Spine Surgery Guide
Know When and Why Spine Surgery Works Best
Spine surgery; minimally invasive spine surgery; laser spine surgery; robotic spine surgery. Regardless of the type of spine surgery you might be considering, or what you might call it, arming yourself with information before making a decision to undergo spine surgery will help improve your chances of a successful outcome.
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Spine surgery can be an effective treatment for many painful back and neck conditions. It is usually only performed after non-surgical treatments, such as physical therapy or steroid injections, have failed to work. Newer surgical techniques, including minimally invasive spine surgery and robotic-guided spine surgery, are now available and can sometimes provide faster healing and less pain than traditional surgery.
Minimally invasive spine surgery is not appropriate for all spine conditions, but surgical techniques for back and neck problems are continually being refined and more procedures are now being performed using minimally invasive techniques. Some spine surgeons, including Denver neurosurgeon Paul Boone, MD, perform minimally invasive spine surgery with robotic systems, such as the Mazor Robotics Renaissance Guidance System that can help provide an additional level of surgical accuracy.
To learn more about spine surgery, continue reading below or jump directly to the section that interests you:
- When to consider spine surgery
- Am I a candidate for spine surgery?
- Appropriate conditions for spine surgery
- Spine Surgery to Decompress or Stabilize the Spine
- Spine Surgery Techniques: From Traditional to Minimally Invasive
- Minimally Invasive Spine Surgery vs. Laser Spine Surgery
- Choosing a Spine Surgeon
- Preparing for spine surgery
- Day of surgery
- Recovery after spine surgery
- Pain management after spine surgery
- Spine surgery resources
In specific cases, such as traumatic spine injury, surgery will be recommended immediately. However, in most cases of back and neck pain your spine surgeon will recommend managing your back pain or neck pain symptoms with conservative treatments first. Spine surgery is usually recommended only after more conservative treatments are tried and fail to provide adequate pain relief. It is important to note that conservative treatments are not always a quick fix – they may need to be tried over a period of many weeks before results are seen. Conservative treatments for back pain and neck pain recommended by your spine specialist may include:
- physical therapy
- acupuncture or massage
- oral anti-inflammatory medications
- steroid injections or other nonsurgical pain management procedures
- patient lifestyle changes, such as weight loss, smoking cessation, and control of medical conditions such as diabetes and hypertension
One thing Denver spine surgery patients should consider is that Colorado has one of the highest rates of spine surgery in the United States, according to the Dartmouth Atlas of Health Care. Nearly 1.5 people out of every 1,000 Medicare recipients in Colorado receive spine surgery vs. a national average of 1 per 1,000. This ranks Colorado in the 90th percentile for spine surgeries. The reason this is important is to ensure that you are selecting a Denver spine surgeon who has experience and can present you with the research supporting the decision for spine surgery as well as the expected outcome for your spine surgery, and in many cases, why surgery is not a good idea.
When you first start experiencing back pain, neck pain or spine problems, your primary care physician or a pain specialist will likely recommend conservative treatments. If these are not effective, you will probably be referred to a neurosurgeon or orthopedic surgeon who specializes in spine conditions. After reviewing your medical history, the spine surgeon will talk with you to determine if you are a surgical candidate. It’s important to note that spine surgery is only effective if a structural cause for your particular pain can be identified. If you answer “yes” to many of these questions, spine surgery may be appropriate for you:
- Have you tried physical therapy? (It is important to note that physical therapy is not appropriate for all spine conditions.)
- Have you tried medications?
- Have you tried steroid injections or other nonsurgical pain management procedures?
- Have you had imaging tests such as X-ray, CT, or MRI of your spine and diagnostic injections?
- Has a structural cause of your pain been identified?
- Does your pain greatly diminish your quality of life or activity level?
While many Colorado residents will visit a doctor for back pain or neck pain at some point in their life, they will more than likely be treated successfully by their primary care doctor or a pain specialist with non-surgical treatments such as physical therapy or medications. For back pain and neck pain patients who do not respond to conservative treatments, spine surgery may be an appropriate treatment and your primary care physician may refer you to a spine specialist. New spine surgery procedures such as minimally invasive spine surgery and robotic spine surgery can offer faster recovery in many cases.
Conditions that may benefit from spine surgery include:
- Spinal stenosis – this narrowing of the spinal canal may be treated with surgery due to greater improvements in pain reduction and function when compared to more conservative treatments.
- Bulging disc – bulging discs are sometimes called disc protrusions. They may cause pain if they press on an adjacent nerve root or the spinal cord.
- Cervical or lumbar disc herniation – disc herniation is most often caused by degenerative disc disease, but can also be caused by twisting or turning while lifting, or by injury or a traumatic event such as a fall. Surgical treatment of a herniated disc may result in less pain and greater long-term improvement than conservative care for this condition, which is sometimes called a slipped disc, ruptured disc or a pinched nerve.
- Degenerative disc disease (DDD) – one of the most common causes of lower back pain, DDD is usually treated conservatively. Disc replacement surgery may be required in rare cases.
- Spondylolisthesis - a condition where the bone in the lower part of the spine slips out of its proper position onto the bone below it. Surgery to fuse the slipped bones back into place in many cases may provide relief if a patient is symptomatic and treatments such as physical therapy, traction, or anti-inflammatory medications don't work.
- Myelopathy - a condition in the neck or mid back in which the spinal cord is irritated or injured.
- Synovial cyst – a fluid-filled sac in the spine that has developed as a result of degenerative disc disease (DDD) and may compress nerves like a herniated disc.
- Facet arthropathy – a type of arthritis that affects the joints in the lower back. It can occur if joints in the spinal area become compressed or if there is inflammation in the fluid-filled disc that helps to protect bones located in the spine.
- Loss of motor or bladder control - conditions such as cauda equina syndrome, a rare condition that affects the nerves in the lumbar area, benefit from surgery. Surgery for these conditions reduces the likelihood of long-term issues.
Spine surgery falls into two main categories: Decompression spine surgery relieves leg or arm pain being caused by pressure on or pinching of spinal nerves, while stabilization spine surgery provides strength and stability to the spine by eliminating motion, and often improves back or neck pain.
Decompression spine surgery helps relieve pressure on a nerve along the spinal cord that is being pressured or pinched. Some common decompression procedures include:
Conditions that may be treated with these procedures, either via open spine surgery or a minimally invasive spine surgery technique, include:
Stabilization spine surgery is performed to reduce or eliminate motion between the vertebrae causing pain. Stabilization procedures often involve the placement of plates, rods or screws. Common stabilization procedures include:
Stabilization procedures and the conditions they are used to treat (with open spine surgery or a minimally invasive technique) include:
Anterior Cervical Discectomyand Fusion
|Cervical Disc Replacement||Transoforaminal Lumbar Interbody Fusion||Lateral Lumbar Interbody Fusion|
- Some spine surgeries may involve replacement of a disc in the spine, sometimes with an artificial disc.
- Some spine surgery procedures, such as anterior cervical discectomy and fusion, combine decompression and stabilization techniques.
Spine surgery is performed in several ways.
- Open surgery: The majority of spine surgery procedures are still performed traditionally as open surgery, with an incision that allows the surgeon to work directly on the spine.
- Minimally invasive spine surgery: About 30 percent of spine surgery procedures can be performed with minimally invasive techniques, including endoscopic spine surgery. Minimally invasive spine surgery also may be referred to as less invasive spine surgery or endoscopic spine surgery. (Sometimes, minimally invasive surgery is incorrectly labeled laser spine surgery or laparoscopic spine surgery.) When performing minimally invasive spine surgery, the spine surgeon makes a small incision (typically less than one-inch). He then uses special tools such as retractors, endoscopes, and microscopes that he controls to see into the incision and perform the actual procedure. Minimally invasive spine surgery typically results in less damage to the muscles around the spine, which can help reduce pain after surgery and lead to a quicker recovery.
- Robotic-assisted spine surgery: Expertly trained spine surgeons may use robot-assisted technology during minimally invasive spine surgery to enhance implant placement and accuracy. Learn more about the Mazor Robotics Renaissance Guided System.
- Laser spine surgery: Patients often do internet research using the term “laser spine surgery” due to heavy consumer advertising using this term. However, spine surgery performed with lasers is rare and used only in very specific cases. Most centers advertising laser spine surgery are actually offering minimally invasive spine surgery.
As noted previously, minimally invasive spine surgery often is mistakenly called laser spine surgery by consumers. However, in most cases the actual procedure a consumer is researching is a minimally invasive surgery that does not involve a laser at all. Minimally invasive spine surgery is appropriate in about 30 percent of cases of back pain or neck pain. It involves the surgeon performing the procedure through a small incision with a miniature camera and specialized instruments. Because muscles are not disturbed during minimally invasive spine surgery, pain is often reduced and recovery times tend to be shorter.
Minimally invasive spine surgery is an option for many traditional spine surgeries, including discectomy, spinal decompression, and transforaminal lumbar interbody fusion. Though laser spine surgery is a term commonly researched by patients, true laser spine surgery is used very rarely and never for degenerative spine disease, which involves spinal discs and accounts for the vast majority of back pain.
Read more about the difference between minimally invasive and laser spine surgery here.
Learn more about minimally invasive spine surgery from the American Association of Neurological Surgeons.
While neurosurgeons are often thought of for brain surgery or nerve surgery, many neurosurgeons are spine surgery specialists who have undergone extra training, including fellowships, in spine surgery. Denver spine surgeon Paul Boone, MD, of Neurosurgery One, has completed fellowship training in spine surgery and is certified by the American Board of Neurological Surgery. J. Adair Prall, MD, and David VanSickle, MD, PhD, of Neurosurgery One, also are board certified and have performed thousands of spine surgeries over more than 20 years each in practice.
Like orthopedic spine surgeons, neurological spine surgeons often only perform spine surgery. In addition to treating structural spine issues, neurosurgical spine surgeons have special expertise and training to evaluate and address issues involving the spinal cord and the central and peripheral nerves.
Some things to consider when choosing a Denver spine surgeon or spine specialist include:
- Experience. While there is no magic number for this, most experts agree that an “experienced” surgeon is one who: (1) has five years’ experience performing the procedure; (2) has performed the procedure at least 30 times. However, depending on the procedure, a surgeon may only perform certain specialized or rare procedures a few times each year.
- Outcomes. Benefits of a more experienced surgeon include reduced surgical complication rates, lower infection rates, shorter hospital stays, more careful patient screening, and less chance a patient will need additional surgeries or revision surgery.
- Board certification. This means that a physician or surgeon meets nationally accepted standards for knowledge and practice, enabling the optimal quality of care to be maintained. If a spine surgeon is a neurosurgeon, he or she may be board certified by the American Board of Neurological Surgery.
- Training. Although all neurosurgeons are trained to perform all types of spine surgery, some neurosurgeons complete spine fellowship programs after completing their residency requirements and becoming board-eligible. Fellowships give some surgeons even more in-depth, specialized training; a spine fellowship usually lasts for one year. A fellowship often includes participation in clinical research; the fellow may also be required to author a scientific or research paper.
In addition to experience and training, it’s important that patients feel comfortable with both the surgeon and his or her office staff.
There are several things you can do to prepare for surgery to help facilitate better outcomes and an easier recovery.
- Learn as much as you can about your condition, your surgery, how to prepare for spine surgery, what to expect on the day of surgery and during recovery. Your Denver spine surgeon and care team are happy to answer any questions you have about your treatment.
- Talk with your spine surgeon about “pre-hab,” which might include a walking program and some exercises to strengthen legs and core that can help you alleviate pressure on your spine while you recover. This should be done with the guidance of your spine surgeon or a trained physical therapist, especially if you’re experiencing a lot of neck or back pain. Some insurance plans only cover a limited number of physical therapy visits, which may be better used for rehab after surgery, so be sure to check with your insurance plan and discuss with your spine surgeon.
- You may be asked to stop smoking prior to surgery, because smoking can interfere with lung function and may delay your recovery. Smoking also is linked to higher infection rates and higher rates of incomplete bone healing.
- You may be asked to stop using certain medications, such as aspirin or other blood thinners or non-steroidal anti-inflammatory (NSAID) medications such as Aleve, Advil, and ibuprofen one week or more before your surgery. Be sure to tell your surgeon about all of the medications as well as any natural supplements you are taking so he or she can determine if they will affect your spine surgery outcomes.
- Prepare your home, including stocking up on easy to prepare foods and asking a friend or family member to help prepare meals, check in on you, and drive you to physical therapy appointments.
- Schedule your follow-up appointments prior to spine surgery.
- You will need a friend or family member to drive you to and from the hospital, and stay at the hospital during your spine surgery.
- Talk with your spine surgeon about your recovery prior to surgery, including how to handle stairs if your home has them, the impact of twisting or bending, exercise, what you can and cannot lift, when you will be able to resume driving, when you can return to work on light duty or full time, and how to refill your medications.
Read more about preparing for spine surgery here.
On the day of your surgery, you will be asked to not eat or drink anything after midnight the day before. Your surgeon and his or her office staff will provide you with a list of additional things to do on the day of surgery, such as showering with antibacterial soap, as well as items to bring with you to the hospital.
The length of your surgical recovery can vary depending on the type of surgery you have, your overall health, and whether you are eligible for the Enhanced Recovery After Surgery (ERAS) program.
Your spine surgery care team will discuss what you can expect during the days and weeks after spine surgery, including:
- when you can return to work
- when you can start driving
- when you can resume other activities such as climbing stairs, lifting, exercising, twisting and bending
- how much pain to expect
- what medications you may be prescribed
- how to refill your medications
- what symptoms are normal and which are considered red flags or cause for concern, and what to do about them, including when to call your surgeon
Read more about recovery from spine surgery here.
Patients who are experiencing neck pain or back pain may be given a recommendation to take medications as an initial treatment before surgery. Patients may also be prescribed pain medications after surgery. Many types of post-surgical medications are available to help control pain, including non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and local anesthetics. Your spine surgery care team will choose the pain control medications that are best for you after surgery, both in the hospital and when you return home to recover. The team will also let you know if alternative pain control therapies are effective or recommended.
To review additional information on spine surgery, please click on the links below:
Downloadable guide: Spine Surgery 101
Downloadable guide: Lumbar Spinal Fusion Surgery
Downloadable guide: Cervical Disc Fusion vs Disc Replacement
Infographic and Assessment: SI Joint Dysfunction
Video: Cervical Spine Fusion vs Disc Replacement
Blog: Shining a Light on the Facts of Laser Spine Surgery
Video: Minimally Invasive Spine Surgery
Neurosurgery One's four spine experts can help you find the treatment that will work best for your condition. To make an appointment, complete the form to the right and one of our schedulers will call you.