Spine surgery: When is it required?

: Dr Himanshu Tyagi

Back or neck pain is undoubtedly the most common reason to visit an orthopedician in today’s era. Low back pain alone accounts for almost 60 % of orthopedic OPD in any given hospital. Normally, low back pain or neck pain respond well to conservative treatment in the form of lifestyle modification, weight loss, posture training and exercises. Occasionally we need to supplement above mentioned measures with medicines (maximum up to 6 weeks).

“Around 97% of the patients respond well to non surgical treatment and only 3% require any sort of surgical intervention.”

Next step for spinal pain management includes well directed physiotherapy (IFT, TENS, Laser, manipulations) or spinal pain injections ( facetal blocks, pain blocks, radio-frequency ablation etc.)

If the problem still isn’t resolved, in such situations surgery becomes a good option.

“Minimum 6 weeks of conservative treatment should be tried before deciding for spine surgery”

Few specific indications to undergo spine surgery includes-

1) Progressive muscle weakness : This is one of the most common and often urgent indication to undergo spine surgery. This happens usually because of a slip disc in neck or lower back region affecting nerve carrying signal from brain to the muscle (through spinal cord). For best surgical result (reversing paralysis) the surgery should be done within 24 hours.

2) Loss of control for urination or bowel : called as ‘cauda-equina syndrome’ , this is usually due to a sudden slip disc in the lower back region affecting the nerves carrying control of urinary bladder, sex and bowel region to the brain. Ideally the surgery should be done within 6 hours of diagnosing the problem.

3) Spinal deformity correction: scoliosis or curved back deformity is a challenging but gratifying surgery. The post surgery results improves not only the cosmetic appearance but also lung function, pain and considerably reduces future risk of paralysis.

4) Severe back or neck pain not responding to conservative treatment: Normally , if the pain is not resolving within 6 to 8 weeks and is affecting the daily activities of a person (like going to office, traveling, sex or social requirements) then going ahead with the surgery becomes a reasonable option.

5) Severe radicular pain in arms or legs : this is mostly because of nerve impingement in the spine either because of a disc protrusion or excessive bone growth or ligament swelling in spine. Severe nerve compression can lead to pain radiating down the arm or leg and can affect activities like normal limb function or even sleep.

6) Neurological Claudication : this is a special condition where compression of the nerves in the lower back can cause stiffness and cramps in legs while walking. This can be a very debilitating condition as the person is not able to stand and walk even to do normal day-to-day activities.

7) Numbness, Sensory loss or Tingling in any body part : This represents a severe nerve compression leading to functional impairment in nerve’s sensation conduction capacity. If left untreated it may lead to permanent sensory loss or may even progress to paralysis.

Apart from above mentioned common reasons , few other indications which may require a spine surgery includes spinal fractures , spinal tumour removal, infections in spine and certain metabolic conditions.

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“Minimally invasive surgery is going to be the future of spine surgery , as it requires a much smaller incision, less blood loss, faster recovery ,less pain to the patient and reduced Hospital stay”