Myths about spine surgery !!
Its been now about 11 years in profession to treat back related problems. During the time I have been to various countries. There have been totally different experiences during my professional journey so far. It has been an experience to know and learn from a patient's psychology and perspective.
One common thing that i find across the patient population suffering from back related problems.
Most of us do not know much about back problem. Except a few words like "sciatica" "slip disc" etc.
the biggest myth prevailing when a patient is offered a surgery for a back problem is "spine surgery can not be done". A patient who can not walk or stand or even sit easily without pain do not want to accept the option of spine surgery thinking that the only outcome of a spine surgery is paralysis or because spine surgery is never successful.
let me try to give a surgeon's scientific views on this.
Q:1 Is a spine surgery never successful ?
Its a known fact that no surgery in this world has 100% success rate. When you operate upon a patient for any ailment whatsoever, the patient is taking the risk associated with a procedure. So to say that spine surgeries are never successful is far from the truth. Most spine surgeries in recent era has a success rate of more than 85-90% depending on the surgery. Simple surgeries like surgery for a slip disc has a success rate of more than 95% in a properly selected patient. Most of the times spine surgeries are the surgeries to improve your quality of life or to make you pain free. So if one is suffering so much so as his quality of life is compromised and he is indicated for a surgery spine surgery is surely a result oriented surgery.
Q:2 Is it true that after a spine surgery , a patient needs a prolonged bed rest?
spine surgery has revolutionized over a period of last decade. It is true that in past patients were kept on a complete bed rest for about 3 months after surgery. But that was the era when technology was not available. Today , with better understanding of spine pathologies and development of technological expertise, that era has parished.
These days except a few cases, after most spine surgeries , we make our patients walk or stand in almost no time. Most patients are up and are made to take few steps in about 5 to 6 hours after surgery or at the most on next day. The recuperation to normal activity level is quite fast.
Q:3 Does a patient get paralyzed after a spine surgery ?
As i mentioned earlier , no surgeries are risk free. We as a surgeon always weigh the risk benefit ratio before offering a surgical option to a patient. What particular complication shall occur depends on the kind of surgery and area of spine is involved. For example if one is operating on a cervical spine or a thoracic spine there are some chances of having paralysis as an complication. But if the operative area is a lumbar spine , the chances of paralysis are quite low or negligible. Even is cervical or a thoracic spine having a permanent paralysis, the chances are quite slim. Most advanced center like ours, we use Intra Operative Neuromonitoring. The device gives us the real time feed back while we are operating on a spine and can warn us if we are endangering a nerve structure. With such technology such a grave complication as paralysis is not a great possibility during a surgery.
It is always important to discuss with your surgeon before undergoing a spine surgery the detailed profile of surgery. Most surgeries have become drastically safe these days and yield a desired results. it is important to know what if you do not get operated for the surgery. Many time in my practice i have seen patients getting paralysed by not getting operated timely.
so if surgery is needed, and if you do not under go it , especially for a cervical or thoracic spine, chances of neuro deficit are much more in non-operative than operative treatment.
Q:4 Is laser surgery possible ?
Many of my patients ask me , doc will you be doing a laser surgery. And my reply to them is always like "what you mean by a laser surgery" . If you mean that using a laser beam from outside and pointing it at a disc one is going to get cured.. that is utter nonsense understanding. There are few endoscopic surgeries where HO:YAG laser is used but they are used as a part of a procedure , its is not the only procedure. Most spine surgeries across the world do not require laser.
So its absolutely a misinformation to say that laser spine surgery is the most advanced surgeries.
Q:5 If surgery is successful once , will it affect a patients future?
most patients ask me a question when they have a herniated disc ( slip disc ) , and i offer them a simplest surgery of MicroEndoscopic Discectomy ( a procedure to remove the slipped piece of a disc).
When we offer this particular surgery , by making a small ( about 1") cut on skin and on back of vertebra, we remove the ruptured herniated portion out with specialized instruments. We only remove a very very very small portion of the entire disc. The rest of the major part is left behind to maintain the stability and motion at that particular segment. So, if someone ask me , if the disc can again rupture after a microdiscectomy, the answer is YES. But , to say that surgery is responsible for that is again an over statement. The chances of reherniation are <10% in most cases. And the reason behind that second rupture would be inherent disc insufficiency that itself lead to first rupture not the surgery.
One may surely ask here , why don't we remove the entire disc to take off the chances of re-herniation ? well a valid argument, but the same thing led to so many failed spine surgeries in past. When you remove an entire disc, you make a spine segment unstable. That instability will lead to future failure of spine surgery. So , if we want to remove the entire disc, we shall have to reconstruct the segment with screws and a metallic cage between two vertebrae to fuse them. This surgery is a too much surgery for a small problem. So, we cant offer that surgery to every patients who come with a disc rupture.
One common thing that i find across the patient population suffering from back related problems.
Most of us do not know much about back problem. Except a few words like "sciatica" "slip disc" etc.
the biggest myth prevailing when a patient is offered a surgery for a back problem is "spine surgery can not be done". A patient who can not walk or stand or even sit easily without pain do not want to accept the option of spine surgery thinking that the only outcome of a spine surgery is paralysis or because spine surgery is never successful.
let me try to give a surgeon's scientific views on this.
Q:1 Is a spine surgery never successful ?
Its a known fact that no surgery in this world has 100% success rate. When you operate upon a patient for any ailment whatsoever, the patient is taking the risk associated with a procedure. So to say that spine surgeries are never successful is far from the truth. Most spine surgeries in recent era has a success rate of more than 85-90% depending on the surgery. Simple surgeries like surgery for a slip disc has a success rate of more than 95% in a properly selected patient. Most of the times spine surgeries are the surgeries to improve your quality of life or to make you pain free. So if one is suffering so much so as his quality of life is compromised and he is indicated for a surgery spine surgery is surely a result oriented surgery.
Q:2 Is it true that after a spine surgery , a patient needs a prolonged bed rest?
spine surgery has revolutionized over a period of last decade. It is true that in past patients were kept on a complete bed rest for about 3 months after surgery. But that was the era when technology was not available. Today , with better understanding of spine pathologies and development of technological expertise, that era has parished.
These days except a few cases, after most spine surgeries , we make our patients walk or stand in almost no time. Most patients are up and are made to take few steps in about 5 to 6 hours after surgery or at the most on next day. The recuperation to normal activity level is quite fast.
Q:3 Does a patient get paralyzed after a spine surgery ?
As i mentioned earlier , no surgeries are risk free. We as a surgeon always weigh the risk benefit ratio before offering a surgical option to a patient. What particular complication shall occur depends on the kind of surgery and area of spine is involved. For example if one is operating on a cervical spine or a thoracic spine there are some chances of having paralysis as an complication. But if the operative area is a lumbar spine , the chances of paralysis are quite low or negligible. Even is cervical or a thoracic spine having a permanent paralysis, the chances are quite slim. Most advanced center like ours, we use Intra Operative Neuromonitoring. The device gives us the real time feed back while we are operating on a spine and can warn us if we are endangering a nerve structure. With such technology such a grave complication as paralysis is not a great possibility during a surgery.
It is always important to discuss with your surgeon before undergoing a spine surgery the detailed profile of surgery. Most surgeries have become drastically safe these days and yield a desired results. it is important to know what if you do not get operated for the surgery. Many time in my practice i have seen patients getting paralysed by not getting operated timely.
so if surgery is needed, and if you do not under go it , especially for a cervical or thoracic spine, chances of neuro deficit are much more in non-operative than operative treatment.
Q:4 Is laser surgery possible ?
Many of my patients ask me , doc will you be doing a laser surgery. And my reply to them is always like "what you mean by a laser surgery" . If you mean that using a laser beam from outside and pointing it at a disc one is going to get cured.. that is utter nonsense understanding. There are few endoscopic surgeries where HO:YAG laser is used but they are used as a part of a procedure , its is not the only procedure. Most spine surgeries across the world do not require laser.
So its absolutely a misinformation to say that laser spine surgery is the most advanced surgeries.
Q:5 If surgery is successful once , will it affect a patients future?
most patients ask me a question when they have a herniated disc ( slip disc ) , and i offer them a simplest surgery of MicroEndoscopic Discectomy ( a procedure to remove the slipped piece of a disc).
When we offer this particular surgery , by making a small ( about 1") cut on skin and on back of vertebra, we remove the ruptured herniated portion out with specialized instruments. We only remove a very very very small portion of the entire disc. The rest of the major part is left behind to maintain the stability and motion at that particular segment. So, if someone ask me , if the disc can again rupture after a microdiscectomy, the answer is YES. But , to say that surgery is responsible for that is again an over statement. The chances of reherniation are <10% in most cases. And the reason behind that second rupture would be inherent disc insufficiency that itself lead to first rupture not the surgery.
One may surely ask here , why don't we remove the entire disc to take off the chances of re-herniation ? well a valid argument, but the same thing led to so many failed spine surgeries in past. When you remove an entire disc, you make a spine segment unstable. That instability will lead to future failure of spine surgery. So , if we want to remove the entire disc, we shall have to reconstruct the segment with screws and a metallic cage between two vertebrae to fuse them. This surgery is a too much surgery for a small problem. So, we cant offer that surgery to every patients who come with a disc rupture.
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