Benefits and Risks of Spinal Surgery

Eight in 10 Americans will experience back or neck pain at some point in their lives, but finding the source of this pain remains key in returning people back to their normal activities. Spinal abnormalities fall into two categories: mechanical and neurological. Mechanical abnormalities, often caused by poor habits or health, place stress on the muscles of the vertebral column and are responsible for most back and neck pain. The goal of treating mechanical abnormalities is maximizing the health of the spine by stabilizing its biomechanical parts. Neurological abnormalities involve nerve root pain or injury, spinal cord compression, sciatica or tumors. Because the pain generator may not be obvious, the goal of diagnosing neurological abnormalities is to observe patterns of nerve damage by using peripheral nerve root blocks, facet blocks or discography.

Conservative management is initially attempted to relieve back or neck pain. This may include range-of-motion exercises, physical therapy, massage, medication, lumbar injections or nerve blocks. Spinal surgery is considered when people have failed these conservative approaches and cannot resume their normal lifestyle due to significant pain. 

Quality spine care and diagnostic techniques

People experiencing back and neck pain undergo a diagnostic work-up that includes a three-fold review of the overall history, physical exam results and radiologic studies. In most cases, an abnormal MRI is the most common diagnostic tool to indicate spinal surgery.

Depending on the diagnostic results, spinal surgery may be beneficial when a person has:

  • A treatable spinal abnormality
  • Failed reasonable efforts to treat the pain
  • An understanding of the goals and expectations of the surgery and postoperative care

Minimally invasive techniques allow for less pain and faster recovery time

If spinal surgery is indicated, minimally invasive (MI) techniques may be of benefit. Minimally invasive procedures require smaller incisions, which causes less damage to the surrounding tissue. This results in less hospital time (many of these procedures can be performed on an outpatient basis) and a faster recovery. A wide range of people can be considered candidates, as minimally invasive techniques may be indicated for people of all ages and degrees of overall health, including various factors such as weight and activity levels. Minimally invasive techniques are not appropriate for trauma situations or for idiopathic scoliosis, tumors or infections.

Minimally invasive techniques can be used for:

Minimally invasive discectomy: In this procedure, herniated disc material is removed to relieve pressure on spinal nerves. The herniated disc is accessed through a small (one-inch) incision. Because the surrounding muscles and tissues are stretched with dilators instead of cut, there is less pain and recovery time, and this may be performed as an outpatient procedure.

Minimally invasive spinal decompression and spinal fusion: Pressure on the spinal cord and nerve roots caused by bulging or collapsed discs can cause debilitating pain. In this procedure, pressure is relieved by removing the bone, bone spurs or ligaments that are pressing on the nerves. It may be necessary to also fuse the adjacent vertebra to eliminate friction and pain that may be caused by bone on bone rubbing.

Minimally invasive spinal laminectomy: Spinal stenosis, the narrowing of the spinal canal, is most common over the age of 50. This narrowing places pressure on the spinal canal and causes significant pain. With minimally invasive spinal laminectomy, a small incision is made to access the spine and remove pieces of bone to relieve pressure and eliminate pain.

Risks of spinal surgery

As with any surgery, there are general and specific risks associated with spinal surgery. General risks include possible complications with the heart, lungs, excessive bleeding or infection. The specific risks to spinal surgery include a feeling of numbness and tingling, or continued pain around the affected area of the spine. People undergoing a fusion surgery may experience a restricted range of motion or stiffening, hardware failure, or a failure to fuse. Spinal fusion may result in additional stress to the surrounding vertebrae, known as adjacent segment degeneration. This occurs in approximately 20 percent of patients, depending on various risk factors including the patient’s overall health, age, weight, and activity level.

Returning to full activity

With any spinal surgery, a postoperative regimen is critical to the success of the procedure. People may have some limitations or restrictions, such as avoiding frequent bending or twisting at the waist and lifting heavy objects. Shortly after surgery, people begin a physical therapy and exercise program to achieve rapid recovery and strength. Core stabilization, stretching and muscle conditioning are beneficial to recovery and long-term health. The ultimate goal of the procedure is for the person to return to his or her normal activities, free from the restrictive burden of back and neck pain.

Tags: orthopedics, neuroscience, spine, surgery, article
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Benefits and Risks of Spinal Surgery

Eight in 10 Americans will experience back or neck pain at some point in their lives, but finding the source of this pain remains key in returning people back to their normal activities. Spinal abnormalities fall into two categories: mechanical and neurological. Mechanical abnormalities, often caused by poor habits or health, place stress on the muscles of the vertebral column and are responsible for most back and neck pain. The goal of treating mechanical abnormalities is maximizing the health of the spine by stabilizing its biomechanical parts. Neurological abnormalities involve nerve root pain or injury, spinal cord compression, sciatica or tumors. Because the pain generator may not be obvious, the goal of diagnosing neurological abnormalities is to observe patterns of nerve damage by using peripheral nerve root blocks, facet blocks or discography.

Conservative management is initially attempted to relieve back or neck pain. This may include range-of-motion exercises, physical therapy, massage, medication, lumbar injections or nerve blocks. Spinal surgery is considered when people have failed these conservative approaches and cannot resume their normal lifestyle due to significant pain. 

Quality spine care and diagnostic techniques

People experiencing back and neck pain undergo a diagnostic work-up that includes a three-fold review of the overall history, physical exam results and radiologic studies. In most cases, an abnormal MRI is the most common diagnostic tool to indicate spinal surgery.

Depending on the diagnostic results, spinal surgery may be beneficial when a person has:

  • A treatable spinal abnormality
  • Failed reasonable efforts to treat the pain
  • An understanding of the goals and expectations of the surgery and postoperative care

Minimally invasive techniques allow for less pain and faster recovery time

If spinal surgery is indicated, minimally invasive (MI) techniques may be of benefit. Minimally invasive procedures require smaller incisions, which causes less damage to the surrounding tissue. This results in less hospital time (many of these procedures can be performed on an outpatient basis) and a faster recovery. A wide range of people can be considered candidates, as minimally invasive techniques may be indicated for people of all ages and degrees of overall health, including various factors such as weight and activity levels. Minimally invasive techniques are not appropriate for trauma situations or for idiopathic scoliosis, tumors or infections.

Minimally invasive techniques can be used for:

Minimally invasive discectomy: In this procedure, herniated disc material is removed to relieve pressure on spinal nerves. The herniated disc is accessed through a small (one-inch) incision. Because the surrounding muscles and tissues are stretched with dilators instead of cut, there is less pain and recovery time, and this may be performed as an outpatient procedure.

Minimally invasive spinal decompression and spinal fusion: Pressure on the spinal cord and nerve roots caused by bulging or collapsed discs can cause debilitating pain. In this procedure, pressure is relieved by removing the bone, bone spurs or ligaments that are pressing on the nerves. It may be necessary to also fuse the adjacent vertebra to eliminate friction and pain that may be caused by bone on bone rubbing.

Minimally invasive spinal laminectomy: Spinal stenosis, the narrowing of the spinal canal, is most common over the age of 50. This narrowing places pressure on the spinal canal and causes significant pain. With minimally invasive spinal laminectomy, a small incision is made to access the spine and remove pieces of bone to relieve pressure and eliminate pain.

Risks of spinal surgery

As with any surgery, there are general and specific risks associated with spinal surgery. General risks include possible complications with the heart, lungs, excessive bleeding or infection. The specific risks to spinal surgery include a feeling of numbness and tingling, or continued pain around the affected area of the spine. People undergoing a fusion surgery may experience a restricted range of motion or stiffening, hardware failure, or a failure to fuse. Spinal fusion may result in additional stress to the surrounding vertebrae, known as adjacent segment degeneration. This occurs in approximately 20 percent of patients, depending on various risk factors including the patient’s overall health, age, weight, and activity level.

Returning to full activity

With any spinal surgery, a postoperative regimen is critical to the success of the procedure. People may have some limitations or restrictions, such as avoiding frequent bending or twisting at the waist and lifting heavy objects. Shortly after surgery, people begin a physical therapy and exercise program to achieve rapid recovery and strength. Core stabilization, stretching and muscle conditioning are beneficial to recovery and long-term health. The ultimate goal of the procedure is for the person to return to his or her normal activities, free from the restrictive burden of back and neck pain.

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