STAGE 5

Decision-making

There are three variables to consider when treating low back pain. 1) Structural problems 2) soft tissue issues 3) the central nervous system. If the pain is in a matching distribution, then you must decide whether the pain is severe enough to undergo any surgical procedure.  You are the one having the pain.  We as physicians, can only guess at how much of a problem you are having based on what you tell us.  For example, pain that consistently limits your function and is there most of the day would seem like a severe enough problem to perform surgery.  However, patients will sometimes request surgery when they only have numbness and tingling.  If is uncomfortable then maybe surgery is worth the risk.  If it is just an annoyance, it should probably be left alone.

Sometimes the structural problem is compelling.  It is common to see extremely severe constriction of the nerves in the lower back and have the symptoms be fairly mild.  This is one situation that one should proceed with surgery. Therefore the first part of the decision-making is for you to understand whether you fall into a type I or type II category.  If you are in type I then you have to decide how severe your symptoms are and how compelling your anatomic problem might be.

STAGE 6

Procedures

Spine surgery is technically challenging due to the fact there are multiple maneuvers being performed in close proximity to the spinal cord, nerves, and vascular structures. Often the pathology that is compressing the nerves or spinal cord is severe and the anatomy is greatly distorted.  Many moves require a lot of force to move muscle and scar tissue. Surgeons are trained to always make each move in a safe way away from the vital structures. In this stage we discuss some of the pitfalls of different procedures. They are presented only with the intent of giving you an idea of the surgery, not to be an exhaustive complication list. You should be able to have a better conversation with your surgeon in regards to his or her perception of potential complications.