Why get spine surgery?
Your spine is made up of 26 bone discs known as vertebrae. The vertebrae in your spine protect your spinal cord. Between the vertebrae, you'll find intervertebral disks, which serve as shock absorbers for your spine.
Your spine has three segments that, when viewed from the side, look like c-shaped curves. The segments are known as the cervical spine, thoracic spine and lumbar spine. These curves help you stand upright.
Your spinal cord runs through your spine, traveling through vertebrae. Nerves branch out of your spinal cord, carrying messages to your brain and muscles.
There are several reasons a person might get spine surgery, such as bone changes associated with spinal stenosis or a herniated disc, tumors or spinal conditions such as scoliosis.
A person becomes a candidate for spine surgery after conservative treatments fail. If a person is still in chronic pain after physical therapy, activity modification, anti-inflammatory medications, epidural steroid injections or chiropractic treatments, then he or she might be a good candidate for spine surgery. Back surgery is only needed in a small percent of cases.
Different types of spinal surgery include a diskectomy, the removal of a herniated disk; laminectomy, which relieves pressure caused by spinal stenosis; fusion, to connect two or more bones in the spine; vertebroplasty, to stabilize fractures and relieve pain; and artificial disk implantation, a treatment alternative to spinal fusion.
What happens when you get spinal surgery?
Some hospitals offer “minimally invasive” spine surgery. Generally, anyone who's a candidate for surgery is a candidate for minimally invasive surgery.
The difference between traditional spine surgery and minimally invasive surgery is in the technique.
With a traditional spine operation, a surgeon will make a cut that's between six inches and eight inches long. To get to a disc in the spine, the surgeon must go through the muscle. The surgeon will scrape the muscle from the bone. The disc itself is deep, and the surgeon will make a cut similar to a ditch in the back, starting wide and coning down to get to the problem.
With a minimally invasive spine procedure, the surgeon does not have to remove the muscle from the bone. Instead, doctors dilate the muscle, pushing a small needlelike wire through the muscle. The surgeon is able to create a half-inch hole by dilating the muscle. The surgeon then repairs the spine through the hole.
Does it hurt?
Any time you have back surgery, it will be painful, especially if it involves spinal fusions.
After a traditional spinal surgery, your body will develop scar tissue where the muscles were cut. Scar tissue can cause pain if it binds the lumbar nerve root with fibrous adhesions. Some controversy exists around this topic.
If you suffer from continuous pain after a back surgery, you should talk with your doctor. Your doctor can perform tests and try to pinpoint the reason you're in pain.
If you receive a laminectomy, which is performed to relieve pain from abnormal pressure on the nerves, you shouldn't experience a lot of discomfort. Some patients who receive a minimally invasive laminectomy leave the hospital the same day. Patients who receive a traditional laminectomy usually leave the hospital within a day.
Patients who receive a spinal fusion surgery, which joins two vertebrae in the spine, will be in the hospital for a few days. These patients are generally on pain medicine either by mouth or IV. Medical staff will teach spinal fusion patients how to move properly. For example, patients might be taught how to get out of bed without twisting their spines.
Patients who had chronic back pain before a spinal fusion surgery still might have pain afterward. Losing weight and getting exercise can help patients feel better.
With spinal fusion surgeries, you're usually on pain medication for about a month. This is based on the fact that a surgeon is rearranging your spine, putting it back in place and bolting it in place.
With a minimally invasive spinal fusion surgery, you could recover more quickly, meaning less pain. Some patients are able to stop taking their pain medications more quickly if they've had a minimally invasive procedure. Although doctors have reported seeing patients who receive minimally invasive procedures recover more quickly, there isn't yet enough scientific evidence to prove this.
What are the risk factors?
As with any surgery, there's a risk of bleeding and infection.
In a microdiscectomy, usually performed to treat a herniated disc, there's a risk of a cerebrospinal fluid leak. This has been known to happen in about 2 percent of these surgeries. If you experience a leak, your doctor might ask you to lie still for one or two days to allow the leak to seal.
One in about 1,000 patients experienced nerve root damage during a laminectomy. There's also a small chance of a cerebrospinal fluid leak.
The most common risk factor for a spinal fusion surgery is failure to remove pain. This is commonly referred to as “failed back surgery syndrome.”
Another risk factor of spinal fusion surgery is pseudoarthrosis. This occurs when the vertebrae do not fuse together properly. This occurs in between 5 percent and 10 percent of these surgeries. People who smoke have a lower rate of successful spinal fusion procedures.
Also, the screws used to fuse vertebrae together can break or loosen and require additional surgery.
Most spinal fusion complications are not frequent. Research has found that obesity can increase risk factors.
Some doctors who perform minimally invasive surgeries see lower bleeding and infection rates. More research must be done to prove this.
Minimally invasive surgeries can take longer than traditional surgery. This means there can be a higher risk related to anesthesia. How long the surgery takes is, in part, related to how comfortable a surgeon is with minimally invasive procedures.
If a patient who has experienced trauma is receiving a spinal surgery, the risk for infection and bleeding are higher. Minimally invasive spinal surgery can sometimes be a benefit to these patients because it is less disruptive.
What's the recovery time?
It depends on the surgery.
If you receive spinal fusion surgery, the success of the surgery can be highly contingent on you following your doctor's orders. For example, it can take about three months for a fusion to successfully reach maturity.
Your activity level will be limited. You won't be allowed to run or participate in any type of vigorous activity. Your doctor might limit your driving, and you also might want to limit the length of trips you take.
Directly after a spinal fusion surgery, you might not be able to eat for a few days and be given nutrients through an IV.
Younger patients in good health who get spinal fusion likely will need to take four to six weeks off from work. Older patients who need more extensive surgery might need to take off work up to six months.
It is important to listen to your doctor's orders regarding rehabilitation. Your spine will be growing and changing, and it's important to complete your therapy to ensure your spinal fusion is as successful as possible.
You might be fitted for a back brace. When you're ready, your doctor or physical therapist might teach you exercises to strengthen your back muscles.
Some patients find that their recovery time is faster with minimally invasive surgery, but this isn't well documented yet in scientific research.
One theory for why patients might recovery more quickly relates to the fact that the surgeon isn't cutting the muscle off the bone and spreading it open.
It's important to call your doctor if you experience fever above 101 degrees, more pain where you had surgery, drainage that is green or yellow, a loss of feeling or change of feeling in your arms, legs or feet, chest pain or shortness of breath, or swelling. Also, you should call your doctor if you have difficulty urinating or controlling your bowels.
Are there follow-up procedures?
Hopefully, you only need one surgery.
However, future spine problems are possible. For example, for patients who get spinal fusion, part of their spine will no longer be able to move. This can cause added stress on other parts of the spine.
It's important to voice all of your concerns with your doctor and find a doctor you trust before making any major medical decisions. It's not a bad idea to get a second opinion, for spinal surgery can be a major commitment.
Source: Dr. Winston Fong,; Spine-Health.com; National Institutes of Health; American Academy of Orthopaedic Surgeons; American Association of Neurological Surgeons; The Mayo Clinic