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ASK THE DOCTOR: Spine surgery has advanced, but should still be last resort

ASK THE DOCTOR: Spine surgery has advanced, but should still be last resort


In any average day as a spine surgeon, I often encounter patients who will tell me that the very last thing they want to have is spine surgery. I am often bemused by this since they are telling that to a spine surgeon; but, at the same time I understand completely what they mean and why they are saying that.

The specialty of spine surgery in its current form is a relatively new specialty when compared to other specialties such as internal medicine, general surgery and even heart surgery. As such, the specialty is still in its “learning” phase, with new procedures and techniques being developed each day. Spine surgery has recently benefited from new imaging techniques such as CT scanning and MRI scanning. These two technologies have taken the much of the “guess work” out of diagnosing what is wrong with a patient’s spine and what treatment to recommend.

Before the 1990s, spine surgeons really had only their diagnostics skills, regular x-rays and CT scan in order to diagnose and to recommend treatment to patients with spinal aliments. X-rays and CT scans are by no means primitive tools, but when compared to the more modern MRI they are definitely lacking in the ability to precisely “look” into the body and clearly see what is wrong with the spine. The advent and regular availability of MRI, plus the continued improvement of MRI imaging, has been a godsend for spine surgeons and their patients. We can now precisely diagnose which disc is herniated, how big the herniation is, which nerve is being pinch and where. We no longer are guessing as to which disc has “slipped.”

All this new information has led to more precise surgical treatments and has removed the “guesswork” and former exploratory nature of early spine surgery. With the advent of better imaging, has come better understanding of spinal anatomy and how the spine functions leading to the additional benefit of more precise and targeted surgery.

The most recent development of minimally invasive spine surgery (MISS) has now allowed surgeons to perform corrective spine surgery through smaller and smaller incisions which, in term, has lead to quicker surgeries and quicker recovery. In fact, spine surgical techniques have advanced to the point where more and more spine surgeries can now be performed in an outpatient setting with patients being able to go home the day of surgery.

So, if with all these new modern imaging and more precise surgical techniques, why does spine surgery still have such a bad reputation with some patients?

Some of this bad reputation is historical, in that patients can recount stories told to them by friends and neighbors neighbors who have had bad experiences and outcomes from spine surgeries. There is no doubt that some of these stories are true, and it will take time of patients telling new stories of the benefits of current spine surgeries to overcome these older tales.

Another equally important factor is the aggressiveness of some spine surgeons to operate too quickly and not to allow other non-surgical treatment options to work. Most patients with neck and back pain should exhaust non-surgical treatments such as chiropractic care, injections, medications, physical therapy, and acupuncture before rushing to surgery. These non-surgical treatments have been proven to be very effective in treating most patients with neck and back pain. In fairness, most patients with these issues are much better off trying these nonsurgical routes before surgery.

Spine surgery, despite all of its recent advancements, should not be the first line of treatment for most patients with neck and back pain but should be reserved for those patients who have tried and failed non-surgical treatments.

Dr. Dwight S. Tyndall, FAAOS, is an outpatient spine surgeon practicing in the Region. His column, which appears every other week, covers a wide range of health and medical issues.


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