Spine Surgery

Ageing, trauma, improper body mechanics, and structural abnormalities can injure the spine causing back pain and other symptoms. In addition, chronic back pain often requires a team of professionals to diagnose and treat it. It is thus advisable to consult different specialists before opting for spine surgery.

Classically neurosurgeons treat brain & spine problems, and orthopaedic surgeons treat other musculoskeletal problems. Orthopaedic surgeons that specialise in spine surgery are popularly known as spine surgeons. However, neurosurgeons rarely dedicated themselves entirely to spine surgery.

Types

The different types of spine surgeries include:

• Discectomy: In this procedure, the surgeon removes a herniated disk that presses on a nerve root or spinal cord. Discectomy is often performed in combination with laminectomy.
• Spinal laminectomy/spinal decompression: This procedure is performed when spinal stenosis causes narrowing of the spinal canal, resulting in numbness, pain, or weakness in the body. In this procedure, the surgeon removes some positions of the bony walls of the vertebrae and any bone spurs. Their aim is to open up the spinal column and relieve the pressure on the nerves.
• Foraminotomy: In this procedure, surgeons enlarge the bony hole at the exit of the nerve root from the spinal canal. This prevents the bulging of the disks or joints that may have increased in width due to age and have been pressing on the nerve.
• Spinal fusion: In this procedure, the surgeon removes the spinal disc between two or more vertebrae for this procedure. This is followed by fusing the adjacent vertebrae with bone grafts or metal devices. Screws secure these devices or grafts. Spinal fusion may cause loss of flexibility in the spine in some cases.
• Artificial disc replacement: This procedure is considered an alternative to spinal fusion. It is advised for people with severely damaged discs. The procedure involves removing the disc and replacing it with a synthetic disk. The synthetic disc helps restore the height and movement between the concerned vertebrae.
• Vertebroplasty and kyphoplasty: These procedures help repair compression fractures of the vertebrae caused by osteoporosis. Both procedures include the injection of bone cement that hardens and imparts strength to the bone.
• Nucleoplasty: This procedure is also known as plasma disc decompression. It is a surgery that uses radiofrequency to treat pain in the lower back associated with a herniated disc.

Symptoms

Spine disorders are usually asymptomatic unless they affect activities of daily living. Sometimes, patients may experience dull pain in the affected area that worsens with activity.

Other symptoms related to spine disorders include:

• Heavyness & Numbness
• Stiffness of Limbs
• Pius & needle sensation in limbs
• Radiating pain in limbs
• Loss of movement
• Fractures
• Changes in sexual function and fertility
• Swelling around a bone
• Night sweats
• Fevers
• Difficulty in breathing
• Coughing or clearing secretions from the lungs becomes challenging
• Altered sensations such as lack of the ability to feel the heat, cold and touch
• Exaggerated reflex activities or spasms
• Difficulty in lifting objects
• Pain on bending
• Pain due to damage to the nerve fibres of the spinal cord
• Difficulty in lying down or getting up
• Dull or sharp pain
• Restricted mobility
• Limping
• Fatigue
• Weight loss

The emergency symptoms of a spinal cord injury are:

• Increased back pain or pressure in the head, neck, or back
• Weakness
• Impaired breathing after injury
• Uncoordinated parts of the body or paralysis
• Numbness and tingling in the limbs
• Lack of sensation in the limbs
• Loss of bladder control
• Difficulty with balance and walking
• An oddly positioned neck or back
• Twisted neck or back

Diseases That Spine Surgeons Treat

Spinal surgery was formerly the job of only orthopaedic surgeons. However, in the past few decades, even neurosurgeons have developed an interest in spine surgeries. However, not all procedures can be performed by one doctor alone.

Hence, both the specialities treat their respective conditions such as:

Orthopaedic surgeons

Orthopaedic surgeons diagnose and treat musculoskeletal disorders associated with the joints, bones, and muscles. The diseases they treat include:

• Spinal disorders
• Spinal tumours
• Arthritis
• Sports injuries
• Trauma
• Deformities
• Scoliosis
• Kyphosis
• Degenerative disorders
• Problems associated with a specific area of the cervical spine, lumbar spine, lower back and others.
• Congenital disorders

Neurosurgeons

Neurosurgeons specialise in diagnosing and treating neurological issues associated with the brain and primary spinal cord. These include tumours or syringomyelia. While most neurosurgeons exclusively perform brain surgery, some do spine work. Some disorders they treat include:

• Spinal arthritis
• Degenerative disc disease
• Spondylolisthesis
• Osteoporosis
• Bulging or herniated discs
• Spinal stenosis
• Spinal deformities (scoliosis, kyphosis, lordosis)
• Fractures

When to see a Spine surgeon?

Patients may need to see a spine surgeon if they are experiencing any of the following:

• Herniated or ruptured discs.
• Spinal stenosis is a serious condition in which there is a narrowing of the spinal column, and it applies pressure on the spinal cord and its nerves.
• Spondylolisthesis, a condition in which one or more bones on the spinal vertebra slip out of place.
• Vertebral fractures are caused by injury to the spine's bones or osteoporosis.
• Degenerative disc disease or damage to spinal disks.

Diagnosis

Doctors first inquire about the symptoms and medical history and then perform a physical exam. Various tests that may be advised are:

• X-rays: Bone disorders can be best detected on X rays. They appear as abnormal outgrowths of irregular shape and size, fracture lines, tumours, bone density and other problems that can be evaluated on a radiograph.
• CT scans: A CT scan gives clear images of the tumours' size, shape, and position and helps identify the enlarged lymph nodes that may be cancerous.
• MRI scans: MRI scans may help examine bone cancer with a detailed view of the structures and may help determine whether or not cancer has metastasized.
• PET scans: In patients with cancer, PET scans can help assess the location of the tumour to assist with spine surgery. The technician injects radioactive glucose into the vein. A scanner then spots cancer cells, which use more glucose than normal cells.
• Bone scans: A technician injects a different radioactive material into the vein. It collects in the bones, where the scanner can see it.

Review

Reviewed by Prof. (Col.) Dr. Bipin Walia, Principal Director and Head - Neurosurgery for Max Saket Complex and Spine Surgery Specialist on 29-Dec-2022.

FAQs

• What is spine surgery, and when is it recommended?
  Spine surgery is a surgical procedure performed on the spine to treat various conditions that affect the spinal column or spinal cord. It is typically recommended when non-surgical treatments, such as medication and physiotherapy, have failed to alleviate symptoms and when there is evidence of structural abnormalities or nerve compression that require surgical intervention.
• What are common conditions that may require spine surgery?
  Common conditions that may require spine surgery include herniated discs, spinal canal stenosis, degenerative disc disease, spinal tumours, spinal fractures, spinal deformities (such as scoliosis), spinal infections, and spinal cord injuries, to name a few.
• How is the need for spine surgery determined?
  The need for spine surgery is determined through a comprehensive evaluation by a neuro-spine specialist. It includes taking a medical history, physical examination, imaging tests (such as X-rays, MRI, or CT scans), and diagnostic procedures. The decision for surgery is made based on the severity of symptoms, the underlying condition, and the potential benefits and risks of surgery.
• What are the different types of spine surgery procedures?
  Spine surgery procedures are performed depending on the specific condition being treated. Some common procedures include microdiscectomy, laminectomy, spinal fusion, artificial disc replacement, spinal decompression, and minimally invasive spine surgery techniques. The choice of procedure depends on the individual's condition and the goal of treatment.
• Can non-surgical treatments be effective in treating spine conditions, or is surgery often necessary?Non-surgical treatments can be effective in managing many spine conditions. These may include physiotherapy, pain medications, anti-inflammatory drugs, epidural steroid injections, bracing, and lifestyle modifications. Surgery is typically considered when conservative treatments fail to provide relief or when there is a significant risk of worsening symptoms or complications.
• What is minimally invasive spine surgery, and what are its advantages?
  Minimally invasive spine surgery is an approach that utilizes smaller incisions and specialized instruments, allowing for a less invasive procedure compared to open surgery. Advantages of minimally invasive surgery include less tissue disruption, smaller incisions, reduced blood loss, shorter hospital stays, faster recovery, and potentially less post-operative pain.
• Are there age restrictions for undergoing spine surgery?
  There are no specific age restrictions for spine surgery. The decision to undergo surgery depends on factors like the individual's overall health status, the severity of symptoms, and the benefits and risks of surgery. Spine surgery can be performed on both younger and older individuals, as they are safe and effective. 
• What is the recovery process like after spine surgery?
  The recovery process after spine surgery varies depending on the specific procedure and individual factors. It may involve a period of physiotherapy, pain management, and gradually returning to normal daily activities. The recovery timeline can range from several hours to days, with regular follow-up appointments to monitor progress.
• How long does it typically take to recover from spine surgery?
  The recovery time depends on factors like the extent of the surgery, the individual's overall health, and the specific condition being treated. It is necessary to follow the post-operative instructions provided by the surgeon and engage in recommended rehabilitation programs. Thus, the recovery time ranges from several hours to days, with regular follow-up appointments to monitor progress.
• What are the risks and complications associated with spine surgery?
  As with any surgical procedure, spine surgery carries potential risks and complications. These can include infection, bleeding, blood clots, nerve damage, spinal fluid leakage, pain at the surgical site, anaesthesia related risks, and the possibility of incomplete symptom relief. It is important to discuss the specific risks with the surgeon before undergoing surgery.
• Can spine surgery fully eliminate pain or symptoms?
  The goal of spine surgery is to alleviate or improve symptoms, but the extent of pain relief and symptom improvement varies among individuals. The outcome depends on factors such as the underlying condition, the extent of damage, and individual factors.
• Are there alternative treatments or therapies to consider before opting for spine surgery?
  Before considering spine surgery, conservative treatments like physical therapy, pain management, and non-surgical interventions are attempted. Depending on the ailment, these alternatives are explored initially, especially if the condition is not severe or if the individual prefers to explore non-surgical options. The decision for surgery is made when conservative measures do not provide adequate relief or when there is a risk of worsening symptoms or complications.
• Can spine surgery correct spinal deformities or improve posture?
  Spine surgery can correct certain spinal deformities, such as scoliosis or kyphosis. These surgeries aim to improve spinal alignment and posture, which have positive effects on both aesthetics and functionality. The specific surgical approach and techniques used depends on the nature and severity of the deformity.
• How does spine surgery impact mobility and range of motion?
  Spine surgery can have varying effects on mobility and range of motion, depending on the specific procedure and the individual's condition. Surgeries like spinal fusion aim to stabilize the spine but may limit mobility in the fused segments. Other procedures, such as decompression surgeries, may improve mobility and alleviate restrictions caused by nerve compression. Rehabilitation and physical therapy are vital in optimizing mobility after spine surgery.
• Can spine surgery lead to the need for additional surgeries in the future?
  Not necessarily in routine, but if there are complications, recurrent symptoms or new issues arise over time. However, the aim of surgery is to address the underlying problem and provide long-term relief. Regular follow-up and adherence to post-operative care can help minimize the likelihood of additional surgeries.
• What pre-operative tests and evaluations are necessary before spine surgery?
  Before spine surgery, a comprehensive evaluation can include a medical history assessment, physical examination, imaging studies such as MRI, X-rays, or CT scans, blood tests, and possibly electrocardiography (ECG) and pulmonary function tests. These evaluations help assess overall health, identify potential risks or contraindications, and assist in surgical planning.
• Can spine surgery be performed on an outpatient basis, or is hospitalization required?
  The need for hospitalization after spine surgery depends on factors such as the individual's overall health condition, the type of procedure and the extent of the surgery. Some minimally invasive procedures may allow as day care surgery, while more extensive surgeries often require a hospital stay to ensure proper post-operative care, pain management, and monitoring.
• How long is the typical hospital stay after spine surgery?
  The length of the hospital stay after spine surgery depends on the procedure and individual factors. It can range from a few days to a week or more, depending on the extent of the surgery, the individual's recovery progress, and the presence of any post-operative complications. The surgeon and healthcare team will determine the appropriate length of hospitalization based on the individual's needs.
• Will there be visible scars after spine surgery, and how can they be minimized?
  Scarring is a natural part of the healing process after any surgery, including spine surgery. The size and visibility of scars depend on the type of surgery and the surgical approach used. Surgeons often strive to minimize scarring by placing incisions strategically and using techniques to promote optimal wound healing. Following post-operative wound care instructions and using scar management techniques can also help minimize the appearance of scars over time.
• Are there dietary or lifestyle changes recommended before or after spine surgery?
  Dietary and lifestyle changes may be recommended before and after spine surgery to promote healing, optimize recovery, and support overall health. These recommendations include maintaining a balanced diet rich in nutrients, staying hydrated, avoiding tobacco and alcohol, engaging in regular exercise (as recommended by the surgeon), and following any specific guidelines provided by the healthcare team.
• Can spine surgery be performed under local anaesthesia, or is general anaesthesia required?
  The choice of anaesthesia for spine surgery depends on the specific procedure, the patient's health status, and the surgeon's preference. Spine surgery is generally performed under general anaesthesia, as it provides good pain control throughout the procedure. However, in some instances, local or regional anaesthesia may be used with sedation to achieve the necessary level of comfort and pain control.
• What is the success rate of spine surgery in improving symptoms and quality of life?
  The success rate of spine surgery depends on factors like the condition being treated, the type of surgery, the individual's overall health, and their adherence to post-operative care. While spine surgery can provide significant symptom improvement and enhance the quality of life for many individuals, the degree of success can vary. The surgeon can provide information on the expected outcomes and discuss the individual's specific case.
• Can spine surgery be performed on individuals with other underlying health conditions?
  Spine surgery can be performed on individuals with other underlying health conditions, but careful evaluation and management of these conditions are necessary. The surgeon will assess the individual's overall health status, review medical records, and consult with other specialists to determine the safety and feasibility of spine surgery. Pre-existing health conditions may require additional precautions, and adjustments to the surgical plan may be necessary to ensure the best possible outcome.
• Is spine surgery recommended for individuals with spinal cord compression?
  Spine surgery is often recommended for individuals with spinal cord compression, especially when the compression causes significant neurological symptoms or deficits. Surgery aims to relieve pressure on the spinal cord and nerve roots, reduce inflammation, and restore or preserve neurological function. The specific surgical approach depends on the location and cause of the compression and the individual's overall health.
• Can spine surgery address nerve compression or radiculopathy?
  Yes, spine surgery can address nerve compression and radiculopathy. Surgical procedures such as discectomy, laminectomy, and foraminotomy aim to relieve pressure on the affected nerves, reduce inflammation, and alleviate radicular pain and other associated symptoms.
• Are there specific considerations for athletes or individuals with physically demanding occupations?Athletes or individuals with physically demanding occupations may have unique considerations when it comes to spine surgery. The surgeon will consider the individual's level of physical activity, functional requirements, and expectations for returning to their sport or occupation. Rehabilitation and a gradual return to physical activities are tailored to the individual's needs and guided by the surgeon and rehabilitation team.
• What is the cost of spine surgery, and does insurance typically cover it?
  The cost of spine surgery depends on factors like the type of surgery, the surgeon's fees, hospital fees, anaesthesia costs, and post-operative care expenses. It is essential to check with the surgeon's office and the healthcare provider regarding the estimated costs and coverage. In many cases, spine surgery is covered by health insurance, but coverage details can vary, and pre-authorization or documentation may be required.
• Can spine surgery be performed on individuals with previous spine surgeries or interventions?
  In some cases, spine surgery may be performed on individuals with previous spine surgeries or interventions. The decision to proceed with additional surgery depends on various factors, including the specific condition, the outcome of previous surgeries, the presence of complications, and the individual's overall health. 
• How can post-operative complications be minimized after spine surgery?
  Post-operative complications can be minimized by following the surgeon's post-operative care instructions, adhering to any activity restrictions, attending scheduled follow-up appointments, and promptly reporting any concerning symptoms or changes. It is crucial to take prescribed medications as directed, practice good wound hygiene, and follow any dietary or lifestyle recommendations provided by the healthcare team.
• Can spine surgery be performed on individuals with osteoporosis or weak bone density?
  Spine surgery can be performed on individuals with osteoporosis or weak bone density, but special considerations are necessary. The surgeon will evaluate the individual's bone health, assess the risks of fractures or complications, and take appropriate measures to minimize complications and optimize bone healing. This may involve the use of specialized implants or bone grafts to enhance structural support.
• Is rehabilitation necessary after spine surgery, and what does it involve?
  Rehabilitation is necessary after spine surgery to aid recovery, optimize functional outcomes, and prevent complications. The specific rehabilitation program will vary based on the individual's condition, the type of surgery, and their overall health. It may include physiotherapy, exercises to improve strength and flexibility, and education on proper body mechanics and posture.
• Can spine surgery worsen existing pain or lead to new complications?
  While spine surgery aims to alleviate symptoms and improve function, there is a small risk of complications or temporary worsening of pain. However, the decision for surgery is made after consideration of the benefits and risks by professionals. 
• Are there specific restrictions on activities or movements following a spine surgery?
  Following spine surgery, there may be restrictions on certain activities or movements to protect the surgical site, facilitate healing, and minimize the risk of complications. Restrictions include limitations on lifting heavy objects, bending, twisting, or participating in high-impact activities. The surgeon will provide specific instructions based on the individual's condition and the type of surgery performed.
• How long does it take to experience the full benefits of spine surgery?
  The timeframe to experience the full benefits of spine surgery varies depending on the individual, the condition, and the type of surgery performed. While some individuals may experience immediate relief of symptoms, others may require a period of healing and rehabilitation before experiencing the full benefits. The surgeon can guide the expected timeline for recovery and symptom improvement based on the individual's case.

Review

FAQs reviewed by Dr. Ashish Gupta, Senior Director, Neurosurgery, Spine Surgery.