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FAQ - The Mature Spine

What are the potential complications of cervical spine surgery?

A. Failure to improve is the most common. Less common complications include failure of fusion, infection, nerve root or spinal cord injury, difficulty swallowing, need for further surgery to extend the fusion, and injury to the adjacent structures in the neck.

A. Cervical spine surgery is usually very safe; however, complications can include non-union, infection, paralysis, nerve injury, bleeding or vocal cord paralysis.

Do I need to wear a brace after surgery?

A. Not usually. We only use a brace in adult patients who have undergone scoliosis surgery and who have soft bone. In such cases, the added support of the brace will hopefully keep the spinal implants from pulling out of the soft bone.

A. This question needs to be answered by the surgeon who performs your surgery. Some surgeons, like myself, hardly ever utilize bracing. Other surgeons use bracing after every procedure they perform.

What is lumbar instability?

A. When the spine loses its ability to maintain its vertebrae in normal alignment, it is defined as unstable.  Instability causes pain from abnormally stressed joints and the adjacent irritated nerve roots.

A. Lumbar instability is abnormal motion or position of adjacent vertebrae in dynamic motion.

What is a bone graft?

A. Bone is placed in the joints and/or discs of the spine in order to fuse them. The source of the bone can be from your own pelvis, or from a bone bank.

A. A bone graft for spinal surgery is bone that is placed into an area that normally does not have bone in order to try to have two bones heal together to form one.

When is surgery necessary in patients who suffer from a spinal condition?

A. Urgent indications for spinal surgery are limited to patients with loss of bowel or bladder control as the result of nerve compression. Surgery happens when you decide you are tired of living with your pain and there is a surgical solution for it. Short term improvement can be achieved with physical therapy, medications, and epidural steroid injections. Symptomatic spinal stenosis does not often respond well to conservative care in the long term. Surgical treatment improves symptoms in 75% of patients.

A. Surgery is truly necessary for only three main conditions, bone infections of the spine, instability of the spine, and neurological dysfunction of the spinal cord or nerve roots.

What are the risks associated with spinal surgery?

A. We inform our patients of the specific risks and complications related to their particular surgery. Some generic complications include infection (1-3%), failure of fusion (2-5% per level), instrumentation problems (<1%), failure of pain to improve (% varies), nerve or cord injury (<1%), spinal fluid leak needing repair (<5%), need for future surgery (% varies), need for blood transfusion, and medical problems (heart, blood clots, ulcers, pneumonia, etc).

How long will it take for me to recover from spinal surgery?

A. The single biggest factor in speed of recovery is probably the patient’s positive attitude and motivation. Other factors include age, overall fitness, and other associated medical conditions. Most people are back to work after lumbar discectomy in 4 – 6 weeks, and after spinal fusion (light duty) in 6 – 16 weeks, depending on the person.

A. Recovery rates depend on the surgery performed. Lumbar disc surgery patients usually can recover from surgery within four to six weeks. Lumbar fusion surgery can take up to a year. Kyphoplasty has an immediate recovery. For lumbar laminectomies or decompressions for spinal stenosis, patients take usually four to eight weeks to heal from the incisional back pain, and then several months to heal from the leg discomfort.

What are the potential complications of lumbar spine surgery?

A. We inform our patients of the specific risks and complications related to their particular surgery. Some generic complications include infection (1-3%), failure of fusion (2-5% per level), instrumentation problems (<1%), failure of pain to improve (% varies), nerve or cord injury (<1%), spinal fluid leak needing repair (<5%), need for future surgery (% varies), need for blood transfusion, and medical problems (heart, blood clots, ulcers, pneumonia, etc).

A. These are very much dependent on the type of surgery performed; however, the majority of the complications include nerve root injury, bleeding issues, failure of fusion, failure of instrumentation, and infection.

What is the success rate for spinal surgery?

A. Spinal stenosis surgery is about 75% successful, with most patients reporting satisfaction with the surgery after 2 years. For patients with instability needing fusion, more than 80% are happy 2 years post-op.

A. The success rate for spinal surgery can be confusing. The surgical success rate, i.e. from a surgeon's standpoint usually is related to whether the spine fuses or if the pain the patient presented to us for has been decreased. Patient success rate is usually if there is complete relief of their discomfort, not whether their spine fused or not.

Why do some surgeons approach the spine from the back and others through the abdomen?

A. Spinal disease can usually be surgically treated from either the front or back of the spine, and sometimes both. There are advantages to each approach, depending on the condition. We have noted less pain and more satisfaction in patients who do not require a surgical approach through the flank or side.

A. Surgeons approach the spine from the back for usually posterior-related issues. Some surgeons will approach the spine from the front for issues in which they are trying to get to the disc, which is more easily and thoroughly accomplished through an anterior or front approach.

Will I have irreversible damage if I delay surgery?

A. Only in cases of significant spinal cord or nerve compression with functional deficits is surgery emergent or urgent. If significant weakness is present, waiting longer than 3 months for surgery is associated with a poorer return of muscle strength. In general, nerves that have been chronically and severely pinched do not respond as well as nerves that have been pinched a short time.

A. Some nerve and spinal cord problems can be irreversible if delayed; however, this is not the norm. Some of the treatment options for spinal stenosis can be grouped into permanent and non-permanent solutions. The non-permanent solutions include physical therapy, oral medications, and injection treatments. The permanent solution for the problem at the particular level in question is surgical intervention called laminectomy.

Will I have to wear a collar after surgery?

A. We use a soft collar in some cases to help control the neck and take stress off the neck muscles after surgery. Some patients feel better wearing a collar. After 4 – 8 weeks, the collar is no longer required.

A. This is a surgeon-dependent answer. For most surgeries done on the neck, a collar does not have to be worn.

When do I need to have an MRI if I have back or neck pain?

A. If back pain occurs with radiating leg pain, if neck pain occurs with shooting pain down the arm, if there has been a recent decline in walking ability, or if there is weakness or numbness in the arms or legs, a MRI is often warranted. When back or neck pain are severe, with or without extremity pain, a MRI scan is helpful.

A. Most patients do not need an MRI for strictly back or neck pain; however, if you do have arm or leg symptoms, MRI is usually warranted. For long-standing back or neck pain whose cause is not easily identified on x-ray, an MRI can be occasionally to identify a potential cause for back or neck discomfort.

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