Why Back Surgery Is Not One-Size-Fits-All

Ronald Childs, MD, is a board-certified orthopedic spine surgeon at Inova Health System. He serves as the Section Chief for the Inova Spine Program, across all Inova locations.

It’s easy to think of back surgery as a single procedure to treat a single problem: back pain. After all, the spine is a long, interconnected set of bones and tissue – it seems as though “back surgery” would be a one-size-fits-all proposition. But that couldn’t be further from the truth.

In actuality, the term “back surgery” covers a wide range of procedures, approaches and techniques. It’s not one-size-fits-all, because the spine runs from the base of the skull through the neck and upper back (called the cervical spine), the middle of the back (the thoracic spine), and the lower back (the lumbar spine), before connecting with the pelvis (the sacral spine).

Problems in different areas of the spine can cause different symptoms. For example, conditions affecting the cervical spine can cause symptoms in the neck and arms, while conditions affecting the lumbar spine can cause symptoms in the lower back and legs.

Most back injuries are self-limited, meaning they will get better on their own, given time. However, persistent neck/arm or back/leg pain should be evaluated, especially if there are any functional problems in addition to the pain. Examples of functional problems, or deficits, include problems with balance as well as difficulty with control of the legs or arms/hands. When a person has persistent back/leg or neck/arm pain and begins to experience functional problems like these, it’s time to call the doctor.

It’s important to begin the diagnostic process by determining the cause of a patient’s symptoms. Once the cause is identified, a precise treatment plan can be developed with a high expectation of success. Here are two examples of back pain that require two very different courses of treatment:

Example 1: You pulled your back while cleaning your garage on the weekend. In most cases, an injury like this would not require a surgical solution. Most of the time, your symptoms will get better within a few weeks with conservative care measures like anti-inflammatory medication, rest and perhaps a course of physical therapy if your doctor recommends it.

Example 2: You have persistent back pain as well as pain that shoots down your leg, often going below the knee. You’ve tried rest and physical therapy, but they have not helped. In that case, an evaluation by a spine specialist and additional treatment, including surgery, may be necessary.

A menu of surgical options for back and neck pain

For each specific spine condition, there are several surgical treatment options. For example:

• Treatment for a herniated lumbar disc can include procedures called laminotomy and discectomy, which are typically done on an outpatient basis with a high success rate.
• If there is instability in the spine, it may necessitate a fusion of some of the lumbar vertebrae to provide strength and stability.

Spinal fusion surgery can be approached form the front, back or side, depending on the levels and pathologies involved. It’s a great example of why every patient needs to be evaluated on an individual basis and why one size truly does not fit all.

The classic symptoms of a cervical spine issue that needs evaluation include neck pain that radiates to the shoulder blades and down the arm. Nonsurgical treatment options include physical therapy, as well as injections to reduce inflammation and treat pain. If those fail to bring relief, there are several surgical options, which can be performed from the front or the back. They include:

• Fusion surgery to stabilize and treat pain
• Artificial disc replacement to replace the herniated or damaged disc

A spine specialist can devise a specific recommendation based on a patient’s unique needs. As a field, we now have a plethora of diagnostic and treatment options including robotic technologies that have truly advanced the management of spinal disorders.

When to see a spine specialist

If you are experiencing any of the following symptoms, it’s time to schedule an appointment with a spine specialist:

• Persistent back and leg or neck pain
• Weakness
• Balance problems
• Bowel and bladder dysfunction

At the Inova Spine Program, we have the talent and experience to handle any spinal issue, from the skull all the way to the pelvis, using nonsurgical and surgical techniques as well as rehabilitative therapies.

Experiencing back or neck pain? The Inova Spine Program can help. Our interdisciplinary specialists are experts in diagnosing and treating back and neck pain, with surgical and nonsurgical options. There is no one-size-fits-all plan to relieve back or neck pain, so we work with each patient to create a customized treatment plan. Read more about Inova Spine Program or call 703-776-4700 to find out how we can help.