The moment one recommends spine surgery to a patient the first response that comes from majority of Indian patient is “sir, we wont go for surgery if you have any other treatment option then do let us know”. The fear these patients have is due to certain myths that are prevalent in Indian population due to ignorance. Most fears are born and propagated out of events which happen when patients get operated at suboptimal centres under care of non-specialised doctors. Spine surgery is a specialised super-specialisation and results of spine surgery are highly dependent on two things – the surgeons skill and a proper hospital environment with state of art instruments and machines. In this article we would be trying to alleviate certain fears associated with spine surgery
Myth number 1: A Spine Specialist will always recommend surgery
On an Average less that 5 percent of patients with back problems actually are advised surgery. Most patients with spinal problems are managed in a conservative way. Physiotherapy / medications are the first line therapy in almost all cases except for patients who present with significant motor weakness in legs or arms. Pain management injection form the second line of therapy in patients who have pain compromising their quality of life. Surgery is indicated in only those patients who have developed weakness due to pressure on nerves in spine or those whose quality of life is severely affected by spinal issues and fails to respond to conservative measures or in patients who have unstable spine due to infection/trauma/tumor.
Myth Number 2: Spine surgery should only be done as the last option
It’s not true. Spine surgery should be done at the right time and right place. As the famous saying goes a stitch in time saves nine. If your spine is unstable due to a fracture or infection and you try and delay surgery thinking that limb movements are fine as of now, You may end up having delayed onset deficit which might not respond to even a good surgical decompression. Thus it can never be emphasized enough that a surgery done at right time is the most important decision that a patient has to take. ,surgery is indicated early on when there is a chance of paralysis in the near future, or in cases where paralysis has already started to set in. It is important for your doctor to diagnose your problems properly before surgery. The chance of success increases if the detection is accurate.
Myth number 3: All spine surgeries are major surgeries and carry the same risks.
There is no single definition of what constitutes a major surgery. All spine surgeries deal with a very important human organ hence these surgeries are precious surgeries but duration of surgery vary from as little as 45 min (discectomy) to as long as 10 hours (deformity correction/revision spine surgeries) although it is fair to categorize long duration surgeries as major but to say that discectomy is a major surgery would be stretching things too far. Also, as the duration of surgery increases its risks increase too.
Another thing that determines risk of surgery is the level of spine that is being operated upon with lumbar level surgeries carrying zero chance of causing paralysis and are inherently very safe surgeries, Surgeries at cord level Dorsal and Cervical do have a low risk of causing paralysis however with use of latest technologies and neuromonitoring equipment’s such episodes are becoming rarer and rarer.
Myth number 4: After Spine surgery, you will be paralyzed
The myth that after spine surgery you will become paralyzed has harmed more patients than perhaps all of the spinal diseases put together. Although every spine procedure does carry some neurological risk but the most commonly done lower lumbar surgeries can never cause paralysis scientifically thinking. With the advent of recent technologies (neuro monitoring and navigation systems) the incidence of significant neurological deterioration or paralysis after spine surgery is minimal these days.
Myth number 5: Recovery from spine surgery is unbearably painful and requires prolonged bed rest.
It’s normal to feel pain after surgery, especially if you have just had a major procedure. Usually, pain is the worst during the first 1 to 2 days after the surgery. After that, it begins to subside. However with modern pain management injections and minimally invasive procedures patients tend to have a very comfortable post operative period with patients beginning to walk as early as 4hrs to 1 day after surgery depending upon the type of surgery. Thus contrary to the belief that spine surgery would require bed rest we motivate our patients to walk as early as possible.
Myth number 6: There are lots of physical restrictions after a spine surgery
This is usually not the situation. Even after a major spine surgery, most of the patients are able to stand and walk the very next day of surgery. Driving is allowed from the 3rd week and bending forward after 1 month. Sitting on the ground is allowed from the 3rd month. Exceptions include cases of complex trauma to the spine with multiple fractures or patients with significant neurological deficits before surgery where period of immobilization may be prolonged.
Myth Number 7 : There is a high chance that another surgery might be required in future
It’s not true to say that one spine surgery leads to another. In Majority of cases only one properly done spine surgery at the correct time and correct place is adequate. Majority of patients don’t require a second surgery. However, it is important on the part of patient to follow certain instructions and precautions to make the surgery successful. These instructions include simple things like quitting smoking, reducing body weight and exercising regularly after surgery. If these instructions are not followed, only then, in rare cases, a second surgery is required.
Myth Number 8 — Minimally invasive surgery is always better than open surgery.
A common question that comes to us in OPD is whether the surgery would be done using endoscopy or open procedure. Both these procedures have their own advantages and disadvantages. Thus a single form of treatment which can be ideal for a patient X may not be ideal for you. Thus blindly going for a form of treatment whether endoscopic/microscopic is not the right decision.Discuss the treatment modality with your doctor in detail regarding pros and cons for each and then take an informed decision. Rather than opting for a fixed treatment option one should consider a treatment option customized to one’s patient need.
To sum up – not all patients who have spinal issues require surgery. However once your disease process is advanced enough to cause motor weakness/neurological deficit or quality of life is being affected then one must consider surgery as surgery done at right time, right place and with the right person can help you get back to your normal lifestyle.