Facts & Myths About Spine Surgery

There's a lot of information out there about spine surgery. The internet has a lot of good and bad information, and it is difficult to tell what is accurate. Most people know someone who has had spine surgery, and that person is usually more than willing to share their "expertise" or opinion about their experience.

Just because your friend or neighbor had back or neck surgery does not mean that your situation is in anyway related. There are many different procedures done for a host of reasons, all with different treatment objectives and outcomes. In many cases, surgery is not the best option. Determining what the best procedure–if any–is right for you, is best done by consulting with a specialist.

I've heard that one spine surgery can lead to another. Why is that?


There are several reasons for this. If you have degenerative disease of the spine, the natural history of the disease itself increases the risk of problems at other levels in the spine. There are, after all, over 20 mobile segments in the spine. Unfortunately, diffuse processes like arthritis and degenerative disc disease continue to progress with age. Therefore, you are at an increased risk of future problems when compared to someone who has never had any spine problems.

There are a couple of other factors as well. If you've had disk surgery (without a fusion), there is an increased risk of a recurrent disk herniation. This can happen soon after surgery, when healing is incomplete, or even years afterwards. In addition, decompression or disk surgery can weaken the spine at that level, leading to instability. This is especially true after multiple surgeries at the same level.

Finally, if you've had a previous fusion, there is an increased risk of developing problems at the adjacent levels (above and below the fusion). This is due to biomechanical stress. Simply put, by immobilizing one segment of the spine, there is an inherent increase in the stress placed on the adjacent levels, as these levels must compensate.

Although these are considerations, they do not necessarily outweigh the benefits of surgery. Fortunately, prior surgery only modestly increases the risk of future problems. The specific risks and considerations should be discussed on an individual basis with a specialist.

I've heard about artificial disc replacement. Am I a candidate for this?


In the United States, artificial disc replacement has been approved recently for use in select situations. It is still in the evaluation process, and is by no means considered the standard of care for treatment of spine conditions.

For years, we have been using the same techniques with good results and low complication rates. Before these techniques are abandoned altogether, more long-term data is needed on artificial discs. Beware of the hype. Artificial discs have just passed the initial approval phases. Until long term follow-up data is available, be wary of jumping on the artificial disc bandwagon.

I was told by a surgeon that I need a "360" (anterior and posterior fusion surgery). Is there an alternative?


Absolutely. There are some rare instances that both anterior and posterior fusions are needed. Significant instability from trauma, tumor, infection, multilevel or previous surgery, or cases of non-union (failed previous fusion) may require more extensive stabilization procedures. However, a vast majority of cases can be treated with a single approach. By using the latest technology and surgical \ techniques, successful fusion can be accomplished in most cases through a single incision.

I have a lumbar disc herniation and was told that I need surgery. Are there any alternatives?


Definitely. If you are symptomatic from a lumbar disk herniation, odds are you won't need surgery at all. Most lumbar disk bulges or herniations improve with time. Medications can help treat your symptoms. If your symptoms don't improve, continue to worsen, or if you develop significant weakness or other neurologic deficit, surgery may be the best treatment for your condition.

However, there are a couple of other options. Decompression therapy (DRX) is a non-surgical option that can gradually relieve symptoms over many treatments. For many years, traction has been used to relieve the pressure on nerves from bulging disks. DRX decompression is based on this principle, but it is a more comfortable and more effective way to get relief.

Other options include epidural steroid injections and physical therapy. Epidural steroid injections, or ESI, help the inflammation and nerve irritation that can arise from disk bulges, bone spurs, or other pathologies of the spine. It does not treat the pathology itself, but rather, provides relief of symptoms in most cases. This is often temporary, but long-lasting pain relief can be seen. One cannot receive more than 3 injections in a year.

Physical therapy, like ESI, is not aimed at treating the pathology but rather in providing improvement in symptoms. Physical therapy (P.T.) can help with proper care of the spine through stretching and exercise. In addition, instructions on posture and avoidance of certain activities should ultimately reduce symptoms and improve range of motion, with the ultimate goal of returning to your usual activities as soon as possible.

I was told that I need a fusion for a herniated lumbar disk. Are there other surgical options?


Absolutely. In fact, most lumbar disk herniations are best treated with microsurgery, without a fusion. By removing the disk through an operating microscope, the goal of surgery can be accomplished through a small incision. This minimizes trauma to the muscle and other structures, thereby reducing postoperative pain and recovery times. This allows you to go home either the day of surgery or the following day.

However, disk herniations that are recurrent or associated with instability are best treated with fusion at the time of surgery.

Artificial disk replacement has not withstood the test of time. Until more data is available, including long-term followup, we will not recommend this treatment.

I've read about a non-operative treatment called decompression therapy (DRX). Does it really have an 86% success rate?


Decompression treatment is a very good non-operative option for select conditions of the spine, and it is quite successful in treating bulging and degenerative disks in both the cervical and lumbar spine. In select patients, the results are better than with routine physical therapy, and the benefit seems to last, unlike many injection therapies.

There are, however, many conditions of the spine that do not benefit from this treatment. Although often helpful in cases of soft disk bulges, it is less successful in cases of advanced spondylosis or hard bone spurs causing nerve compression. The success rate drops off as the number of disk levels increases. It is not beneficial for treating stenosis, and is contraindicated if there is any instability.

For these reasons, you should consult with a specialist regarding your specific condition. If you have developed weakness or clumsiness from your spinal condition, this could be serious and you should be evaluated by a physician as soon as possible.

There are no good scientific studies to support the claim of an 86% success rate. Realistically, the success rate is more on the order of 60-70%.

I've read that spine surgery is very risky, with a high rate of complications, including paralysis. Is this true?


Absolutely not. Any treatment has inherent risks, and spine surgery is no exception. However, the chance of a serious complication (such as paralysis) is actually very low. Depending on your condition, the risk of permanent neurologic injury may actually be higher if left untreated.

Risks depend on multiple factors and should be discussed on a case-by-case basis.