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Spine Surgery – Myths Busted

The images of the spine during the minimally invasive treatment procedures.
Published by Dr. Umesh Srikantha on April 19, 2020

Myth #1

Most spine problems will subsequently end up in surgery

In fact majority of the spinal problems do not need surgery. Approximately, only 2-3% of patients having back pain or neck pain will ever need surgery. Less than 5% of patients having a slipped disc or lumbar disc prolapse will need surgery. Surgery is advised only in cases where medications and physiotherapy has not been successful in reducing the pain or there is progressive weakness or numbness suggesting significant nerve injury directly as a result of the spinal condition. Also, once a spinal condition is diagnosed, chances of progression and worsening can be prevented by physical therapy and preventive lifestyle and postural modifications.

Myth #2

There is a high risk of neurological injury (nerve damage) during spine surgery

Spine surgery always carries the risk of nerve damage. However the risk is very small. In most surgeries on the lower back, there is less than 1% risk of nerve damage. The percentage may be slightly higher (2-5%) in surgeries of the mid back and of the neck. Moreover, these risks are in very complex cases. In majority of routine cases, there is hardly any risk of nerve damage due to the surgery. Moreover, Intra-operative Neuromonitoring (IONM) is a tool, which helps surgeons to monitor the function of the nerves and spinal cord during the surgery and identify and warn the surgeon of any inadvertent damage to the nerves, which may not be evident otherwise. This helps in confirming nerve function preservation throughout the surgery. Presence of IONM significantly increases surgical safety and helps preserve neurological function.

The interior view of an operation theater for spine surgery.

Myth #3

Often inaccurate/misplaced screw/ implants

It is not uncommon that implants (screws/ rods/ plates/ cages) may have to be used during spine surgeries. There are several instances when these screws may not be in the correct position, which can result in nerve irritation, compression or damage. Also, an incorrectly placed screw is not as strong a correctly placed one. Though such screw misplacement is uncommon, there is a high risk in complex cases or in presence of deformity. Intra-operative 3d imaging systems (eg. O-arm) coupled with Intra-operative navigation provides the surgeon with an accurate 3d reconstructed patient anatomy during the surgery and also guides the surgeon about the accurate placement of screws and implants. It has been proven beyond doubt that presence of Spinal navigation and O-arm significantly improves the accuracy of surgical procedures in general and screw placement, in particular.

A collage image of a minimally invasive spine surgery.

Myth #4

Extensive surgeries – takes time to recover with prolonged bed rest

“How long will I have to be on bed after the surgery?” is a universal question by patients undergoing spinal surgeries. Much of the fear of prolonged bed rest and inactivity after spinal surgeries stems from older experiences and extensive conventional/ open surgeries. With the advent of minimally invasive and endoscopic spine surgeries, where the muscle damage and blood loss is lesser than conventional / open surgery, it is possible for patients to be up and about on the same day after surgery. Also, Minimally invasive spinal surgeries aid in faster recovery, lesser post-operative pain and faster return to work/ normal activity as compared to conventional/ open surgeries; at the same time, maintaining similar clinical results. More than 80% of the spine surgeries; sometimes even the complex ones can be treated by minimally invasive techniques.

Image of the tool used in spine surgery.

Myth #5

Spine surgery has poor outcomes

This myth should be busted already by now. With availability of advanced technologies (Intra-operative 3D imaging, Intra-operative Navigation, Intraoperative Neuromonitoring) and newer techniques (Minimally invasive spine surgery, Endoscopic spine surgery), spine surgery is rendered simple, safe, accurate and effective. Presence of all of these modalities helps a surgeon in delivering good results and excellent outcomes in even the complex of spinal conditions.

The Image of an endoscopic spine surgery.

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