Generally, surgery is more successful in curing problems arising from a single structural injury rather than in relieving back pain that results from years of gradual deterioration.
By far the most common reason for back surgery is to treat prolapsed discs. You are likely to be chosen for surgery only for a specific reason. This may be severe, continuous pain caused by a prolapsed disc pressing on a nerve, or evidence of spinal stenosis where the spinal canal has become narrowed, perhaps by ostephytes bony growths on the vertebrae, compressing the spinal cord. Occasionally, surgery is the only option and needs to be carried out quickly.
This sort of emergency can occur if the cauda equine becomes compressed by a large disc prolapsed, for example. In a normal situation, as a possible candidate for surgery you will have to undergo various investigations so that the surgeon can build up as detailed a picture as possible about your condition before deciding if surgery is an option. For example, the location of a disc prolapse can be ascertained by a physical examination, however, the exact extent of the problem can only be discovered by taking sophisticated tests such as myelography or a CT or MRI scan.
If these tests show that an operation can be carried out, the surgeon will discuss the situation with you, explaining the advantages and disadvantages of surgery, its chances of success and the amount of improvement you can expect. If, after this, you are still unsure about whether you wish to go ahead, you are perfectly free to refuse to have the operation. If you do undergo surgery and your condition does not improve, be wary of agreeing to a second operation as research suggests that the chances of success are much lower for repeat procedures of this kind.
One important, non medical factor that needs to be considered in your decision about surgery is how you will cope when you are discharged from hospital after the operation. The chances are that you will be unable to carry out normal daily tasks, such as cooking, cleaning and shopping, for several weeks. If you do not have a partner or family members who can help, you may have to consider the expensive options of a booking into a convalescent home or paying for someone to come in and look after you. The procedures described are among the most common operations for back problems.
Spinal Surgery – A new procedure
One of the most radical spinal operations ever undertaken was carried out by surgeons at Bristol, England in the late 1990s. The patient was a 36 year old woman suffering from ankylosing spondylitis, which had caused the vertebrae in her neck to fuse. She subsequently broke her neck in a fall and when the injury healed; her head was fixed facing downward and to the right.
In a 17 hour operation surgeons made an incision into the back of her neck to expose the spine. They then detached her head from her spine so that it was attacked only by the spinal cord, blood vessels and tissues. A wedge was cut into the base of the skull and into the top vertebrae. The skull was then placed in a normal, forward looking position and re attached to the spine using a metal plate and screws. The operation was a success and the woman recovered fully.