Not all spine problems need to be seen by a spine surgeon. Majority of these symptoms are resolved within few weeks. Initial treatments in all kind spine problems are hot/ cold fomentation, local analgesic gel application, spinal braces, activity restrictions, pain medicines, muscle relaxants and physiotherapy. Patients’ family physician or regular orthopedic surgeon can prescribe this treatment. Pain not subsiding after taking these treatments for few weeks indicates that there is a significant problem in spine, which needs to be further evaluated and investigated. In following situations a spine specialist’s opinion should be taken:
Spinal surgery is required if the patient has severe neck or back pain; severe pain, numbness or weakness in arms or legs. Significant symptoms affecting daily life of the patient and not responding to other non-operative treatments like medicines, physiotherapy, bed rest etc. are a good indication for need of surgery. Decision to undergo surgery is usually left to the patient depending on how much the symptoms are affecting him/ her.
No. Surgery is usually kept as a last option. Majority of the patients respond well to medications, physiotherapy and other non-operative treatments, especially if the problem is of recent onset. Read more…
Decision to have surgery or not is usually left to the patient depending upon the amount of suffering patient has and result of previous non-surgical treatment. However, if patient has tried non-surgical treatment for sufficient period and not getting relief, then it is recommended to get the surgery done. There are certain emergency situations where spine surgery is recommended on immediate basis. Most of these emergencies are due to acute damage to the nerves. In some cases where spine is unstable, immediate surgical instrumentation and stabilization of the spine is required to prevent damage to nerve/ spinal cord.
As per the spine literature, which we also notice in our practice, longer the patients suffer before undergoing definitive surgical treatment, longer it takes for them to recover after surgery. One of the main reasons behind it is that their nerves are significantly (and in some cases permanently) damaged which take months to recover. Also, in a patient who is suffering from spine problems since long, muscle weakness occurs, causing recovery process to be extremely slow. A reasonable period of non-surgical treatment is always warranted; however, an unnecessary delay in getting required surgery done will lead to slow and in some cases incomplete recovery. This is one of the main reasons why many patients do not recover completely after surgery.
Spine surgery is basically divided in two broad categories; 1) decompression only and 2) Spine instrumentation and fusion (commonly done along with decompression of the nerves in majority of the cases). Spinal decompression surgeries are done to remove pressure of the disc, bone and ligaments on the nerve to help them recover. Spine Instrumentation is required to stabilize the spine in cases where backpain or neck pain is significant, in cases with associated instability of the bone, spinal infection, spine fracture and deformity correction.
Patients are scared of spine surgery. Partly this is because of the wrong information they get from friends and relatives. But it is also partly due to other patients they have seen who were recommended prolonged bed rest after spine surgery in the past.
In the past, due to extensive nature of the surgeries and non-availability of rigid spine instruments, it used to be necessary to keep patients in bed until there soft tissue/ bone healing takes place. This sometimes used to take months. Spine surgery is greatly evolved in the last decade. Patients can sit and walk very next day after the surgery. In micro-endoscopic surgeries, patients are allowed to walk on the very same day of surgery. Advanced spinal instrumentation provides strong support to spine to allow patient to get mobilized soon after surgery. In certain situations where patient has weakness in legs, bones are extremely fragile (osteoporosis), old age, and complex surgeries, a few days of rest is recommended.
Patients can sit, stand and walk on same day or very next day after the surgery in majority of the cases. An office going person can resume his job as early as within 3-4 days after the surgery. However, for someone whose job requires heavy labour or sports, 3-6 months are required before they can do unrestricted activities.
Spine is a dynamic structure. After a discectomy/ decompression surgery, continuous wear and tear of the disc and joints can cause recurrence of disc prolapse and spinal canal stenosis, which can cause recurrence of the symptoms. This might need another surgery if symptoms are severe. Also, as spine is made up of multiple bones, other levels also can get affected independently. However, percentage of patients requiring repeat surgery is very low.
It’s a common myth that spine surgery is risky and can cause paralysis. With the recent advances in surgical techniques, availability of specialized instruments and minimally invasive procedures, spine surgery has become as safe as any other surgery. It is extremely rare to have paralysis after spine surgery. Theoretically, it is possible as spinal cord is right next to surgical area. Use of microscopes and endoscopes provides magnified view of structures during the surgery, so chances of nerve injuries are minimal. Even in high risk and deformity correction surgeries, neuro-monitoring allows continuous assessment of the nerve function during surgery to prevent any nerve damage. Use of fluoroscopy and navigation techniques helps in precise instrument placement.
A patient taking a decision to undergo spine surgery almost always wants a surety that he/ she will be 100% cured of the spine related symptoms and those symptoms will never come again. Though, a 100% recovery can never be guaranteed, a well-executed surgery in a patient with correct indication gives excellent results. Many patients get 100% relief also.
A patient who undergoes nerve decompression surgery, some amount of back pain might remain due to persistent disc degeneration. Similarly, if nerve was compressed for a long duration and compression was severe, nerve might take some time to recover. Patients who were suffering for long duration before surgery usually take longer to recover compared with patients who were suffering for shorter duration.
Normal spine has few curves when seen from side. Cervical (neck) and lumbar spine (lower back) are convex to the front, which is called cervical lordosis and lumbar lordosis, respectively. Thoracic spine (upper back) is curved backward and this is called thoracic kyphosis.
In severe painful conditions affecting cervical or lumbar spine, neck or back muscles go into spasm. This is body’s natural defence mechanism to prevent excessive movement at painful spinal area. Muscle spasm pulls anteriorly curved spine and leads to straightening of normal lordotic curvature. This is called loss of lordosis.
Minimally invasive spine surgery is not much costlier than routine spine surgery. The marginal additional cost is due to use of specialized equipment used during the surgery. For a decompression surgery, use of microscope/ endoscope might incur some equipment charges by the hospital. Endoscopic spine surgery needs certain disposable instruments (LASER probe, burr tips et.). Similarly, for fusion surgery, use of navigation/ robotics will attract equipment charges by the hospital. Minimally invasive instrumentation requires use of specialized retractors and implants, which can be marginally costlier than their routine counterparts.
Some of the increased cost of MIS spine surgeries gets compensated by reduced need of medicines and shorter hospital stay. Also, patients are able to get back to routine activities and work earlier. Other benefits of MIS surgeries also justify these procedures, even if cost of MIS procedures is marginally higher compared to traditional spine surgeries.
Function of the implant is to hold the bone until bones unite. Once fusion takes place, implant has no active function, even though it might be still providing some support to spine. Instrumentation provided with imported implants is always better and help spine surgeon perform surgery smoothly. But if cost is a concern, Indian implants serve the purpose very well. Current generation of Indian fusion implants are excellent. If fusion doesn’t take place, even imported implant is going to fail, although it happens very rarely.