Myths about spinal surgery

Myth #1: A spine surgeon will always recommend surgery.

Truth is the opposite. There are very limited situations when surgery is the only option. In majority of cases there are a lot of ideas for curing back pain, disc herniation, spinal stenosis or instability without surgery. These individually tailored treatments might include modification of daily activities, physical therapy, medications, injections, braces etc. Patient and surgeon should achieve a solution to existing problem in the least invasive way. Surgery in most cases is reserved as a last resort. However, it is important that patients are being informed that some mild back problems can predispose them to surgically treatable disease at some point in the future. With or without surgery, there is always a way to help you to get back to doing things you love to do and need to do.

Myth #2: All spine surgeries are major surgeries with large incisions and extensive tissue trauma.

In most cases truth is the opposite. Although spine constitutes a large part of the body, it doesn’t mean every spinal surgery has to be major operation. Thanks to modern state-of-the-art diagnostic and surgical equipment, nowadays majority of surgical interventions to spine can be done by deploying minimally invasive techniques.

This means surgery is meticulously planned to achieve surgical plan with intervention as little as possible. Small incision, usage of the operating microscope, microsurgical techniques and micro instruments as well as image guidance helps to minimise extent of intervention, therefore these surgeries cause little damage to tissue, require less time for recovery, are less painful and has a lower risk of infection than major surgeries.

If you have herniated disc, pinched nerve, synovial cyst in spine, spinal stenosis, degenerative disc disease, vertebral compression fractures, spinal instability or spinal canal lesion, you are likely to be a good candidate for minimally invasive spine surgery.

Myth #3: Recovery from spine surgery is always very painful and long.

Not truth for most cases – if surgery is done by deploying minimally invasive techniques, pain management usually require only relatively short use of over-the-counter pain relievers and only one-night stay in the hospital.

In general, pain is usually worst during the first three days after surgery, then it gradually subsides.

Major surgeries may potentially carry more risk of prolonged and severe pain, longer hospital stay and limitations on mobility.

Recovery time depends on many factors such as your age, type of surgery and overall health and fitness, but equation is always the same – more invasion leads to longer recovery and more pain.

Therefore recovery from microdiscectomy or minimally invasive spinal stenosis surgery might take only a couple of weeks at home setting until full recovery and in contrast recovery from conventional spinal fusion surgery may take from three to six months.

Myth #4: Once you have a spinal surgery, you will never be able to walk again.

Actually, it’s the other way around – spinal surgeries are typically applied when there is a risk of losing ability to mobilise normally without surgery due to spinal condition.When spinal surgery is discussed and considered between patient and neurosurgeon, it usually means that risk of surgery is significantly lower than risk of not having a surgery (in terms of long-term health consequences).

Although every spinal surgery carries associated risks (including damage to spinal cord), all precautions are taken to avoid these risks, and in general, spinal surgeries are considered as very safe.

Additionally – percentagewise most of spinal surgeries are performed on lumbar spine, where spinal cord has ended (spinal cord ends at the level between first and second lumbar vertebrae in average adult human), therefore there is little to no risk of damage to spinal cord. Theoretically only separate nerves can be damaged during the lumbar spine surgery which dramatically reduces any risk of major disability.

There are little to no other complications that can potentially carry risk of inability to walk after surgery.

Minimally invasive techniques in spinal surgery additionally reduce risks of short- and long-term disability after surgery.

Myth #5: You will be in a wheelchair soon unless surgery is done immediately.

The short answer is that becoming paralyzed is an extremely unlikely event as most of degenerative spinal conditions are slowly progressive over years and almost never cause sudden paralysis (please see below for exceptions).

This is quite frequently seen patient’s wrong interpretation of the real situation as well as statement of aggressive surgeon for scared patient.

The Father of Modern Medicine Sir William Osler told, “Listen to your patient, he is telling you the diagnosis”. Be aware of very busy surgeon, who is not interested in conversation with his patient and has only one quick unexplained option for treatment (urgent or expedited surgery). Analysis of spinal imaging scans is the last part of decision making.

You always have a right to get a second opinion on your condition and to choose not to have the treatment that you feel uncomfortable with.

Exceptions: In general, only some of spinal diseases usually with sudden onset of symptoms might require urgent surgical intervention and might carry a great risk of severe disability (paralysis included). These urgent conditions are spinal fractures (due to trauma) with spinal cord/cauda equina compression, metastatic spinal cord compression, spinal tumour, spinal haemorrhage (spontaneous spinal epidural haemorrhage), spinal infection (spinal epidural abscess) or large herniated lumbar disc with cauda equina syndrome. Please note – none of these diseases are degenerative spinal conditions (except Cauda Equina Syndrome).

Myth #6: I am too old/young to have a spinal surgery.

Regardless of your age, any decision regarding your treatment should be based on careful evaluation of surgical problem and any comorbidities that you might have.

Processes that cause spinal degeneration and are associated with conditions such as spinal stenosis come with age and are rare in middle-aged and young patients. In contrast there are spinal surgical diseases which are more common at young age (like herniated/protruded/slipped disc with associated impingement of nerve). Therefore there is no right or wrong age to have a spinal surgery, each age has its typical spinal problems.

Not all patients with the same age have the same risks of surgery, therefore age itself is an inadequate measurement of a patient’s health. Many risk increasing co-morbidities such as diabetes, obesity, heart and lung diseases, atherosclerosis are not only common in older people, but also quite widespread among younger people.

Treating the patient as a whole rather than particular disease is the right way to achieve the best results and avoid predictable complications.