Who Should Have Spine Surgery?

By Dr. Jeffrey R. Carlson, MD
Spine surgery is usually the last thing on your mind when you visit the doctor for a back problem. Even when patients have severe pain in the neck, back or nerve pain in the arm or leg, they generally want to exhaust all options before deciding to have surgery. This is a reasonable approach, as surgery is only one of the tools that are useful for improving function in patients with spinal disorders. There are, of course some emergent conditions including tumors, fractures and infections that have only a surgical treatment option. In degenerative spine disorders, there are usually three treatment methods: medications (pills or shots), therapy or chiropractic treatments and surgery. When these non-surgical treatments have failed, surgery still may not be the best option for the patient.
Researchers have worked diligently to determine what patients would best benefit from spine surgery. There is an ongoing study called the “Spine Patient Outcomes Research Trial” (SPORT) that recently helped to define those characteristics which related to a better outcome from spine surgery. 395 patients with nerve compression in the lumbar spine (spinal stenosis) related to the degeneration of the discs in the lumbar spine which allowed the bones to slip (spondylolisthesis) were studied. These patients were followed throughout their treatment and used pain scales, disability scales and quality-of-life scales together to aid researchers in determining treatment effectiveness. The researchers were able to find specific characteristics in some patients that led to a superior surgical outcome.
Although all of the patients got better after surgery, the researchers were able to select the 50 patients with the most outstanding improvements and determine what set them apart from the rest. These patients were characterized by the following:
• 67 years of age or less
• No stomach problems
• Nerve pain
• Changes in reflexes
• Not taking antidepressants
• Dissatisfied with their current symptoms
• Anticipating a high likelihood of improvement with surgery
There are some themes to this list. Younger patients are more often dissatisfied with the pain and dysfunction related to their spinal nerve problems. Younger patients are used to a higher quality of life, so they generally want to return to the activities they enjoyed and therefore look for effective treatments and expect improvement. These patients also have significant symptoms as characterized by the nerve pain and changes in reflexes. This shows that the symptoms have become bad enough to cause the patient dysfunction, which leads to the dissatisfaction with their current state of health.
Conversely, patients who exhibit the opposite of the symptoms described above indicates they may do less-well with surgery. Patients that don’t have significant nerve pain or dysfunction related to their spine disorder, are not unhappy with their current activity level and don’t really think the surgery will help, are not good candidates for surgery.
It is important to talk with your spine surgeon about your symptoms, your state of health and expectations of treatment before you make a decision to have surgery. Together, you can make the best choice regarding management of your condition and moving your care forward in a positive direction.
Dr. Jeffrey R. Carlson is a Fellowship-trained, Board-certified, Orthopaedic Spine Specialist who practices at Orthopaedic & Spine Center in Newport News, VA. Dr. Carlson has been voted a “Hampton Roads Top Doc” in 2012, 2013, & 2014. For more information about Dr. Carlson and his practice, go to www.osc-ortho.com or for an appointment, call 757-596-1900.