This is a question that is frequently asked by patients. Many state that they have been told to “never have spinal surgery.” Spinal surgery historically has developed a poor reputation because of decades of poor results. This created a misperception that if one has spinal surgery, his or her life would never be the same. This cannot be further from the truth when modern spinal surgery is performed by a qualified, competent spinal surgeon. The entire goal of modern spinal surgery is to minimize the trauma of the surgery on an individual, while maximizing the return to function. Most patients who undergo proper surgical treatment for one or two levels of spine pathology usually experience a full and complete return to their lifestyle. This is especially true in the motivated patient who is willing to perform a quality rehabilitation program and comply with the necessary exercise and fitness regimen to optimize their overall spine health.
To understand why spinal surgery has developed such a bad reputation, we must realize that the era of modern spinal surgery only began during the past fifteen to twenty years. It has only become common place nationally in the past decade. Prior to the early 1990s, the instrumentation that was available to treat spinal conditions was mainly first and second generation equipment. In the 1950s through 1970s, patients were frequently kept on bed rest for months at a time after spinal fusion in order to try to obtain a solid arthrodesis. Even with these prolonged periods of bed rest, a stable fusion was frequently not achieved. Minimally invasive surgery did not exist and every operation required major trauma to the body and major disruption of muscles. More recent implants have great technological improvement. Current instrumentation advantages include: lower profile, greater strength, and ease of use which allows smaller incisions and faster surgeries. These modern options allow patients to be mobilized immediately after surgery, eliminating debilitating bed rest. The main reason the national incidence of spinal surgery has increased over the past decade is because of improved knowledge combined with improved technology.
Through gradual technological developments in the 1980s, initial improvements were made thereby decreasing the failure rate of surgeries. All of the work that was performed in the 1980s led to great technological breakthroughs in the 1990s and into the early 2000s. Over the past decade, we have significantly improved upon these monumental gains. Now, spinal surgery is performed minimizing the trauma to the body, preserving maximum function, and optimizing a patient’s return to his or her life. Many patients who have undergone minimally invasive discectomy or even major lumbar reconstructive fusion surgery have returned to professional athletics, golf, running, work, and most importantly, their families. I feel truly blessed as a spinal surgeon to be able to help so many people recover from severe incapacitating pain and guide their return to full and complete lives. This is only possible because of monumental advances which modern surgery and true spine specialists bring to our patients.
In answering the question, “Should I have spinal surgery?”, the answer is simple. If you need it, then, yes, one should have spinal surgery performed by a spinal specialist. However, if one has reasonable non-operative options to improve their function, then by all means those should be completed prior to performing any surgery. I have had patients come to me and say that they were told by a physician that they should not have spinal surgery until urine was running down their leg. I could not disagree more with such a comment and feel that it is inappropriate for a medical professional to make such a dangerous statement. If one would wait until they were suffering from severe neurologic deficit to undergo surgery, then the ability to return them to a full and active lifestyle may be impossible at that point. Furthermore, they may suffer permanent neurologic dysfunction. One of the clear urgent indications for spinal surgery is progressive loss of nerve function. The symptoms of this may include numbness in an extremity, weakness in an extremity, or loss of bowel or bladder function. Even persistent radiating pain into an extremity that goes untreated can lead to permanent nerve damage and chronic painful conditions. If a patient experiences persistent or even recurrent radiculopathy from a spinal nerve impingement, for greater than three months, then I would often recommend surgical correction. Surgery could be performed on it sooner if the patient’s symptoms were not tolerable, or deteriorating, or the spinal imaging studies demonstrated pathology which, in the opinion of the spine expert, would not improve with additional non-operative care.
The bottom line is that spinal surgery, when done for the right reasons and in the proper fashion, can yield excellent results. Delaying treatment unnecessarily can often limit the results of the surgical procedure as well as impair the patient’s recovery. In essence, delaying surgical treatment may compromise the success of surgery. For spinal surgery to accomplish the best results possible, it must be coupled with a quality rehabilitation program, a committed patient, and appropriate timing of surgery to optimize the body’s ability to recover. The appropriate time is determined based upon the patient’s symptoms, the patient’s needs, their response to non-operative treatment, the pathology identified on the diagnostic studies, and the surgeon’s experience and expertise. Understanding all of this, the answer to the question, “Should I have spinal surgery?” is yes, if the above criteria are met.
– Thomas C. Schuler, MD, FACS