When is spine surgery the appropriate next step?

Gregory Grabowski, MD

Spine Surgery

The decision to have back surgery is an important one. Gregory Grabowski, MD, offered some advice on when spine surgery might be the appropriate next step.

Choosing spine surgery should always be the last resort a patient takes to improve their back pain after already exhausting nonsurgical, conservative options, including physical therapy, stretches, modifying your daily activities, improving your diet and over-the-counter treatments. Some individuals choose to have spine surgery when the pain is persistent and clearly related to a functional issue in the spine. Often, this pain is considered chronic, meaning it has persisted for three months or longer. If this sounds like you, now might be a good time to talk to your doctor about surgical options.

While spine surgery is neither easy nor without risk, it has the potential to restore a normal lifestyle to people who thought “living with the pain” was their only reality. Is spine surgery for everyone? No. Setting up a consultation with a doctor is the first step to understanding if a surgical procedure is necessary for you.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health (NIH), if you have one of the following conditions, you may be a candidate for surgical treatment:

• Herniated or ruptured disks, in which one or more of the disks that cushion the bones of the spine are damaged
• Spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves
• Spondylolisthesis, in which one or more bones in the spine slip out of place
• Vertebral fractures caused by injury to the bones in the spine or by osteoporosis
• Degenerative disk disease, or damage to spinal disks as a person gets older

What are some types of back surgery?

Some of the most common spinal procedures that are performed include:

• Spinal laminectomy/spinal decompression. A laminectomy is performed when spinal stenosis causes a narrowing of the spinal canal that results in pain, numbness or weakness. The surgeon removes part of the vertebrae and any bone spurs, which opens up the spinal column and removes pressure from the nerves.
• Discectomy. This procedure is used to remove a disk or portion of the disk that has herniated or “bulges” and presses on a nerve root or the spinal cord.
• Spinal fusion. The surgeon removes the spinal disk between two or more vertebrae, then fuses together the adjacent vertebrae using bone graft and/or metal devices secured by screws. A fusion will take away some of your flexibility but will be limited to a small segment of your spine.
• Artificial disk replacement. This is considered an alternative to spinal fusion for the treatment of people with severely damaged disks. The procedure involves removal of the disk and its replacement by a synthetic disk that helps restore height and movement between the vertebrae.

While not all back pain may have an explanation, your problem may have a solution. Collaborating with your doctor on an individualized plan for pain management or a surgical procedure will be the first step to getting you back to a normal lifestyle.