By Daniel R. Fassett, MD, MBA, Illinois Neurological Institute Spine Institute
There are non-surgical and surgical treatments options when it comes to the spine. It’s important to have a long discussion with patients regarding their options. Treatment options typically include observation (giving things more time to improve on their own or living with their current level of pain), physical therapy, chiropractic therapy, medications, injections into the spinal canal (epidurals), or surgery. There are many instances where surgery may be the best option for relief of symptoms and other situations where surgery should not be considered. It all comes down to the patient’s symptoms (type and severity), what is seen on the imaging studies (MRI and X-rays), and what surgery would entail (minor versus an extensive surgery).
Everything is a balance of risk versus benefit. For instance, a patient might have severe compression (called stenosis) upon a nerve or nerves. In some instances, the patient’s symptoms may be severe to the point where they might not be able to walk, work, or sleep. In that instance, surgery could be the best option for treatment as it has a higher success rate of relieving the patient’s issues and fixes the issue over the long term. With severe nerve compression, non-surgical treatments such as medications, physical therapies, and pain injections are less likely to produce long-term relief.
A 2007 National Institute for Health multi-center study looked at the effectiveness of spinal surgery compared to non-surgical treatments. This study, the Spine Patient Outcomes Research Trial (SPORT), attempted to randomly select treatment for patients between non-surgical treatments with medications, physical therapy, steroid injections, and those receiving surgery. There were some challenges within the study as many of the patients selected for non-surgical treatment ultimately had surgery during the study period when their symptoms were not improving with non-surgical treatments. Overall, the study showed that for patients with lumbar disc herniation, lumbar stenosis, and lumbar spondylolisthesis (slippage of vertebrae), surgery has a higher success rate with greater relief of pain, more immediate relief of symptoms, and greater long-term improvement in quality of life.
Common surgical procedures
There are 100 different types of surgical procedures available, ranging from procedures that have been performed successfully for 60 years to new experimental technologies where the long-term outcome is less known.
Here are some of the more common procedures patients may be offered:
- Laminectomy — removal of some of the back of the spinal canal to decompress the spinal nerves or the spinal cord
- Discectomy — removal of some disc material (the shock absorber between the vertebrae) to relieve pressure on nerves or the spinal cord
- Fusion — locking of two or more vertebrae together
Non-surgical options
For some patients, undergoing surgery isn’t necessary. Here’s a look at some non-surgical options:
- Observation — giving things more time to improve on their own or living with their current level of pain
- Medications — NSAIDS (anti-inflammatory) medications and steroids are commonly tried
- Physical therapy — exercises, stretching, and strengthening designed to improve a patient’s symptoms
- Pain interventions — pain specialists may inject medications in and around the spinal nerves to relieve inflammation and pain. One of the more common injections is an epidural, where a steroid is injected into the space around the spinal nerves
- Chiropractic therapy — chiropractic measures to treat spinal pain
What to consider before having surgery
There are a number of factors that should be considered before having surgery. Patients need to weigh their symptoms and quality of life against the likelihood for success, risks of surgery, and extent of recovery after surgery. For patients in severe pain and where a minor, highly successful surgery can be performed, the decision to proceed is easier. For patients requiring a more extensive surgery, the decision is obviously more challenging.
Seeking a second opinion
Patient references and second opinions are always wise decisions for patients. When it comes to spine surgery, and pretty much any surgery, the best chance for success is the very first surgery. As a surgeon, I find it definitely more challenging to fix a failed surgery that was performed by another surgeon. Doing the surgery correctly the first time provides the best chance for long-term success.
Patients need to feel comfortable with their surgeon. If a patient has any reservations about what is being recommended, a second opinion should strongly be considered. Of course, getting multiple opinions may be confusing to some patients and families, but considering multiple opinions and options is, in general, a good thing. Patient references can also be valuable for patients considering surgery. Talking to another patient that has been treated with a given procedure helps by providing information about recovery and reassures a patient that a procedure may successfully relieve their pain.
A patient should be prepared to ask their surgeon tough questions:
- “How many of these procedures do you perform a year?”
- “What do you expect is the likelihood for success?”
- “What are the risks?” or “What could go wrong?”
- “Will this procedure create any problems in the future?”
- “What would you do if this was your family member?”
With every patient I see, I always try to answer these questions. I especially always try to put myself in the patient’s situation. I ask myself, “What would I do if this was me, my mother, or another family member?”
Dr. Daniel R. Fassett is board-certified in neurosurgery by the American Board of Neurological Surgery. He serves as director of the Illinois Neurological Institute Spine Institute. To request an appointment or second opinion with the Spine Institute team, call 877-464-6670. For more information about the Illinois Neurological Institute, visit www.ini.org.