Issue 41.14
Spine surgery is a complicated medical procedure that is not without its risks. We are extremely fortunate in our town to have several neurosurgeons and orthopedic spine surgeons who have brought a tremendous amount of expertise and skill into our community over the last few years. Our local hospital has also gone to great measures to bring in state-of-the-art equipment to perform these surgeries. This has made it possible for patients of Southern Utah to get highly complex and advanced surgical techniques of the spine performed right here in our hometown. Each spine surgery candidate must consider the risks and benefits of such surgery.
So when should you think about having surgery on your back? The spine, not unlike the heart, is an area of the body that we only perform surgery on a few specific situations. Most spinal conditions can be compared to common heart conditions. Cardiac disease is commonly treated with diet, exercise and medications such as antihypertensives and cholesterol-lowering medications as well as interventional treatments such as stent placement. The spine is very similar. In order to treat painful conditions of the spine, the standard of care is to use exercise, weight loss, medications such as anti-inflammatories and interventional treatments such as epidural steroid injections and radiofrequency ablation. Some conditions of the heart and spine don’t respond to these treatments and require open heart surgery or spinal surgery.
The three most common conditions that require surgery to correct lumbar spine conditions include: spinal conditions causing nerve compression, shifting or instability of the spine, or painful spinal disease that has not responded to medical or interventional treatment. First I’ll discuss nerve compression. Any patient that has a spinal condition should see their primary care provider or a pain specialist to be evaluated. History, physical exam and radiologic studies help the physician determine if there is nerve damage associated with the spinal condition. Patients experiencing significant numbness or weakness affecting the legs, require surgery. Spinal nerves that exit the spinal cord and the bones of the spine can be compressed with herniated discs or bone spurs. It is much more common for these spinal problems to irritate and inflame the nerve and cause pain. Conversely, if the spinal nerve is being completely compressed, it could lead to permanent nerve damage. Thus, most of these types of patients are sent to surgery.
Arthritis of the spine, or spondylosis, is a common degenerative problem and develops in practically every patient. Sometimes this arthritis can cause shifting of the spine that is unstable or moves during normal day to day activity. This shifting, called spondylolisthesis, can cause nerve damage if the segments of the spine shift during every day activities. A flexion-extension lumbar x-ray series is ordered to assess for potential instability. Some degrees of shifting require surgery.
Another common condition that requires surgery is spinal pain that has been unresponsive to nonsurgical treatments. Arthritis of the spine, spinal stenosis, disc rupture, sciatic pain and other painful spinal conditions are most commonly and effectively treated with medications, and interventional treatments. In a small percentage of patients, these nonsurgical treatments will fail.
Finally, surgery of the spine is not something that most patients want to line up for. However some conditions require spinal surgery for treatment. If you have symptoms of your low back including possible nerve damage, spinal shifting, or pain that has not been responsive to nonsurgical treatments please consider meeting with your primary care provider or call our office for a consultation with a pain specialist. I hope that you do not need surgery of your spine, but if you do, we will be happy to arrange a consultation with one of our highly qualified local spine surgeons.
Dr. Court Empey is a board certified interventional pain and spine specialist and founder of Desert Pain Specialists in St. George, Utah. (435) 216-7000.