When you’re considering having spine surgery, complete and reliable information is important to help you make the decision whether or not to have the surgery, as well as how to select a spine surgeon, prepare for back surgery and make the best use of the recovery process.
When to See a Spine Surgeon for Back Pain
Typically, spine surgery is considered as an option only after a course of nonoperative treatments (such as medications, physical therapy, injections, exercise, osteopathic or chiropractic manipulations) has been tried. Additionally, the decision about spine surgery depends largely on your symptoms (level of pain, ability to perform daily activities), how extensive the surgery is and if there are any adverse consequences to delaying surgery.
For some types of pain, minimally invasive surgical techniques offer an option to get relief from the pain quickly. For other types of pain, the surgical intervention is more extensive and it's often advisable to pursue several conservative care options before considering surgery. See When to See a Surgeon for Lower Back Pain.
An Accurate, Specific Diagnosis is Vital
Spine surgery is focused on correcting a specific anatomical lesion and is never "exploratory". For those patients who suffer from back pain, but no specific anatomical reason can be found, spinal surgery is not advised and conservative treatment is the recommended course of action. Modern diagnostic tests (such as an MRI scan, discogram) are used to pinpoint the anatomical reason for the pain. See Getting an Accurate Back Pain Diagnosis.
Back Surgery is Almost Always Your Choice
Spine surgery is typically an "elective" undertaking, meaning that it is considered as a possible approach to enhance your ability to function and decrease your pain. This means that your doctor can recommend spine surgery, but it's your choice whether to have the surgery or continue to pursue non-surgical treatment alternatives. Only in rare instances (such as 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. See Overview of Back Surgery and Neck Surgery.
A Spine Surgeon Should Help You With Your Decision
When deciding on surgery, the spine surgeon's role is to educate you and assist with the decision-making process - providing you with information about your full range of options, and describing what is technically possible, the difficulty and risk of the procedure and potential benefits. Therefore, it's important that you select a spine surgeon who is helpful in providing you the information you need to decide whether or not to proceed with surgery. If you ever have any doubts, it's always a good idea to get a second (or third) opinion from another surgeon.
Select a Surgeon Who Focuses on Spine Surgery
One important factor in selecting a surgeon is the amount of time the surgeon's practice devotes to spine surgery. A physician who focuses on spinal surgery is going to be far more adept and current in newer surgical techniques than one who performs spine surgery only occasionally. Both neurological surgeons and orthopedic surgeons can specialize in spine surgery and may have had specific fellowship training in spine surgery. Also, it's a good idea to make sure your spine surgeon is board certified or board eligible in orthopedic or neurological surgery. See How to Select a Spine Surgeon.
Psychological Preparation is Equally Important, Too
Importantly, psychological preparation can help shift the patient's role from that of a passive participant to a more active, empowered role that can positively impact one's healing and recovery. Extensive research has shown that use of psychological techniques to prepare for back surgery can improve the patient's overall experience and enhance the ultimate outcome – including less pain after surgery and a faster recovery process. For more information, please see How to Prepare Psychologically for Back Surgery and Preoperative Preparation for Spine Fusion Surgery.
After Spine Surgery: Postoperative Pain Management Can Help Your Recovery
Appropriate pain management after spine surgery can really help your recovery - both from a physical and emotional/morale point of view. In addition to pain medications, your physician and or nurses in the hospital can instruct you on some simple pain management aids. As an example, applying ice in the first 48 hours after surgery can be very helpful. Additionally, after the first 48 hours, ice can be used after activity to decrease any activity-related discomfort.
Scar Tissue is Normal After Back Surgery
Scar tissue formation is part of the normal healing process after a surgical intervention. Scar tissue itself contains no nerve endings, so it is rarely painful. Instead, the underlying cause of pain is thought to be fibrous adhesions that bind the lumbar nerve root. Because scar tissue after surgery is so common, the role that it plays in postoperative pain (also referred to as "failed back surgery syndrome" or "epidural fibrosis") is quite controversial. If you have scar tissue following surgery, this is perfectly normal. However, if you have continued postoperative pain, it's important to get a thorough medical exam to pinpoint the exact cause of the pain. See Post-Operative Care for Spinal Fusion Surgery and Scar Tissue and Pain After Spine Surgery.
Actively Participate in Your Rehabilitation Program
While it seems obvious, it bears repeating that you should carefully follow your postoperative rehabilitation program. Appropriate physical therapy, stretching and lifestyle changes (e.g. quitting smoking) will significantly enhance your recovery, help maintain a healthy back and decrease the chances of recurrent pain. After all you've been through before, during and after your spine surgery, it's worth the investment of time and effort to participate in a rehabilitation program to help maximize your chances of a successful and lasting recovery.
Whether or not to have back surgery or neck surgery is definitely a major decision. And it's made all the more difficult when you're in a lot of pain. However, with comprehensive, reliable information you should be in a better position to make a well-informed decision and proactively manage the process, which ultimately should lead to a better outcome for you.