Over the past twenty years, spinal surgery for painful neck and low back conditions has become much more common and sophisticated. Unfortunately, surgery for low back and neck problems is often expensive, exposes the patient to the risks of complications, and requires time for recuperation. While many patients find great relief after surgery, there remain a considerable number of patients who, despite undergoing very technically advanced procedures, find their lives and pain unchanged. Therefore, patients need to understand how the surgery will help in their case.
There are basically two types of surgery done for spinal problems in the neck and back.
1. Decompressive Operations:
These operations remove abnormal pressure on the nerves to reduce neurological pain and give a chance for improvement in neurological dysfunction.
The benefit of decompressive surgery in improving neurological dysfunction and pain where there is a progressive weakness, numbness, and the presence of bladder, bowel, or sexual dysfunction is well established and accepted.
Patients with very minor dysfunction or neurological pain from a herniated lumbar disk, however, who have been treated without surgery, when compared with those who underwent surgery at one year's time, seem to have the same outcome, meaning that the surgery for this population did not seem to be absolutely necessary.
2. Reconstructive Operations:
These operations are performed when there is a concern that the spine's stability and ability to maintain its support and alignment safely are threatened.
The benefit of reconstructive surgery, the joining of two or more adjacent vertebrae, was traditionally considered for those who had clinical findings of spinal instability. Instability means that the spine is not strong enough to resist injury from normal everyday stresses. If left untreated, this instability will lead to further deformity (misalignment or slippage of the vertebrae) and neurological dysfunction from nerve compression.
The benefit of reconstructive procedures for these types of spine pain sufferers as compared with those treated with rehabilitation alone is controversial. Patients who undergo reconstructive surgery still need to undergo extensive rehabilitation.
Imaging studies may reveal objective clinical evidence of cervical, thoracic, or lumbar spine instability. A plain X-ray should be performed by asking the patient to flex and extend the affected area of the spine to rule out occult instability because X-rays that are done only in the standard view may be misleadingly normal.
Significant destruction of both facet joints or the vertebral body by trauma, infection, tumor, or surgery may create a need for a fusion by viewing a CT (computed tomography)scan of the spine or MRI (magnetic resonance imaging) of the spine.
Most patients with neck or lower back pain suffer pain, not from pressure on the nerves. Still, it is hypothesized that dysfunction of the intervertebral disks is the soft tissue shock absorbers between the vertebrae or the facet joints between adjacent vertebrae.
To date, no reliable objective test for measuring this phenomenon is known. So, that is often, at best, an educated guess by the surgeon as to what exactly is causing neck or low back pain without traditional signs of instability or nervous system compression. In addition, provocative testing such as injecting the disk, called discography, is subjective in nature and not always reliable.
Lifestyle changes for those suffering from neck or low back pain without instability or nervous system compression:
Use the body the right way while lifting heavy things.
Lose weight if obese.
Change your occupation if it is a physically demanding one.
Get treatment for addiction to pain medication.
In the absence of significant neurological dysfunction or instability, pain associated with disk herniation or degenerative spine changes, a thorough trial of conservative treatment including physical therapy consisting of body mechanics instruction, stretching, and core strengthening, instruction in lifestyle changes, and patient counseling with reassurance should be done before consideration for surgery.
Here is a rating of the relative benefit of the neck or low back surgery indications.
Strong Indications for Surgery for Neck or Low Back Pain:
Significant neurological dysfunction where imaging studies corroborate the localization of dysfunction seen on clinical examination or physiologic studies like electromyogram (EMG) and nerve conduction studies (NCS) and when there is a great probability of neurological improvement following surgery.
Progressive subluxation (partial dislocation of a joint) and slippage of a vertebra relative to another lead to progressive neurological dysfunction.
The decompression of the spine is likely to render the spine unstable, thus necessitating a reconstructive procedure as well.
Progressive compression of the nerves and/or instability of the spine are either present or likely to occur in the future from a tumor, infection, trauma, developmental abnormality, or previous surgery.
Equivocal Indications for Surgery for Neck or Low Back Pain:
Reconstructive procedures, fusion (the joining of adjacent vertebrae into one), or artificial disk placement for repeated herniated lumbar disc have mostly caused leg pain and nerve dysfunction without instability.
The reconstructive procedure, fusion, or artificial disk placement for pain is mostly confined to the spine without nerve compression or instability for patients who have physically demanding jobs requiring heavy lifting. Most patients in this situation can still not return to their previous job.
Reconstructive procedures, fusion, or artificial disk placement for pain mostly confined to the spine at a single level of involvement with other disks being normal.
Weak Indications for Surgery for Neck or Low Back Pain:
Reconstructive procedures, fusion (the joining of adjacent vertebrae into one), or placement of artificial intervertebral disks in patients with mostly leg pain from a herniated lumbar disk and no clinical instability for the first time are the weak indications for surgery for neck and low back pain.
Reconstructive procedures for patients who have multiple levels of disk abnormalities in the spine without instability or nerve compression to treat low back or neck pain.
A devastating nerve or spinal cord injury will likely not improve following surgery. After a spinal cord injury, patients with no motor function have a low probability of returning to normal functioning following decompression.
Get a second opinion from a qualified spine specialist before accepting or getting operated on for a back or neck surgery. Spine surgeons may have different opinions regarding when and what type of surgery to perform.
Frequently Asked Questions