Video presented by Peter F. Ullrich, Jr., MD
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There are only two things surgery can do. Surgery can either decompress a nerve root or it can stabilize a painful motion segment. So we have to identify a nerve root that’s pinched or we have to identify a painful motion segment. And if we can do that, it would make you a candidate for surgery. Just having pain and having failed conservative treatment is not an indication for surgery if there is no pathological cause of the pain – it does not mean there is not pain, but we have to identify the cause of pain in order to be able to correct it. The only thing surgery can do is correct an anatomical defect, so we have to be able to identify it.
What is Conservative Treatment?
Conservative treatment consists of non-surgical treatment. Things like physical therapy, chiropractics, epidural injections, and medications. Failing conservative treatment can mean different things. If it’s a painful acute process, like a disc herniation, failing it can be interpreted as four to six weeks of treatment. If it’s a more chronic problem such as degenerative disc disease, failing it may encompass doing conservative treatment before deciding it is just not working or the pain is getting too bad.
Surgical Indications and Elective Surgery
Almost all surgeries on the spine are elective, meaning that it’s the patient’s choice to elect to have the surgery or not to have the surgery. There are only two indications that are absolute that you have to have surgery: progressive neurological deficit or bowel/bladder incontinence – what is known as cauda equina syndrome. Both of those things are exceedingly rare, so that means virtually all other spine surgeries are an elective surgery and if you want to have a more aggressive treatment to try to get rid of your pain, you can elect to have surgery. The surgeon’s job is to tell the patient what can technically be done. It is still up to the patient whether or not they want to have it done because basically they are the only one with the pain. Deciding on having surgery or not having surgery has a lot to do with the amount of pain, amount of disability, the length of time they’ve had the pain, and what treatments they’ve already tried and have failed. Since it’s an elective surgery, they need to know what technologically can be done, but that doesn’t mean that it has to be done.