Back Surgery Questions
What are common causes
of back pain?
There are numerous causes for back pain ranging from muscle
strain, trauma, arthritis, disc herniation, muscle spasm,
facet joint pain, and cumulative effect of poor body
How do disc injuries cause
When the disc bulges or herniates into the spinal canal, the
nerves in that area can become inflamed or agitated,
creating both back pain and pain in the area where that
nerve carries impulses. The muscles surrounding the injured
disc can become fatigued and spasm.
What is the difference
between a herniated disc and a bulging disc?
A bulging disc is a slight protrusion of the center of the
disc (nucleus pulposus) into the spinal canal. In a bulging
disc, the annulus fibrosus (outer ring) has not been
ruptured. A disc herniation is a large protrusion of the
nucleus pulposus (center of the disc), which has burst
through the annulus fiborsus (outer ring of the disc) into
the spinal canal, invading the surrounding nerves and
causing pain in the back, buttocks, hips, or legs.
Is it true that a bulging
disc can be normal?
Bulging discs are very common, and may not produce any
How did I herniate my
As we age, the disc may lose hydration and develop small
tears and bulges. The herniation can occur due to a lifetime
of poor body mechanics, a trauma, or by lifting, bending or
twisting the wrong way at the wrong time.
What are the symptoms of a
The classic symptoms of a herniated disc include back pain,
hip pain, and any combination of burning, numbness,
tingling, or pins and needles in the legs.
What is the treatment for
A herniated disc is treated with conservative therapy unless
there is a spinal deformity or neurologic deficit.
Conservative therapy can include physical therapy,
chiropractic care, acupuncture, Pilate's, ultrasound, pain
medication, muscle relaxants, and a short course of
steroids. If these do not work, the next steps include a
steroid epidural or facet joint block. Surgical intervention
is the last resort. If surgical intervention becomes
necessary, a microdiscectomy is the most common procedure.
Does non-surgical spinal
What is degenerative disc
There are many services advertised that offer "non-surgical"
spinal decompression. These treatments may not be covered by
insurance companies. And there is no published information
to suggest that a disk can be unherniated. In my opinion,
the results are equal to inversion therapy.
Degenerative Disc Disease refers to the loss of loss of
hydration in the disc and weakening of the annulus (outer
lining of the disc). Trauma can cause the annulus to tear
and disc material leaks out and presses on a nerve.
Degenerative disc disease is very common in the human
population but is not always symptomatic.
What is lumbar
Lumbar instability occurs when there is unnatural movement
of the vertebras. This can be a result of degeneration of
the discs, a spinal deformity such as spondylolisthesis, or
occur after a decompression procedure.
What is spinal stenosis?
Spinal Stenosis is an abnormal narrowing of the spinal canal
which holds the spinal cord or the nerves. The narrowing may
be caused by age related changes of the spine such as disc
degeneration and arthritis causing a bone buildup in and
around the canal and nerve holes producing nerve
compression. The compression of the nerves causes arm or leg
symptoms such as numbness, weakness, or pain.
What is the treatment for
Conservative therapy may relieve the symptoms of spinal
stenosis. If not, a spinal decompression is necessary. This
is the removal of the bony narrowing around nerves. The
operative strategy will depend not only on the location of
the spinal narrowing, and the relative stability and
condition of the spine as a whole.
My doctor told me that I
have arthritis of my spine and that I should learn to live
with the pain. Is this true?
Generally, the pain associated with arthritis can be managed
with conservative therapies, exercise, and medication.
When is surgery necessary
for patients with spine problems?
Surgery is only indicated if conservative therapy fails, the
patient becomes dysfunctional, or the patient should
experience progressive neurological problems.
What is a laminectomy?
A laminectomy is the removal of a small portion of the
vertebra, (lamina) around the affected area. This is done to
relieve pressure on the nerve roots.
My spinal specialist said
I need a fusion. Is that true?
A fusion is recommended if there is spinal deformity or
instability, or if the spine will become unstable due to the
removal of the disc or bone.
If I have a fusion does
that mean I will never be able to bend?
No. Very little bending capacity comes from the spine. It is
from the hips.
My spinal specialist said
he would be using implants in my spine. Is this really
The spinal instrumentation serves two purposes. First, it
allows the surgeon to restore the alignment and balance of
your spine. Secondly, the instrumentation acts as an
internal brace, stabilizing the spine while the bone fusion
Does it matter what screws
and rods my surgeon uses?
There are differences in the instrumentation on the market.
Your surgeon will select the instrumentation based on the
Will fusing my spine cause
damage to adjacent areas?
That is an excellent question. In a one level fusion, there
is little impact on the spine. In a multi-level fusion, the
major concern about a fusion is adjacent segment
degeneration. The discs act as shock absorbers between the
vertebras. When the spine is fused, the discs above or below
the fusion may absorb the sheer force from every day motion,
and thus wear out. When the fusion is performed it is
essential that the balance of the spine is maintained. If
this is done, the adjacent segments are at less risk of
What are the risks
associated with spinal surgery?
There are risks associated with any surgical procedure. The
risks for spine surgery include but are not limited to:
inter operative complications, infection, bleeding, and
Do I need to wear a brace
I always prescribe a brace if a patient is at a high risk
for not fusing.
Does my insurance cover
low back surgery?
In most cases insurance will cover spine surgery. Your
insurance benefits will be verified and explained prior to
How quickly can I expect
to recover from surgery?
Recovery from surgery is individualized, and depends on the
surgical procedure. Regardless of the procedure, patients
are walking within 24 hours of surgery.
I have heard people talk about less invasive back
surgeries. What are these? How do I know if I am a
Minimally invasive surgery is an option for certain
conditions, when performed by a spine specialist.
It is not an option for Idiopathic Scoliosis.
Your physician will explain the treatment options and the
pros and cons of each.
Will I have to have
physical therapy? If so, for how long?
Your physician will determine if you need physical therapy.
In general, I prescribe physical therapy for my patients
between 4 and 12 weeks post-surgery. Core stabilization,
stretching, and muscle conditioning are very important to a
patient's long term health.
Will I have to take
medication for pain? Are there any medications I should be
Pain medication is administered in the hospital following
surgery. Patients typically require oral medication for a
period ranging from 1-4 weeks, depending on the individual
and the procedure performed. If a fusion has been performed,
it is important to avoid anti-inflammatory medications,
including aspirin products, until cleared by the physician.
These medications will inhibit the growth of the bony
I hear that men should not
have fusion surgery. Is this true?
No. There is an additional risk for men during any surgery
involving the abdomen. When an anterior fusion is performed
on male, there is a small chance that the nerve that
controls ejaculation can be damaged, resulting in retrograde
ejaculation. If this occurs, the patient will still be able
to become erect, and orgasm, but will not produce semen.
What are some of the
complications associated with fusion surgery?
There are potential risks with any surgical procedure. The
complications specific to a fusion surgery, while rare,
include failure to fuse, hardware failure, infection,
excessive bleeding, and adjacent segment degeneration.
How many times will I need
to see my surgeon after surgery?
Post-operative visits will depend on the procedure and your
surgeon. Patients that have had a fusion will normally be
seen one week post-operatively, and then at intervals of one
month, three months, six months, 9 months, and 12 months
Why do some surgeons
approach the spine from the back and others through the
The surgical approach is determined by the physician based
on the diagnosis and symptoms of the patient. The anterior
(front) and posterior (back) combination increase the
surgical success rate dramatically.
What are the risks from
going in from the front?
The anterior (front) approach to the spine is generally
accompanied by a skilled vascular surgeon. The major
complications associated with this procedure are blood
vessel damage and sexual dysfunction in males.
What are the risks from
going in from the back?
The risks of a posterior (back) surgical approach include:
nerve damage, bleeding, infection, cerebral spinal fluid
leaks, failed hardware, and a failure to fuse.
My doctor said he would be
using a bone graft. What does this mean? What is a bone
A bone graft is a bony substitute for a disc, which grows
over time to stabilize two or more vertebra together. There
are two categories of bone grafts, allograft (donor bone) or
autograft (bone used from your body, generally the iliac
crest.) The type of bone graft used is based on the
procedure, the amount of bone needed, whether the patient is
a smoker, and the patient's overall health.
Are there any alternatives
to having a bone graft taken from my hip?
The alternatives to using a bone graft from the patient's
hip are to use local bone, cadaver bone, or a bone graft
What are the differences
between bone taken from my hip and donor bone?
The bone taken from the patient's hip has a higher fusion
rate than donor bone.
I have heard people talk
about the pain associated with harvesting bone from the hip.
Does this happen to everyone and how long does it last?
I rarely harvest bone from a patient's hip. There is pain
associated with any surgical procedure. In the majority of
patients the pain is resolved in a short period of time and
they do not require medication. There are a small percentage
of people who do suffer chronic pain following this bone
Are there any potential
complications with harvesting bone from my hip?
There are potential complications with any surgical
procedure. The complications most often associated with
harvesting bone include: infection, bleeding, or chronic
My spinal specialist said
that he will perform the fusion from my back and will
harvest bone from my hip without a separate incision. Will I
be able to tell the difference between that pain and the
main procedure pain?
Most patients can distinguish between the pain generated
from the procedure and the bone harvesting.
I have heard people talk
about hip pain after harvesting lasting up to two years or
longer. Is that true?
The majority of patients do not experience long term pain,
but it is possible for patients to experience long term hip
pain following harvesting.
Can I have an MRI or CT scan after fusion surgery?
MRI or CT scans are performed on patients that have had
spinal fusion with titanium instrumentation to rule out
re-herniation or to aid the physician in diagnosing a new
problem. Always inform the imaging technician performing the
MRI or CT scan that you have spinal instrumentation.
Will my surgery be photographed or video taped?
Occasionally we will take interoperative pictures for
educational purposes. The photos or video do not show any
identifying features (such as name or your face). This is
covered in your surgical consent form. If you have a
preference about being photographed, please let us know when
you sign the consent form.
After spine surgery, do I
need antibiotics before getting my teeth cleaned?
According to a joint study by AAOS (American
Association of Orthopedic Surgeons) and the American Dental
Association. At this time antibiotics are recommended for
two years following an implant procedure. Notify your
dentist when scheduling an appointment. The dentist will
prescribe the recommended antibiotic if necessary.
After a spinal fusion, will the instrumentation
in my body set off the alarm at the airport?
It is recommended, but not mandatory that you advise the TSA
officer of an implanted medical devise. With the current
screening system, patients have not reported setting off the
alarm. With the advent of full body scanners, this may
change. Should I donate blood before