Spine Surgery Requirement

Whenever patients are recommended spine surgery by spine specialist, they face dilemma whether they should undergo spine surgery or not. A decision to undergo spine surgery is based on several factors:

1. Has the patient tried other non-surgical treatment?
2. Is patient getting sufficient relief in reasonable period of time from non-surgical treatments?
3. How severely spine problem is affecting patient’s day to day life?
4. Is the patient willing to wait for non-surgical treatment to work or wants acute relief?
5. Are there any danger signs/ red flags and spine specialist feels an immediate surgery is in best interest of the patient?

General rule of thumb is that a patient should undergo spine surgery only when he/ she has exhausted all other non-surgical treatments. Usually a spine doctor would recommend a step-wise treatment protocol where initial treatment will always be by medicines (anti-inflammatory and nerve medicines), brace, local heat and physiotherapy. In patients with no/ insufficient relief, spinal epidural injection is next treatment usually prescribed.  Whether one need to go to next step in treatment protocol is dependent on how much relief one gets from current treatment.

For the patients with severe symptoms, who are unable to take a step-wise approach due to severe symptoms, personal reasons (lost days of work, severe difficulty in activities of daily living) and in patients with emergency signs (loss of sensation/ muscle power in arm/ leg, loss of control over bladder-bowel, acute spine fractures, spine infection with severe pain/ spine instability) your spine specialist might recommend you to undergo spinal surgery immediately. This is done to not only take care of current symptoms but also to prevent further progression of spinal problem which might lead to irreversible damage to spinal cord causing incomplete/ unsatisfactory recovery in future if the surgery is postponed. One of the primary reason behind incomplete recovery after spine surgery is delay in surgery. Occasionally, there are red flags on patients’ MRI/ x-rays which warrants an immediate spine surgery to prevent an impending disaster, even if the patient’s symptoms are not very severe.

Patients can always take a second opinion from another spine surgeon; however, they should remember that all spine specialists have different protocols to treat any particular spine pathology. Even if different spine doctors agree that surgery is required, their choice of surgical procedure might be different. This is due to the fact that every spine specialist receives different training, has unique surgical experience during his spine surgery practice career and belief in a particular type of surgical procedure. Majority of the spine specialists now-a-days choose a minimally invasive spine surgery procedure for majority of the spinal problems to provide a safe and quick recovery with early return to routine activities and work.

So, essentially if you have any of the followings, then you should undergo spine surgery.

• if your symptoms are severe,
• symptoms are since long duration,
• symptoms are not responding to medical/ non-surgical treatment,
• symptoms are causing severe limitation to your activities of daily living,
• there is an obvious cause of these symptoms on spine x-ray/ MRI,
• spine specialist feels a surgery can cure the pathology leading to a safe and effective relief of your symptoms,
• there are red flags on MRI/ x-ray requiring spine surgery to prevent future problems.