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YOU are here : Home > Spinecare Topics > Options for Spine Treatments > Back Surgery: When is it Appropriate?
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Options for Spine Treatments
Back Surgery: When is it Appropriate?
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Back Surgery: When is it Appropriate?
Informed Consent
The surgeon must provide full disclosure to individuals awaiting surgery to let them know that there are many factors that may contribute to a negative outcome from surgery. Back pain is not always relieved by surgery. Pain is significantly influenced by emotional and social factors. The surgeon should discuss with you reasonable expectations from surgical intervention. If your spine surgeon does not ask about post surgical support from your family, your work and other aspects of your life that will be impacted by surgery, strongly consider seeking a second opinion.
Conditions Where Spine Surgery is Absolutely Necessary
Cauda Equina Syndrome: The cauda equina refers to a group of nerve roots that travel together through the central canal of the low back (lumbar spine). The term cauda equina means horse’s tail. The group of spinal nerves in the low back look like a horse’s tail. Some of the nerves within the cauda equina provide control to bowel and bladder function and connect with the groin and anal areas. Some nerves travel into the legs to provide sensation and muscle control. Select nerves of the cauda equina provide control of bladder and bowel function. Any condition that compromises this group of nerves can lead to a cauda equina syndrome. The symptoms associated with this syndrome include numbness in the genital region, around the anus and in the feet. The presentation is often accompanied by an inability to urinate and a loss of sexual function. Without immediate surgical decompression the disorder may result in permanent bowel, bladder and sexual dysfunction. The patient may also experience pain radiating into the lower extremities (sciatica) along with varying degrees of leg and foot muscle weakness.
The most common cause of a cauda equina syndrome is a large disc herniation that may or may not be associated with a free disc fragment. Severe narrowing of the central canal called spinal stenosis places an individual at greater risk for acquiring a cauda equina syndrome because of reduced space for the nerves in the spinal canal. Any mass effect including a tumor or hematoma can also cause this syndrome. Having a disc herniation does not mean that you will develop a cauda equina syndrome. The syndrome is relatively uncommon. The combination of low back osteoarthrosis, bone spurs, and disc herniation can all contribute to narrowing the spinal canal and to compression of the nerves of the cauda equina.
Tumors: Spine surgery is frequently required to remove a spinal tumor. Even a slow growing benign spinal tumor can become large enough to compromise the neural elements in the vicinity of the tumor. A malignant spinal tumor may represent a primary tumor or metastatic spread from a tumor in another region of the body. If the tumor is determined to be non-cancerous and slow growing, your attending surgeon may take a “watch and wait� approach. Spine tumors are often characterized by nighttime pain that is severe enough interfere with sleep. It is always important to get a second opinion when a spine tumor is suspected or confirmed.
Infections: Infectious organisms can reach the spine through the blood, lymphatics or direct spread. More common sources of infections which spread through the blood (septicemia) originate from the mouth, the lungs and the gastrointestinal tract. Some individuals are more susceptible to develop a spine infection, particularly those with a weakened immune system and diabetes. Direct spread of infection may result from surgery or open wound trauma. The pain associated with a spine infection is usually very intense and of a throbbing nature, unrelieved in any position. A spine infection can contained locally and become an abscess that increases pressure on adjacent tissues. A spinal infection may or may not be associated with fever. Lab work and diagnostic imaging studies are usually required to confirm the presence and causative organism. Treatment will require an aggressive antibiotic approach and in many cases surgery is required to drain the infection. Spine infections can spread to other regions and can also lead to neurological complications secondary to inflammation from the infection or a mass effect.
The surgeon must provide full disclosure to individuals awaiting surgery to let them know that there are many factors that may contribute to a negative outcome from surgery. Back pain is not always relieved by surgery. Pain is significantly influenced by emotional and social factors. The surgeon should discuss with you reasonable expectations from surgical intervention. If your spine surgeon does not ask about post surgical support from your family, your work and other aspects of your life that will be impacted by surgery, strongly consider seeking a second opinion.
Conditions Where Spine Surgery is Absolutely Necessary
Cauda Equina Syndrome: The cauda equina refers to a group of nerve roots that travel together through the central canal of the low back (lumbar spine). The term cauda equina means horse’s tail. The group of spinal nerves in the low back look like a horse’s tail. Some of the nerves within the cauda equina provide control to bowel and bladder function and connect with the groin and anal areas. Some nerves travel into the legs to provide sensation and muscle control. Select nerves of the cauda equina provide control of bladder and bowel function. Any condition that compromises this group of nerves can lead to a cauda equina syndrome. The symptoms associated with this syndrome include numbness in the genital region, around the anus and in the feet. The presentation is often accompanied by an inability to urinate and a loss of sexual function. Without immediate surgical decompression the disorder may result in permanent bowel, bladder and sexual dysfunction. The patient may also experience pain radiating into the lower extremities (sciatica) along with varying degrees of leg and foot muscle weakness.
The most common cause of a cauda equina syndrome is a large disc herniation that may or may not be associated with a free disc fragment. Severe narrowing of the central canal called spinal stenosis places an individual at greater risk for acquiring a cauda equina syndrome because of reduced space for the nerves in the spinal canal. Any mass effect including a tumor or hematoma can also cause this syndrome. Having a disc herniation does not mean that you will develop a cauda equina syndrome. The syndrome is relatively uncommon. The combination of low back osteoarthrosis, bone spurs, and disc herniation can all contribute to narrowing the spinal canal and to compression of the nerves of the cauda equina.
Tumors: Spine surgery is frequently required to remove a spinal tumor. Even a slow growing benign spinal tumor can become large enough to compromise the neural elements in the vicinity of the tumor. A malignant spinal tumor may represent a primary tumor or metastatic spread from a tumor in another region of the body. If the tumor is determined to be non-cancerous and slow growing, your attending surgeon may take a “watch and wait� approach. Spine tumors are often characterized by nighttime pain that is severe enough interfere with sleep. It is always important to get a second opinion when a spine tumor is suspected or confirmed.
Infections: Infectious organisms can reach the spine through the blood, lymphatics or direct spread. More common sources of infections which spread through the blood (septicemia) originate from the mouth, the lungs and the gastrointestinal tract. Some individuals are more susceptible to develop a spine infection, particularly those with a weakened immune system and diabetes. Direct spread of infection may result from surgery or open wound trauma. The pain associated with a spine infection is usually very intense and of a throbbing nature, unrelieved in any position. A spine infection can contained locally and become an abscess that increases pressure on adjacent tissues. A spinal infection may or may not be associated with fever. Lab work and diagnostic imaging studies are usually required to confirm the presence and causative organism. Treatment will require an aggressive antibiotic approach and in many cases surgery is required to drain the infection. Spine infections can spread to other regions and can also lead to neurological complications secondary to inflammation from the infection or a mass effect.
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