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When is Surgery Necessary for Neck or Low Back Pain?

Published on Sep 20, 2014 and last reviewed on May 04, 2022   -  4 min read

Abstract

Patients need to understand the probability that neck or low back pain surgery will improve their lives.

When is Surgery Necessary for Neck or Low Back Pain?

Introduction:

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.

Conclusion:

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.

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Frequently Asked Questions


1.

What Are the Indications for Neck Surgery?

There are three main signs or conditions that may require neck surgery -
- Cervical Radiculopathy - A condition caused by exerting excessive pressure on one nerve root present in the neck.
- Spinal Cord Compression - A condition in which the spinal cord gets compressed or inflamed. 
- Fractured Neck - One or more neck bones get fractured.
- Nerve compression is getting worse.
- No success in non-surgical treatment plans.
- Neck instability.

2.

What Are the Conditions in Which Neck Surgeries Are Contraindicated?

Reasons to avoid neck surgery are - 
- High Blood pressure.
- Uncontrolled blood sugar level.
- Intolerance to general anesthesia. 
- Pregnancy.
- Previous failed neck surgeries.
- Breathing difficulties.

3.

What Are the Chances for Successful Neck Surgery?

The success rate of neck surgery is high and helps eliminate neck pain. In addition, neck surgeries are safe and effective; there are 85 % to 90 % chances of successful neck surgery.

4.

What Are the Risks Involved in Neck Surgery?

Generally, neck surgeries are safe and successful. The following are the risk involved in neck surgery -
- Nerve damage.
- Swallowing difficulties.
- Breathing problems.
- Hematoma at the site of injury.
- Infection.
- C5 palsy.
- Chronic pain and shiftiness.
- Incomplete or faulty bone fusion.
- Leakage of cerebrospinal fluid.

5.

Is It Possible to Lead a Normal Life After Neck Surgery?

Yes, it is possible to lead a normal life after going for neck surgery. However, post-surgery, an individual may face some difficulties while standing and sitting. It takes 3 to 4 weeks to get back to routine activities.

6.

What Is the Duration of Neck Surgery?

Neck Surgery is safe as well as complicated as it involves handling the spinal cord, which can lead to many complications. The time duration of the surgery is around 4 to 6 hours till the patient comes back in a conscious state.

7.

What Percentage of People Suffering from Back Pain Require Back Surgery?

Back pain is one of the most common problems observed, especially in older people. However, it can be subsided with the indication of medication and infection for pain management. Only 10 % of people require back surgery for problems like back pain.

8.

Is Neck Surgery Advisable?

Yes, neck surgery is recommended when the non-surgical treatment is ineffective for the patient, and neck surgery is a safe procedure with a high success rate. However, every surgery comes with some complications.

9.

When Can a Patient Recover Their Voice After Neck Surgery?

Most of the patients recover their voice after neck surgery in 2 to 3 weeks. But in some cases, there might be some change in the quality and the sound of the voice.

10.

Why Are Neck Surgeries Performed From the Anterior Side of the Neck?

It is recommended to perform neck surgery from the front side of the neck for easy accessibility. The posterior part of the neck has a spinal cord, spinal nerves, and other strong neck muscles, making it difficult for the operator; performing surgery from the front side helps avoid damage to the associated parts of the neck.

11.

How to Prepare for Neck Surgery?

Following are the things to keep in mind before going for neck surgery -
- Do not eat or drink prior to the surgery.
- Do not consume alcohol; it may hamper the effect of anesthesia.
- Avoid administration of medication like blood thinners, corticosteroids, and nonsteroidal anti-inflammatory drugs.
- Wear loose clothes.

12.

What Are the Different Types of Back Pain Indicated for Back Surgery?

Following are the types of back pain that require back surgery -
- Slipped disk.
- Bone spur in the joints.
- Degenerative spinal conditions.
- Spinal infection.
- Tumor in the spinal cord.
- Broken or dislocated joints.

13.

What Are the Different Types of Surgeries Performed for Neck Pain?

Surgeries indicated for neck pain are -
- Anterior cervical discectomy and fusion - It is one of the most common neck surgeries using discectomy performed to remove the problem-causing part of the neck.
- Cervical artificial disk replacement - It is a newer type of surgery involving the removal of a disc and replacement by an artificial disk.

Article Resources

Last reviewed at:
04 May 2022  -  4 min read

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