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Surgical Options

When do you need spine surgery?

Spine Group Alabama is affiliated with the top-trained spine surgeons in the Birmingham, Alabama region. These surgeons specialize in neck; low back; minimally invasive spine surgery that can get you home the same day; and artificial disc replacement surgery. Other spine surgeons specialize in spinal tumor; scoliosis (curvature of the spine); complex instrumentation; or spinal cord stimulators for pain management.

As a spine center, we are able to determine IF spine surgery is necessary for you, and then we can recommend the right surgical specialist for your problem rather than having you “shop” for a spine surgeon that may not be the best match for your back or neck problem.

The problem of jumping to a "Quick Fix” mentality

Americans often look for "quick fix” to their back or neck pain — a pill, injection, manipulation or spine surgery. But sometimes rushing into spine surgery can create worse problems. Some people emerge from spine surgery with "failed back surgery syndrome," where their back or neck problem is now worse than it was initially and many options eliminated. Treatment for failed back surgery syndrome, for example, can often require additional, complex surgeries, metal plates, or worse, the implantation of a lifelong spinal cord stimulator to manage pain.

The good news is that 80% of the time back or neck pain can resolve with non-surgical treatment options like spinal injections and spine therapy. As a multi-disciplinary spine center we recommend exhausting all your NON-surgical treatment options at Spine Group Alabama in advance of considering spine surgery. A top-trained spine surgeon will likewise recommend the exact same advice. These same spine surgeons often refer patients to Spine Group Alabama to try non-surgical treatment options first.

When you need spine surgery

It is important to understand what symptoms need to sent quickly to a spine surgeon, because with back or neck problems, pain is NOT the right indicator of an emergency symptom.

Here are the cases where you can use watchful waiting and allow some time to help heal your back or neck pain. Assuming there was no trauma or injury from a fall or car accident, you can use watchful waiting for the following symptoms:

• Pain that is mostly in the low back or neck area that has been diagnosed as a possible muscle or ligament strain.
• Pain that radiates into the leg or arm. (However, if this radiating pain persists for longer than three months we will likely refer you to an affiliated spine surgeon. Some studies have suggested that if a herniated disc impinges on a nerve for several months, it may impact the pain relief ultimately achieved with spine surgery.)

However, YOU CANNOT USE WATCHFUL WAITING for the any of the following symptoms:

• Loss of control of the bowel or bladder. You need to see a spine surgeon or go to an emergency room within 24 hours, or that symptom of incontinence could be permanent and lifelong.
• Numbness or weakness in a hand or foot, including footdrop, where you are unable to raise your toes as you walk. This needs to be seen by a spine surgeon within a couple days to prevent permanent neurological damage and cause the symptom to be permanent and lifelong.
• Trauma from a car accident or serious fall which may have fractured a vertebrae causing instability and potential damage to the spinal cord, including paralysis.

In the top two cases, the symptoms can be caused by a herniated disc that is pressing on a nerve root, and the pressure needs to be relieved (de-compressed) quickly with a surgery.

Does a herniated disc require surgery?

There can be many non-surgical treatment options even for herniated discs. In fact, some studies of MRIs of healthy people have shown that 40% of people over age 40 can have herniated discs without any symptoms whatsoever. The study found that herniated discs can be a harmless byproduct of aging. Herniated discs do NOT necessarily require spine surgery.
— https://pubmed.ncbi.nlm.nih.gov/2312537/

Keep in mind that if you’ve been told you have a herniated disc, spine surgery does NOT repair the disc. Spine surgery often REMOVES the disc and replaces it with a bone fusion, which locks two vertebrae together, reducing movement. While you have many levels in the low back, and other discs can retain some movement, the same is not the case with a herniated disc and fusion in the neck where you have only 6 disc levels. Fusing one level in the neck reduces motion, and has been shown to increase the risk of herniations at other levels in the neck.

A disc is like a jelly donut. A herniated disc is when the jelly center breaks through the wall of the donut. Typically spine surgery is intended to remove the part of a herniation that is pressing on a nearby nerve. Sometimes that can be done with a micro-discectomy that relieves the pressure on the nerve, and leaves some disc between the vertebrae. Other times the entire disc is removed, and a piece of bone is inserted between the vertebrae to maintain the necessary space.

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