Misconceptions About Spinal Surgery

Posted on Wed., June 3, 2009
By Laszlo Tamas, MD

Back and neck problems are common and can be extremely painful and debilitating.

Some who suffer back or neck pain think they need surgery, when in many cases surgery won't help them. Others, with pain in the arm or leg, avoid spinal surgery, when it might bring them great benefit.

The following are common misconceptions about spinal surgery for degenerative spinal problems, which are the most common cause of spinal symptoms. The answers might be different for problems such as fractures, instability and tumors. Every patient is different and needs a full evaluation by a qualified physician.

"I have had severe neck pain for a long time, so I must need surgery to fix it."

In fact, spinal surgery is better at fixing symptoms of pinched nerves, which usually cause shooting pains, weakness or tingling down an arm or leg.

A long history of "axial" pain (pain in the back or neck) often suggests arthritis of the spine, which surgery seldom helps. More than 90 percent of patients nationwide with persistent, even severe, neck or low back pain are not candidates for surgery, because surgery is unlikely to help them.

"I've had severe pain in my back and down my leg since lifting boxes last week. I need an MRI and maybe surgery right away."

Most patients who have a herniated disc make a full recovery within three to six months, without the need for surgery. (A herniated disc, also called a "slipped disk", is when the soft tissue—the disc—between the spinal bones pushes against a nerve as it exits the spinal column.)

An MRI is an X-ray-like technique that produces detailed images of body parts, including the spine. In this scenario, the patient usually does not need an MRI, since the cause of his pain is clear, and he will likely recover on his own.

"I don't have any neck pain, so I don't need surgery on my cervical (neck) spine."

Pressure on the spinal cord can be painless, yet often needs surgery to prevent permanent paralysis. A person with no pain, but whose walking has become stiff and clumsy—and whose examination and MRI show signs of severe spinal cord pressure—needs surgery urgently.

"I've had this sciatica for the last two years, so I can safely avoid surgery for a little while longer." (Sciatica is a pinched nerve in the lower back that causes pain in the buttock or leg.)

While most people who have lumbar disc disease get better without surgery, the longer the back pain and sciatica continue, the less the chance that they will spontaneously improve.

"Back surgery will completely cure my back pain."

While this occasionally happens, most patients continue with some amount of back pain. Usually, though, surgery lessens pain enough to improve daily function.

So should you have a spine surgery or not? Ask your physician the following questions:

Do I have a surgically treatable problem in my spine?
Are you confident this problem explains the symptoms?

And ask yourself the following question:

Will improvement in these symptoms improve my overall life?

If the answer to all of these questions is "yes," surgery is likely to help you.

Tamas is a neurosurgeon with Contra Costa Health Services.