Myths about Spine Surgery by Dr Niraj Vasavada

I have been in the profession of treating “Back Related Problems” for about 11 years now. During this time span, I had been to various countries and the experiences I gathered are totally different. My journeys so far provided me with opportunities to know and learn from patient’s psychology and perspective about spine surgery.

One common thing that I find across the patient population suffering from back-related problems is that most of them do not know much about back problems” except a few words like “Sciatica, Slip Disc” etc.

And the biggest myth prevailing about the spine is that “spine surgery cannot be done”. A patient who cannot walk or stand or even sit easily without pain does not want to accept the option of spine surgery thinking that the only outcome of spine surgery is paralysis because spine surgery is never successful!

Let me try to give a surgeon’s scientific views on this:

Q:1. Is spine surgery never successful?

It is a known fact that no surgery in this world has a 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 the recent era have a success rate of more than 85-90% depending on the surgery. A simple surgery like surgery for a slipped disc has a success rate of more than 95%, in a properly selected patient. Most of the time, spine surgeries are done for improving the quality of life of a patient, or to make the patient, pain-free. So, if one is suffering so much so, and his/her quality of life is compromised and the patient is indicated for spine surgery, it is surely a result-oriented surgery.

Q:2. Is it true that after spine surgery, a patient needs prolonged bed rest?

Spine surgery has created a revolution over the last decade. It is true that in past, patients were kept on complete bed rest for about 3 months after surgery. But that was the era when technology was not available. Today, with a better understanding of spine pathologies and the development of technological expertise, that era is no more in existence. These days, except for 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 a few steps in about 5 to 6 hours after surgery or at the most on the very next day. The recuperation to normal activity level is quite fast.

Q:3. Does a patient get paralyzed after spine surgery?

As I mentioned earlier, no surgeries are risk-free. We as surgeons 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 the area of spine involved. For example, if one is operating on a cervical spine or a thoracic spine, there are some chances of having paralysis as a complication. But if the operative area is a lumbar spine, the chances of paralysis are quite low or negligible. Even in cervical or thoracic spine having a permanent paralysis, the chances are quite slim. In most advanced centers like ours, we use Intra Operative Neuromonitoring. The device gives us real-time feedback while we are operating on a spine and can warn us if we are endangering a nerve structure. With such technology, grave complication as paralysis is not a great possibility during a surgery.
It is always important to discuss with your surgeon, before undergoing spine surgery, the detailed profile of surgery. Most surgeries have become drastically safe these days and yield desired results. It is important to know what if you do not get operated for the surgery. Many times in my practice, I have seen patients getting paralyzed by not getting operated on in, timely.

Therefore, if surgery is needed, and if you do not undergo it, especially for 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 by using a laser beam from outside and pointing it at a disc, one is going to get cured, it is an utter nonsense understanding. There are few endoscopic surgeries where HO: YAG laser is used but they are used as part of a procedure; it’s is not the only procedure. Most spine surgeries across the world do not require a laser.

So it’s absolutely a misinformation to say that laser spine surgery is the most advanced surgery.

Q:5. If surgery is successful once, will it affect a patient’s future?

Most patients ask me a question when they have a herniated disc (slip disc), and I offer them the simplest surgery of Micro Endoscopic 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 the back of the vertebra, we remove the ruptured herniated portion with specialized instruments. We only remove a 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 asks me if the disc can again rupture after a microdiscectomy, the answer is YES. But to say that the surgery is responsible for that is again an overstatement. The chances of re-herniation are <10% in most cases. And the reason behind that second rupture would be inherent disc insufficiency, that itself lead to the first rupture, and 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 the 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 too much surgery for a small problem. So, we can’t offer that surgery to every patient who comes with a disc rupture.

Dr. Niraj Vasavada, Head of Department — Spine, SG Shalby, Ahmedabad.

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