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?

Over the last couple of years, artificial cervical discs have become available and more widely used in the United States. They have been used for a longer period of time in other countries with good results. The advantage is, unlike a fusion, motion is preserved. In theory, this should put less stress on the levels above and below the operated level. In other words, it should lower the incidence of so-called "adjacent segment disease", which is seen not too uncommonly after a fusion is performed. By immobilizing one segment of the spine (i.e. a fusion), more stress is translated to the levels above and below the fusion, which have to compensate. This could lead to the adjacent levels of the spine "wearing out" over time.

The results so far have been encouraging. There are however, no long term studies (10 years or more). Pros and cons of fusion versus artificial disc replacement is discussed on an individual basis and it depends on many factors, including number of levels involved, the patient's age, and the degree of arthritis already present in the facet joints in the spine. Artificial disc replacement is a very good option for certain patients, especially young patients with a single cervical disc problem. It is not intended for older patients, patients with significant degenerative changes and arthritis, and several other exclusion criteria. Again, this should be discussed on an individual basis.

Artificial lumbar disc have essentially "fallen off the map". There was early enthusiasm with these several years ago but problems with the disc itself requiring multiple revisions, along with poor insurance reimbursement, have made this procedure almost obsolete. There could be a resurgence of this technology in the future.

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 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 follow up, I will not recommend this treatment.

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.

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.

Common 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.

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. Unfortunately, it is not covered by insurance companies and is generally expensive.