Spine surgery: in what situations is it considered, and how do you prepare for it?

The main situations that may lead to surgery

Lumbar spinal stenosis

With age, wear of the discs, joints and ligaments can narrow the canal through which the nerves run. The patient feels pain, tingling or heaviness in the legs when walking, which forces them to stop and improves when bending forward or sitting. Surgery to release the nerves may be discussed when the problem severely limits walking despite properly conducted treatment.

Compression of the spinal cord in the neck

Narrowing of the cervical canal can compress the spinal cord. The signs are often progressive: clumsiness of the hands, difficulty doing up buttons, balance problems, stiffness of the legs. This condition, called cervical myelopathy, warrants a specialist opinion without delay, because established deficits sometimes recover poorly.

Slipped vertebrae and deformities

A spondylolisthesis, where one vertebra slips over another, or scoliosis in adolescents or adults may require correction and stabilisation when the deformity progresses, becomes painful or compresses the nerves.

Fractures

After an injury, or in someone with fragile bones, a vertebral fracture may be unstable or threaten the spinal cord. Treatment ranges from a brace to surgical stabilisation, depending on the type of fracture and the neurological condition.

Infections of the spine

An infection of a disc and the vertebrae, spondylodiscitis, shows as persistent back pain, sometimes fever and a general decline in health. Spinal tuberculosis, or Pott’s disease, is one form that remains common in some regions. Treatment relies first on antibiotics or anti-tuberculosis drugs, after the organism has been identified; surgery is reserved for compression, large abscesses or unstable deformities.

Tumours and spinal metastases

Persistent back pain, at night, in someone who has or has had cancer should prompt a search for spinal involvement. Compression of the spinal cord by a tumour is an emergency: weakness of the legs, sensory disturbance or sphincter problems require immediate care.

What tests before deciding?

Neurological examination looks for weakness, sensory disturbance or abnormal reflexes. MRI shows the nerves, spinal cord, discs and soft tissues; CT shows the bones in detail; standing X-rays, sometimes in flexion and extension, assess balance and possible instability. Electromyography may complete the assessment of the nerves. For a remote opinion, the images themselves are essential, together with a precise description of the symptoms and examination.

What types of operation?

• Decompression releases the nerves or spinal cord by removing what is compressing them: a herniated disc, a thickened ligament, part of a vertebra.
• Fusion stabilises one or more segments by fixing them with screws and rods, then encouraging the bones to fuse.
• Some operations can be carried out with less invasive techniques, through smaller incisions, when the indication allows.

The surgeon explains the expected benefits, the symptom the operation aims to improve, the risks, including infection, nerve damage or failure of fusion, and the alternatives.

Recovery

Getting up is often early, but full recovery takes time, especially after a fusion. Leg pain may improve quickly, while long-standing weakness or sensory problems recover more slowly, sometimes incompletely. Rehabilitation, a gradual return to activities and sometimes a brace are adapted to each operation. The time before a long journey is set by the surgeon, taking into account the risk of deep vein thrombosis and tolerance of sitting.

Frequently asked questions