When is Spine Surgery Appropriate?

Many times it is easier to exclude conditions for which spine surgery is not warranted. Many problems that are thought to be caused by “pressure on nerves in the spine” are easily identified as having nothing to do with the spine! Not all bodily pain is from the spine or the spinal nerves. Hip and shoulder arthritis, bursitis, sacroiliac joint dysfunction, neuropathies, and a score of other problems are often diagnosed by us as being the actual diagnosis when it was believed their problem was their spine. The patients are glad to have a diagnosis that describes their problem and we’re happy to assist patients to get to see the specialists they need to treat these other important problems.

Back and neck pain is another large category of problems for which surgery is rarely an option. There are many treatments for these problems, and we use a comprehensive approach and depend on a variety of non-surgical specialists and other professionals to help treat these problems. For the majority of degenerative conditions that cause primarily back and neck pain, surgery has not been proven to be an effective or superior alternative compared to other non-surgical treatments including spinal manipulation, therapy, pain management, and other important treatments.

Most importantly, spine surgery is not an alternative just because other treatments have not brought about significant improvements. Frequently a patient is told, “If everything else has failed, the next step must be a surgery.” Or, “It must be a reflection of the severity of the problem.” This is a sad and unfortunate application of logic. If the problem is not one for which surgery is an option, it is not an option simply because other spine treatments haven’t worked. Most likely, it is because the diagnosis is not clear.

Generally, neurologic problems are the first category of problems for which surgery is an excellent option. Problems of pressure on the spinal cord or nerves which cause radiating arm and leg pain are usually amenable to surgery. For severe problems that are causing weakness, surgery is generally the first option in order to prevent further damage. For neurologic problems that cause primarily pain, there are a variety of non-surgical treatments which may be tried as an alternative to a surgery. Failing that, surgery then becomes an excellent option.

Herniated discs and spinal stenosis causing extremity pain, traumatic and osteoporotic vertebral fractures, conditions creating instability of the spine, and some spinal deformities are all examples of problems for which surgery is likely an excellent option.

Copyright 2009 - Missouri Spine Institute