Surgery
The following are general comments, for more details on spine care, please click on "Spine" in the menu above.
Simply put back surgery is overdone. Not only is it overdone in our opinion, but also fairly aggressive procedures are performed when smaller ones might be more appropriate with equal results, and certainly lesser risks, pain, and cost.
Most patients should do well from spine surgery. The indications are numerous from a simple disc or spur, to complex tumors or spine malformations.
Surgery is usually performed with the operating microscope or endoscope. You are encouraged to seek out surgeons who are board certified and have at least 5 years of experience "under the belt." Furthermore, knowing 1 or 2 patients who have been treated surgically by their physician is highly advisable. If you are unable to find such references, than a second opinion by a qualified surgeon would be recommended.
One caveat is "emergency surgery." When there is severe paralysis, especially the bladder, a surgeon may recommend a needed operation. If an immediate second opinion is not possible, we are left relying on that physicians recommendations. Generally, if you have time to read this on the internet this is not an emergency.
Please see “back surgery”, but note that spine surgery includes the cervical, thoracic, and lumbar as well as sacral areas. A neurosurgeon operates on all areas as well as inside the spinal cord (should an intrinsic tumor be found).
Many new techniques are presently being developed and are frankly worth looking at. Traditional treatment of a lumbar disc and routine problems are for the most part standardized, using a microscope or endoscope. Instrumentation however, changes yearly and frequently, so does the fusion devices. Totally absorbable plating and intrabody devices for the neck, arthroplasty where there is joint replacement, and even dynamic stabilization using flexible rods, are all options that need to be considered.
The future for spine surgery, specifically good results from an operation, never appeared better. However, as with all scientific endeavors, those that are looking for the “cutting edge” need to be cautious that their problem is unique, and that a dependable surgical technique does not already exist.
Surgery in the cervical spine or neck frequently is done for a disc or a spur. Usually the pain goes down to one side of the shoulder or arm, and frequently precipitated by the patient rotating the chin to the same side as the pain, and then elevating the chin. There are other reasons to do neck surgery including stenosis, and tumors, etc.
Surgery in the cervical spine can be done from behind or from the front of the neck. From behind, unless it is trauma, usually decompression alone is in order without plating or fusion. From the front, fusion is usually indicated with or without plating. There are different risks and reasons for choosing one approach over the other.
Your surgeon should be familiar and able to utilize both approaches based upon your particular needs. A patient is cautioned that if fusion at more than 2 levels is recommended, a second opinion is suggested by this surgeon. Arthroplasty or joint replacement is “around the corner” as a surgical alternative for an anterior or frontal approach to the neck. The exact indications, risks, complications, and long-term affects of Arthroplasty are not fully known at this time.