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. However, surgeons are quite clear in their own minds that there is no such thing as “simple spine surgery.” Although there is a higher complication rate with more complex procedures, they are unpredictable and the most simple operation can have devastating outcomes.
As presented in the decision-making section, you are the only person that can assess your own pain. It is the surgeon’s role to determine if surgery is even an option and then to present the choices of procedures. Generally we try to offer the simplest solution, which has the least short and long-term negative implications along with a realistic picture of the risks versus the benefits. The first choice is always to avoid surgery if your pain has resolved or is tolerable. If you cannot live with your pain, the strategies presented in the rest of this website often will cause your pain to dramatically decrease and you should be actively involved with these approaches before making a final decision.
The goal of this section is to present as realistic a view as possible for you to understand the magnitude of the procedure and to help you decide whether the pain you are in is worth the risk. This is not intended to be a substitute for conversations with your care team but to be the foundation.
Surgery is often held up by patients and non-surgeons as “the definitive solution.” It is only one tool to be used in conjunction with a full rehabilitation approach. Well before I understood anything about chronic pain, I estimated that surgery was only a third of the solution for a given pain, physical conditioning was about a third, and addressing the central nervous system component was the final third, but also the most critical aspect since your pain pathways are memorized within six to twelve months after the onset of your pain.
There are three general categories of procedures that can be performed on the spine.
- Relieve pressure on nerves or spinal cord—Decompression
- Stabilize the spine—fusion
- Correct deformity
A final word of caution. You can’t fix what you can’t see. Please review the section on structural versus non-structural sources of pain.
Posterior lumbar fusion
Anterior lumbar fusion – ALIF