you should seek further consultation.
When Surgery Might Be Right for You
Severe spine can affect the quality of your everyday life. Having surgery is a big decision.The more aware you are of the choices and the potential benefits and risks, the better. Make sure you know what questions to ask when consulting a spinal surgeon. Don’t be shy about your healthcare, surgery can be extremely helpful, but make sure it is the right decision for you.
Typically spinal surgery is performed after other noninvasive treatments (or conservative care) has not produced adequate results to relieve your back pain. The following are the best noninvasive, evidence-based treatments for spine pain that should be considered before surgery:
- Medications such as anti-inflammatories, muscle relaxers, painkillers and oral steroids
- Pain Management – typical epidural steroid injections
- Chiropractic for biomechanical problems
- Acupuncture
- Physical therapy for core muscle support
However, if you have the following exam findings, you may want to give surgery serious consideration sooner rather than later:
- Myelopathic findings upon exam (spinal cord or central canal compression)
- Sharp radiating and electric like pain down your arms or legs
- Significant neurological deficits (muscle weakness, sensory loss, absent or pathological reflexes)
- Loss of bowel and bladder control (cauda equina syndrome)
- Instability after a trauma
- Pathology such as bone or soft tissue tumors
In these situations we always recommend advanced imaging (MRI or CT) and immediate neurosurgical consultation.
When Conservative Care Is No Longer An Option
If you have tried conservative care but continue to experience significant spine pain, it might be time to consider surgery. Make sure you know what type of doctor to see and what type of doctor is best for your condition, for example:
- Orthopedic spine surgeon (with or without fellowship in spine)
- Neurosurgeon
A thorough examination and diagnosis will dictate the best doctor for your surgical needs. We typically recommend having your initial consultation with a neurosurgeon. If they determine a surgical procedure is best for your situation, the doctor will either schedule you for surgery or refer you to an orthopedic spine surgeon who is most appropriate for your condition.
Surgical Options and Approaches
Spinal surgeries and technology have advanced significantly over the years. Depending upon your condition and surgical needs, you may have the option of traditional open procedures vs. minimally invasive procedures.
Traditional Open/Posterior Surgeries
An open, posterior surgical approach usually involves lying on your stomach under anesthesia while the surgeon makes a large incision along your spine through your surrounding spinal muscles. A retractor is used to open up an area large enough to see the damaged area and work openly by sight.
The open posterior approach can be helpful for operating on multi-level decompressions and fusions, as the doctor can better address challenges such as dural adhesions of the pathological tissue involved. This approach also allows for better visualization of the nerve roots, thus less risk of damage to them during the procedure.
The drawbacks can be longer recovery times, disruption of healthy supporting muscles, and the necessity to remove the posterior elements of the spine (spinous process, lamina), more blood loss, and longer hospital stays.
Minimally Invasive Surgeries (MIS)
Typically, the goal of minimally invasive approaches is to preserve the spinal bones and joints and/or relieve pressure on the spinal nerves. Minimally invasive surgical approaches can be faster, safer, and require less recovery time. Because of the reduced trauma to the muscles and soft tissues (compared to open procedures), the potential benefits are:
- Less scarring due to smaller skin incisions
- Less blood loss during surgery
- Reduced risk of muscle damage due to less or no cutting of muscle tissue
- Less disruption of of bony structures and facet joints
- Reduced risk of complications and postoperative pain
- Less time in the hospital and even may be an outpatient procedure
- Faster recovery from surgery and less rehabilitation required
- Diminished reliance on pain medications after surgery
The risks can be the inability for the surgeon to see all of the structures as in an open approach. If the cannula is placed incorrectly, there is the chance for an incomplete surgery and the need for revision.
Tubular Retractor
Use of a tubular retractor allows the progressive dilation of the soft tissues instead of cutting directly through the muscles. Thus, the surgeon works through the tubes without having to make a wide incision.
The surgeon also may use an endoscope or microscope through the tube to assist with performing the surgery. Once the procedure is complete, the tubular retractor can be removed, allowing the separated tissue to come back together..
Endoscope
Endoscopy makes use of a camera at the end of the fiber optic device. The surgeon can use special instruments to operate though the endoscope while watching the anatomy on a screen transmitted from the camera. Thus, what the surgeon sees can be more targeted and more detailed.
There are multiple options for minimally invasive procedures. Make sure you discuss with your doctor which procedure is most appropriate for you and what the pros and cons of these options:
- Tubular approach
- Endoscopic anterior or posterolateral approach
- Anterior lumbar interbody fusion (ALIF)
- Posterior lateral interbody fusion (PLIF)
- Extreme lateral interbody fusion (XLIF)
- Transforaminal lumbar interbody fusion (TLIF)
- Percutaneous pedicle screw placement (through the skin vs. open placement)
Be An Informed Healthcare Consumer
Know your options. Spine surgeons have different levels of training and experience and it is not uncommon for them to have differing opinions on the best surgical approach. Be sure to ask the doctor:
- If they are trained in minimally invasive procedures?
- If the anatomy to be corrected is best served by a less invasive approach?
- What are the success vs failure rates of the recommended approaches?
- What are the benefits and the possible risks?
We understand that you need to explore all your options when you look for a doctor to treat your neck and back pain. If surgery is necessary for you, make sure you get as much information as possible in order to make an informed decision.
At Precision Spinal Care we are happy to help you determine the best way to address your specific needs. If we can help, we will.
Call our office at (757) 382-5555 to speak with me or set up a consultation. You can also set up an appointment through our webpage.
