How to Decide If Spine Surgery Is Right for You
For those patients who are good candidates, minimally invasive spine surgery can reduce or eliminate pain and offer a return to an active lifestyle. Minimally invasive spine procedures are worth considering if you’re struggling with back or neck pain.
Nearly a million Americans undergo some type of spine surgery every year.1 But every patient must consider their choices carefully, in consultation with their physician, before proceeding.
“If you’re considering spine surgery, it's important to go through a checklist of questions to consider before you move forward with it,” said Peter Derman, M.D., a spine surgeon on the medical staff of Texas Health Center for Diagnostics and Surgery. “Such as: Are your symptoms sufficiently bad to even consider this? Are you comfortable with your surgeon? Are you comfortable with the surgical plan? You want to consider all these factors to know that you are ready to go through with it.”2
Before you schedule surgery, a frank and thorough conversation with your surgeon is part of the process. You should feel confident you’ve made the right choice.
“Don't let anyone talk you into spine surgery,” Dr. Derman cautions. “I never try to talk patients into surgery. It's something that I tell them about and let them make their own decision.”3
Am I a Candidate for Minimally Invasive Spine Surgery?
In most cases, patients are encouraged to try nonsurgical treatments before considering surgery. Back pain can often be treated or managed with medication, physical therapy or other treatments.
“Before choosing surgery, it’s important to exhaust all nonsurgical options,” said Dr. Derman. “Frequently I'll have patients that come to me because surgery has been recommended to them. I ask them: ‘Have you done physical therapy before? Have you tried anti-inflammatory medications? Have you tried injections?’ Those things are effective in the majority of cases in preventing the need for spine surgery. It’s important to at least consider them before moving forward with surgery.”4
If nonsurgical options have not provided relief, the next step is an evaluation to assess whether the patient is a suitable candidate for minimally invasive spine procedures.
“Generally, anyone who's a candidate for spine surgery is a candidate for minimally invasive techniques,” said Dr. Derman.
However, he adds, it’s important to understand what “minimally invasive” means. You may have seen ads or TV commercials hyping the ease of minimally invasive spine surgery, but it’s important to know that every patient’s case is different. The meaning of “minimally invasive” depends on the diagnosis, the patient’s condition, and the type of surgery.
“Minimally invasive spine surgery techniques vary,” Dr. Derman said. “At one end of the spectrum is the kind of surgery where the patient leaves with a very small incision, covered by a little band-aid, and goes home the same day. At the other end, for example, is multi-level scoliosis surgery. It’s major surgery, but there are minimally invasive ways to do it. It's really a matter of crafting a surgery using a whole menu of techniques that we have at our disposal to provide the least invasive surgery for any given problem.”
One subset of minimally invasive spine surgery is endoscopic spine surgery, an ultra-minimally invasive surgical approach used to relieve chronic pain in the neck, buttocks or legs, and numbness or tingling in the arms and hands.
“Endoscopic spine surgery involves inserting a camera in through the skin via a tiny — approximately eight-millimeter — incision,” Dr. Derman said. “The patients get one stitch under the skin and go home the same day. Very little pain medication is necessary after a surgery like this. In fact, I often have patients just take Tylenol. The beauty of an endoscopic procedure is that patients get up, they get moving and they don't lose any range of motion.”5
Minimally invasive spine surgery is often used to treat a herniated disc (in which the soft, gel-like center of a spinal disc protrudes through a tear in the outer layer, causing pain and discomfort) or spinal stenosis (narrowing of the spinal canal that can compress nerves and cause pain, numbness, or weakness in the arms or legs). However, some conditions, such as tumors or infections in the spine, may not be treatable with minimally invasive techniques. The severity of the spine condition or prior treatments and surgeries may also limit the feasibility of minimally invasive spinal surgery.6
How To Choose a Minimally Invasive Spine Surgeon
Before proceeding with surgery, you should feel comfortable with your surgeon and your surgical plan.
“If there's any question about the plan itself or if you feel uncomfortable at all, don’t hesitate to get another opinion,” Dr. Derman advises. “I'm never personally offended – in fact, I frequently encourage people to get second opinions if they're not comfortable.”7
Another important question: How many of the recommended surgical procedures has the doctor done?
“You shouldn't feel bashful about asking that question,” said Dr. Derman. “You don't want the person who does maybe one or two of these surgeries a year, who kind of dabbles in the minimally invasive realm. You want somebody for whom that's their entire practice.”8
Finally, don’t overlook the intangibles. Listen to your gut. If you don’t feel comfortable, get a second opinion. Ask questions. Drill down until you’re confident you’ve made the right choice.
“You want to pick a surgeon that's a teammate for you,” said Dr. Derman. “You want somebody that is empathetic and that resonates with you. Because it's not just about the surgery itself. It's about the follow-up care and establishing a relationship that feels right for you.”9
Questions to Ask a Spine Surgeon
Here are some questions to ask when choosing a spine surgeon, to help you weigh candidates’ qualifications.
Ask about the surgeon’s education and certifications:
Board certification, a spine surgery fellowship, and additional training are preferable when seeking a surgeon for spine surgery.
• Is the spine surgeon board certified by the American Board of Orthopaedic Surgery or the American Board of Neurological Surgery?
• Has the spine surgeon completed a one-year fellowship in spine surgery?
• Is the spine surgeon trained in microsurgery and other minimally invasive techniques?
Ask about the surgeon’s practice and focus:
It’s important to choose a surgeon whose practice is focused solely or predominately on spine surgery.
• Is the spine surgeon part of a multidisciplinary spine center?
• Is spine surgery a big part of the surgeon’s practice or is he or she more of a general orthopedic or neurologic surgeon?
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746582/
[2] https://www.youtube.com/watch?v=nwJ1uenEXoc
[3] https://www.youtube.com/watch?v=nwJ1uenEXoc
[4] https://www.youtube.com/watch?v=nwJ1uenEXoc
[5] https://www.youtube.com/watch?v=F8JXWvrPtK8&t
[6] https://longislandneuro.com/how-to-determine-if-youre-a-candidate-for-minimally-invasive-spine-surgery/#:~:text=Determining%20good%20candidates%20for%20MISS.&text=Do%20you%20have%20persistent%20pain,and%20are%20still%20experiencing%20symptoms%3F
[7] https://www.youtube.com/watch?v=-CvQfEZp36o
[8] https://www.youtube.com/watch?v=-CvQfEZp36o
[9] https://www.youtube.com/watch?v=-CvQfEZp36o