Spine Surgery - When It Works and When It Doesn't
By Mark Chilton, M.D.
Spine surgery can provide relief from debilitating neck, back and radicular arm or leg pain. But not everyone is a good candidate for successful pain relief through surgery. If your doctor is recommending spine surgery, take steps to learn everything you can about your condition, the treatment options and your surgeon.
Spine surgery is generally divided into two categories, cervical and lumbar (neck and low back). The thoracic or chest spine does not normally require surgery with major exceptions that include severe scoliosis or tumors.
Surgery of the neck is generally for herniated discs or stenosis, otherwise known as narrowing of the spinal canal. Symptoms include neck pain, radiating arm pain, dizziness, headache, numbness/tingling in the arm or hand and/or weakness in the upper extremity.
Generally, approximately 97% of the time, surgery is not needed. Symptoms can be relieved with anti-inflammatory medications, physical therapy, chiropractic care and an occasional cortisone injection. When all non-operative care fails or if there is progressive rapid neurologic loss, then surgery is indicated.
Surgery for the lumbar spine or low back is very similar to the neck with the most common causes being herniated discs or stenosis. Again, the same non-operative therapy with anti-inflammatories, physical therapy, chiropractic care and the occasional cortisone injections are tried before surgery is considered.
Surgical technique varies according the surgeon. No one technique is “better” than another, though I generally discourage internal fixation of the spine if possible because of increased complication rates.
However, surgery doesn’t work in certain groups of patients. If previous spine surgery has been performed, the success rate of subsequent spine surgeries decreases. Success rates are low for patients with some psychiatric conditions such as bipolar disease or depression as well as for patients addicted to tobacco, alcohol or narcotics. Another patient group with traditionally low success rates for spinal surgery are those injured as a result of a motor vehicle accident or work injury.
Many patients can experience a good outcome with spinal surgery. While there are no guarantees an operation will provide relief, when proper indications are met and surgery is performed by an experienced board certified orthopaedic or neurosurgeon, relief of pain is to be expected.
Mark Chilton, M.D. is a board certified orthopaedic surgeon with the Mid-Maryland Musculoskeletal Institute (MMI) division in Frederick and Urbana, Maryland. He sees all manner of orthopaedic complaints, including fracture care, sports injuries, spinal abnormalities and joint arthritis though his surgical practice is now limited to outpatient procedures. Dr. Chilton is an examiner for the American Board of Orthopaedic Surgeons and is on the teaching faculty at several local institutions.