The primary purpose of back surgery or neck surgery is to correct an anatomical lesion in individuals who fail to show improvement with conservative (nonsurgical) treatment. Surgery is not an option for patients when an anatomical lesion accounting for their pain can not be identified.
Surgery is only useful to change a patient’s anatomy (e.g. remove a disc herniation). There is almost never any reason to consider exploratory surgery to “look” for a cause of pain.
Failing conservative treatment is not in and of itself an indication for surgery. An identifiable anatomic lesion is also necessary.
Advancements in Spine Surgery
Modern spine surgery has made major advancements in both technique and spinal instrumentation/implants over the past couple of decades, but by far the most significant advancement in spine surgery has been better preoperative imaging techniques, which have greatly improved the ability of surgeons to identify accurately and correctly an anatomic lesion as a cause of pain.
Specifically, magnetic resonance imaging (MRI scan) has revolutionized back surgery and neck surgery. It is most often the best test to identify an anatomical lesion responsible for the patient’s problem.
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The most important factor in the determination of the success in spine surgery is proper preoperative diagnosis. Without an accurate preoperative diagnosis, even the most technically successful surgery has little chance for a successful outcome.
Although spine surgery is performed by either orthopedic surgeons or neurosurgeons, it is increasingly becoming a field unto itself. Many surgeons are doing additional specialized training in the field after their residency training (fellowship training).
Given the precision required for these more demanding surgical techniques, many orthopedic surgeons or neurosurgeons with fellowship training are choosing to focus more of their practice on spine surgery. Some believe that the increased level of specialty training and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (e.g. reduced post-operative discomfort) with many types of spine surgeries.
Spine surgery is typically an “elective” undertaking, meaning that it is considered as a possible approach to enhance a patient’s ability to function and decrease pain. However, just because spine surgery is elective does not mean it is not covered by insurance.
Elective surgery can be medically necessary. “Elective” just means that surgery of the spine is rarely an absolute necessity. Only in rare instances, such as for patients who have a progressive neurological loss of function or sudden onset of bowel or bladder incontinence, is spinal surgery actually necessary on an emergency basis.
Spine surgery can basically accomplish three tasks:
Decompress a nerve root or the spinal cord
Stabilize an unstable or painful segment with spinal fusion surgery
Reduce a deformity (e.g. scoliosis surgery in the thoracic spine).
Spine surgery is not done for exploration. The cause of a patient’s pain is not readily apparent with opening and exploring the spine. The preoperative evaluation and imaging results are what identify the problem and guide the design of the procedure.