Do I Really Need Spine Surgery?

Spine Surgery:  The Honest Truth

Most elective spine surgery in the United States is done for degenerative spinal conditions.  These are conditions that have occurred as the result of normal wear and tear on the spine, that can sometimes be accelerated by injuries or other medical conditions such as poor nutrition, smoking, or obesity.

As such, even the most satisfied patients will tell you that they do have some pain from time to time.  While new, recurrent, or severe pain can sometimes be  the sign of a problem, a small amount of pain after surgery is normal and usually a sign of continued degeneration of the spine that continues during a lifetime.  While patients should expect a significant improvement in their pain after surgery, they should also be skeptical of surgeons who habitually promise completely pain-free solutions.

Criteria for Undergoing Spine Surgery

Surgery is definitely not for everyone.  In order for patients to even be considered for surgery, they have to be suitable medical candidates, and must have symptoms that can be explained by findings on an  imaging study such as an MRI.  I typically perform spine surgery on eligible patients for one of only four reasons:

1. There is a neurological deficit.  Once the spinal cord or a nerve is compressed to the point where a neurological deficit such as weakness, difficulty walking, or bowel/bladder incontinence occurs, the chance that the damage will become permanent without surgery increases significantly.
2. There is a significant threat of neurological injury.  An unstable spine or significant compression of the spinal cord or nerve roots can cause damage to the spinal cord and nerve roots with even a small shift in the spine or its contents if not addressed surgically.  This is one of the few situations in which I recommend an operation on even an asymptomatic patient.
3. The patient is in severe pain.  Severe pain can be harmful to a patient if it persists for a long period of time, or requires large dosages of medications in order to control it.  The question that I always ask my patients is “Is your pain severe enough to consider surgery?”  If the answer is no, it is hard to justify surgery.
4. The patient has exhausted all reasonable conservative treatments and continues to have bothersome symptoms.   Patients who do not respond to activity restrictions, medications, physical therapy, or targeted steroid injections are generally offered surgery, but only if their symptoms are bothersome enough to them to interfere with the activities they enjoy.

In any of the above circumstances, most patients and doctors will agree that the inconvenience and pain associated with surgery are well worth the benefits.  Patient selection is the key to our success.