Spine surgery introduction
The primary purpose of back surgery or neck surgery is to correct an anatomical lesion in individuals who fail to show improvement with conservative treatment. For those patients who have pain, but no anatomical lesion can be identified that accounts for their pain, surgery is not an option. Surgery is useful only to change a patient’s anatomy (e.g. remove a disc herniation). There is almost never any reason to consider exploratory surgery to “look” for a cause of pain.

Advancements in spine surgery
Modern spine surgery has made major advancements in both technique and spinal instrumentation/implants over the past couple of decades, but by far the most significant advancement in spine surgery has been better preoperative imaging techniques. Specifically, magnetic resonance imaging (MRI scan) has revolutionized spine surgery. It is most often the best test to identify an anatomical lesion responsible for the patient’s problem. The most important factor in the determination of the success in spine surgery is proper preoperative diagnosis. Without an accurate preoperative diagnosis, even the most technically successful surgery has little chance for a successful outcome.

Although spine surgery is performed by either orthopedic surgeons or neurosurgeons, it is increasingly becoming a field unto itself. Many surgeons are doing additional specialized training in the field after their residency training (fellowship training). Given the precision required for these more demanding surgical techniques, many orthopaedic or neurosurgeons with fellowship training are choosing to focus more of their practice on spine surgery. Some believe that the increased level of specialty training and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (e.g. reduced post-operative discomfort) with many types of spine surgery.

Reasons for spine surgery
Lumbar Spinal Fusion Spine surgery is typically an “elective” undertaking, meaning that it is considered as a possible approach to enhance a patient’s ability to function and decrease pain. Just because it is elective does not mean it is not covered by insurance. Elective surgery can be medically necessary. It just means that surgery of the spine is rarely an absolute necessity. Only in rare instances, such as for patients who have a progressive neurological loss of function or sudden onset of bowel or bladder incontinence, is spinal surgery actually necessary on an emergency basis.

Spine surgery can basically accomplish three tasks: It can decompress a nerve root or the spinal cord. It can stabilize an unstable or painful segment with fusion surgery. It can reduce a deformity (e.g. scoliosis surgery in the thoracic spine). Spine surgery is not done for exploration. The cause of a patient’s pain is not readily apparent with opening and exploring the spine. The preoperative evaluation and imaging results are what identify the problem and guide the design of the procedure.

(By: Peter F. Ullrich, Jr., MD)