Having spine surgery is a big decision, and it’s in your best interest to ask questions so you know how to prepare, and what to expect both immediately after the surgery and long-term. Scott Boden, MD, director of Emory Orthopaedics & Spine Center, is a sought-after and accomplished spine surgeon, award-winning researcher and considered a visionary in the treatment of musculoskeletal ailments. He’s been a leader at Emory Spine Center for 30 years and was designated as one of the top 100 Spine Surgeons in the U.S.
Dr. Boden addresses some of the most common questions you should ask your provider before spine surgery.
When is it time to be evaluated by a spine surgeon and when is surgery an option?
Dr. Boden: Over 90% of spine-related problems usually resolve on their own or with some simple non-operative treatment, such as physical therapy or medications. If you have radiating pain, numbness or weakness down your arms or legs that has not been getting better within a short amount of time, that is an indicator you should be evaluated by a spine surgeon. Only a very small percentage will require or benefit from surgery. In some cases, surgery can worsen the situation. But the right operation for the right problem can give a patient their life back.
Who is a good candidate for spine surgery?
Dr. Boden: For people under age 50, one of the most common problems that could lead to spine surgery is a herniated disc. If that doesn’t resolve with non-operative treatment, then a patient with that problem is usually an excellent surgical candidate, assuming their main symptom is persistent radiating arm or leg pain – pain that they can feel traveling down the limb. In those over age 50, the best candidates for surgery have pinching of the spinal nerves (spinal stenosis) with or without a slippage of the vertebral bone. In both cases, the primary limiting symptom would be radiating leg pain, usually worse with standing or walking. If this is your situation, and the pain has not resolved in two months of non-operative treatments, you may be an ideal candidate for spine surgery.
What type of tools or techniques are generally involved with spine surgery?
Dr. Boden: It depends on what the patient’s specific spine problem is. For a herniated disc, treatment will be an outpatient surgery with a small incision that removes the herniated piece of disc cartilage and unpinches the nerve. For adults over 50, the spinal canal gradually gets narrower as we age, and that causes pinching of multiple nerves that control the legs. In these situations, treatment involves surgery that will unpinch or decompress multiple nerve roots and may also involve a spine fusion with metal screws, rods, or cages if there is excessive motion or instability in one area of the spine.
How do you alleviate severe spine pain?
Dr. Boden: Back pain can often be lessened through a variety of medications, exercises, and special pain treatment methods. Also, as the spine ages and naturally becomes less mobile, some of the painful causes of back pain in middle-aged patients will remedy themselves over time. If the situation is associated with significant pain radiating down one or both legs, then surgery may be an option. If the pain is due to a fracture, tumor, infection, or excessive mobility of the spine, then surgery may be an option.
Are there any new advancements in spine fusion surgery?
Dr. Boden: There are many new advancements in spine fusion surgery, including less invasive surgical approaches and better ways to minimize blood loss. We also use biologic drugs to improve the healing of bone, which is necessary for scoliosis surgery to be successful.
When should a patient consider surgery following a disc herniation?
Dr. Boden: In general, a disc herniation might need surgery if the primary symptom is radiating leg pain rather than just low back pain. The majority of disc herniations – over 90% – resolve on their own within three months. During that time, steroid injections, physical therapy and medications can be tried to help relieve pain while the body heals the disc. If the leg pain persists longer than three months, the ideal surgical window is between three and six months after the leg pain started. You can still get acceptable results after two years, but the likelihood of success is slightly smaller.
Can a person be “too old” or “too young” to have spine surgery?
Dr. Boden: I have performed spine surgery in children and patients over 100 years old. Age, in and of itself, is not the most important factor in assessing risk. Instead, it’s overall health and chronic medical conditions that raise the risk of surgery. I’ve seen 90+ year old patients who are in better health for spine surgery than some 55 year olds.
What does recovery look like for patients that have undergone spine surgery?
Dr. Boden: The recovery process really depends on the type of surgery. If there is just unpinching of nerves without a spine fusion, then the incision will heal itself in a week, the soft tissues between four to six weeks, and normal activities can resume shortly thereafter. If the surgery involves a spine fusion with metal hardware, then restrictions on activities like bending, twisting, heavy lifting, or athletic activity may last up to six to nine months.
Besides back pain, what are other examples of pain that may be associated with spinal issues?
Dr. Boden: Pain in the buttock area and radiating leg pain, especially when standing and walking, are symptoms that may be related to spine issues, as well as weakness in the knee or ankles. In very rare cases, a loss of bladder control could also be a factor to causing spinal issues. Some of these symptoms are treatable.
What is one of the most important pieces of advice you could offer young adults to avoid possible chronic back or spine issues when they get older?
Dr. Boden: Many spine problems are due to a person’s genetic makeup or to normal wear and tear, and thus aren’t preventable. However, some lifestyle habits can worsen spine problems, so it’s important for people to maintain a healthy weight and avoid smoking.
Considering Orthopaedic, Sports or Spine Surgery?
Before making a big decision, seek a second surgical opinion from the experts at Emory Orthopaedics & Spine Center. Our physicians are specifically trained to handle all types of joint, sports and spine-related issues and injuries, and can evaluate and treat conditions ranging from the simple to the more complex cases.
Our physicians will take time to evaluate your medical history, talk with you to find out your current issues and problems and develop a customized treatment plan so you can make an informed decision.
