Busting the myths around Spine Surgery

Busting the Myths around Spine Surgery

The human spine is one of the intricate structures of the human body. Multiple bones, nerves, muscles, ligaments, tendons, discs and cartilages all work in an orchestrated manner throughout our lives to ensure smooth and seamless movement of the back in addition to bearing weight.

However, like any other part of the body, the back too is vulnerable to many problems. Lower back pain is a common problem that affects a vast majority of the population. The elderly with weakened muscles and bones, people who are living a sedentary lifestyle, people who are overweight, young people who need to lift heavy weight or do hard labour everyday and school children carrying over loaded back packs are all prone to back pain. While most bouts of back pain can be relieved through rest, painkillers, exercise, and physiotherapy, there are instances when the pain doesn’t go away and when spine specialist consultation becomes necessary.

When is spine surgery necessary?

1. Trauma: High speed motor vehicle accident, fall from height, injuries that are sustained by sports persons on the field, weight-lifters who over-exercise, and people who had motor vehicle accidents, may sustain neuromuscular damage and/or fractures in the back. These are best treated with surgery as other treatments may not be very effective.
2. Disc Conditions: The discs which separate the bones in the back have a soft gelly-like substance in the centre and a hard outer layer. In some people, the outer layer develops a tear & the soft jelly pushes its way through the tear. This condition is called a herniated disc. While for many people medication, low-key exercises and physiotherapy can relieve the pain, in some people, spine surgery is an ideal way to relieve the pain and symptoms which are radiating or causing neurological functional disturbance.
3. Bone Spurs: The facet joints at the back of the spine have gaps between the facet and vertebral body for nerves to pass through. These nerves carry signals to and fro the brain with respect to parts of the back. In some people who are suffering from osteoarthritis, spurs like growth of the bone develop at the joints. This reduces the gap where the nerves pass, so the spurs tend to squeeze the nerves. This causes pain which is not relieved with injection, exercise and medication. Only surgery will give good results. Problems which affect the spine stability or cause compression of the neurological structure affecting the function are best treated with surgery & will help to get back to their routine life at the earliest.

Myths and misconceptions around spine surgery

• The surgeon will always recommend surgery

  When an Orthopaedic doctor wants a second opinion or a new perspective on your condition, he/she will refer the patient to a spine surgeon. This doesn’t mean the surgeon will certainly recommend surgery. The surgeon will conduct more tests to decide if surgery is really required. He will plan for the optimum treatment for that patient by a thorough clinical assessment and imaging and based on the symptoms, signs and radiological findings decide whether the surgery is required.

• Surgery should be the last option

  If the spine is destroyed by either infection or the tumour causing pain found unstable, surgery is indeed the treatment. When the back or neck pain does not involve any compression of the nerves, surgery may not be required. But if there is compression, leaving it untreated can increase the risk of paralysis in the future. The surgeon will first put the patient through conservative treatments like exercise, medication and physiotherapy. Only when there is no relief, surgery will be inevitable. Back pain which is recurring and bringing their life to a standstill due to severe alteration in the anatomy of the spine can be relieved with surgery. Hence, the decision to do surgery or not, and when to do so, will depend on each person’s unique case. Its best left to a surgeon to decide.

• I may suffer paralysis or may not walk again

  No, this is a widespread myth and a legacy of the past when spine surgeries were only incisional. One complication from those surgeries was paralysis in a small number of cases. But today, most spine surgeries are minimally invasive and endoscopic procedures, so inorganic damage to other nerves or muscle tissue is minimal. Precise diagnostic imaging and precision tools helps the surgical procedure and the results are predictable. The risk of paralysis is almost obsolete and transient paresthesia are observed in less than 1% of our patients and also they recovered completely within two to four weeks. In fact, as outlined in the previous point, not going in for surgery can increase the risk of paralysis in cases where there is compression of the nerves. Identifying the problem early helps to treat effectively.

• There are other complications too

  Again, this is another legacy of the past when spine surgeries were incisional. Today, spine surgery is very sophisticated and technology-driven. Most surgeries are endoscopic microscope-assisted neuro-navigational procedures with advanced neuro-monitoring. This means the nerves in the back region will be closely observed, monitored, and cordoned off to prevent any unwanted damage at every step of the surgery. As a result, other complications are extremely rare, to the tune of less than 3% of cases.

• Spine surgery means there will be more pain than before?

  No. As mentioned before, spine surgeries in the past were open procedure. That is, the surgeon would make a wide cut with a blade to access the concerned area and then operate on it. There was bleeding, trauma (injury) to muscles and tissues in the surgical site, chances of infection in the concerned tissues, and a scar after the surgery. But today, a majority of spine surgeries are minimally invasive. The incision to thread the instruments through is no bigger than your finger nail. This means less bleeding, less trauma, less chances of infection, and no scar at all.

• The surgery will lead to long bed rest and delayed recovery?

  No. Thanks to all the advantages of minimally invasive surgery mentioned in the previous point, recovery is quick. Most endoscopic and minimally invasive procedures are performed as day care. No bed rest is required. On the contrary, the surgeon will recommend you to be as mobile as possible after the surgery. This will help restore function and strengthen the back gradually.

• Another surgery will be required in the future?

  Not true at all. Proper ergonomics, core strengthening exercise and periodic review will help prevent another surgery.

• Surgery will relieve my pain completely

  Spine surgeries have a very high success rate. But once the surgery is over, there are lifestyle changes required to ensure good spine health and that your back pain does not return. The patient must reduce weight and maintain it at healthy number for the rest of his/her life. He/she must be active, exercise regularly, and quit smoking. These will help strengthen the bones and muscles in the back and reduce the possibility of pain.

• There are several restrictions after surgery

  Not really. Given that most spine surgeries are minimally invasive today and not incisional like the past, there are fewer restrictions. Between the 10th day and 1 month after surgery, there are various activities that you will be allowed to resume one by one, thereby getting back to normal life in a month or two. Only in rare cases of multiple fractures or injuries sustained in a motor vehicle accident the surgeon may recommend a certain period of immobilization followed by gradual activity. Restriction will be based on bone quality and general health of the individual.

• One of my parents had spine surgery; I may also require it?

  Again, not true. Back pain or spine issues don’t have any genetic pre disposition, so if one or both of your parents had spine surgery, it doesn’t mean you will need it too. Each case is unique, so the spine surgeon will examine you thoroughly to decide if spine surgery is really required.

Outlook

Myths and misconceptions around health, medicine and nutrition are plenty today. Well-meaning friends and family may give you wrong advice based on incomplete facts or outdated reality. Do not let this affect you.

Consult a reputed hospital for your back pain. Such hospitals have qualified, experienced Orthopaedic doctors and spine surgeons on their rolls. They will provide correct diagnosis and recommend the right course of treatment for quick recovery and rehabilitation.



Prof Dr S Karunakaran

Director & Senior Consultant -Institute of Advanced Spine Sciences