There are a number of treatments you can be offered for a spine-related condition, and surgery is unlikely to be first on the list.
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Dr Nicholas Tsai from Orthopaedics ACT believes that spinal surgery should only be done when the more conservative solutions haven’t worked.
“Ideally, it is better to deal with the pain without surgery. If tablets, injection or physiotherapy doesn’t work, that’s when we offer them surgery" he says.
“The thing that’s different about the spine is that many people will, in general, improve over time. If you have a pinched nerve in the neck or lower back, it may get better without surgery.”
Even for disc herniation or sciatica, “there’s a good chance that patients probably don’t need surgery straight away.”
However, “If you have a pinched nerve or radicular pain and you try everything else first, that’s when surgery can play a role in relieving your suffering.”
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When spinal surgery started in the ’50s and ’60s “it was primitive initially, but it has moved on a fair bit. Now there are almost too many things we can do, which means we have to make sure that we offer what is best for the patient."
There are also different types of spinal surgery.
“Broadly speaking, spinal surgery can involve decompression of nerve roots or spinal cord, (with or without) fusion.
“Decompression aims to relieve pain in the leg (sciatica) or arms. Fusion is only required if your spine is deemed unstable.”
That instability can be caused by trauma, infection, tumour and to a much smaller percentage, degeneration.
“Fusion may be required for severe deformity correction such as scoliosis”
It has its downsides though. “Fusion is also closely associated with adjacent segment disease. For example, there are five levels of lumbar vertebrae. When you fuse two levels together, then all the bending is now shared by the remaining levels which have to work harder. And they then wear out more quickly.”
In terms of risks, “80-90 percent of spinal surgery is in the lower sections of the lumbar spine, whereas the spinal cord stops higher up at the L1 to L2 level (the top of the lumbar region), so the risk of becoming paralysed is extremely small.
"Surgery for the thoracic spine (middle) or cervical spine (upper), is near the spinal cord so the risk increases, but the overall risk of paralysis is still quite small."
The results also vary depending on why you’re having the surgery.
“Surgery for back pain in general is quite disappointing, whereas decompression for sciatica works quite well.”
Also, for patients who have already tried everything conservatively, “90 percent with radicular pain respond very well to surgery. The risk is relatively small as well."
However, for most cases of severe chronic pain, “Unfortunately, current surgical strategies do not provide a predictable successful outcome despite new implants and surgical techniques. They may improve, but they won’t be completely pain-free or necessarily able to do the work they did before.”
Prevention can be achieved through the use of proper lifting techniques, regular stretches, core strengthening exercises, and keeping your weight down.
