I hear it all the time; “I will never have back surgery”. As a spine surgeon, I am humbled that anyone would let me operate on their back when so much is riding on the success of surgery. I respect the overwhelming apprehension over back surgery. People trust others and their opinion. When someone hears about a bad experience with back surgery, it forms a powerful influence. I try not to be offended when people tell me in my office; “I heard you should never have back surgery because it doesn’t work”. If that were the case, I would never and should never operate on anyone! Might as well close up my practice and do something else. Right? The reality is spine surgery can be life changing in a good way if the correct surgery is matched with the right condition. Research and experience has enlightened spine surgeons as to which surgeries work and which do not. I use this knowledge to filter through many patients with painful spinal problems finding treatments that work whether it be surgery or not. I may see 100 patients a week in the office and only recommend surgery to 10. In other words, 90% of patients in my clinic do not need surgery. Selectivity drives better results.
Another factor unique to the spine is that it isn’t just one joint like a hip, knee, or shoulder. In fact, just the lumbar spine or the low back has 5 vertebrae connected together by 10 joints called facet joints as well as 5 discs. This complex structure was elegantly designed to protect the delicate spinal nerves AND allow movement through all those aforementioned joints. Unlike mammals, we humans do this standing up! It is part of what makes us humans. Unfortunately, gravity is not kind to the spine. Over time, the spongy discs and fluid joints wear causing spurs to develop. These spurs or overgrowth if the spine can narrow and pinch the nerves, ouch! If I operate on one of the five levels, there are 4 more which may go bad or cause problems down the road. My former partner Dr. Lehman used to tell his patients; “Spine surgery is like potato chips; you can’t just have one!”. Joking aside, spine surgery can feel like a failure if another level goes bad sometime after surgery. The surgery didn’t fail, the spine did. Sounds depressing but it shouldn’t be. Again, not all these conditions will need an operation. They can often be treated with exercise only. Because there are multiple spine levels, there is no guarantee another level will cause problems down the road. It doesn’t mean the surgery failed.
The good news is minimally invasive spine surgery decreases the rate of wear on the neighboring spine levels. By accessing the spine through small windows and minimal disruption of normal anatomy, we can preserve the adjacent levels thereby decreasing the need for further surgery. This has been proven in many studies and I have definitely noticed the difference in my own practice.
The bottom line is, you should only resort to surgery after exhausting all other treatments. Are you following an anti-inflammatory diet? Are you exercising? Are you doing the right exercises? Did you try physical therapy? Did you try shots? Medicine? If you tried everything and the pain is unbearable you should consider surgery. I often wait for patients to reach this conclusion on their own and tell me when they are ready. After all, it’s your body. Once you have surgery I will do my best to give you back that quality of life you are missing. The greatest part of my job is hearing positive feedback from satisfied patients. The next time someone tells you “never have back surgery”; make your own judgement.