How Do I Know If I Need Back Surgery? (video)

James Bruffey, MD, a spine surgeon at Scripps Clinic, discusses spine surgery, how to determine whether you need one for your ailing back and the risks and benefits of minimally invasive spine surgery.

How do you determine when you need spine surgery? A lot of its based on your symptoms and failure of other treatments that don’t involve surgery. So, if you’ve done all the appropriate non-operative care options for treating your condition — physical therapy, exercise, medications —and avoiding those things that generally would provoke symptoms, then if your condition warrants it, you could be considered for a surgical remedy.

There are things that drive the need for surgery more rapidly, such as a neurologic deficit, changes in bowel or bladder function, or weakness that develops in an extremity. Those are the kind of things where we would move more urgently for surgical care.

So, what’s the recovery from spine surgery? How quickly can you get back to activities? It varies based on what surgery you have to have done. We do a lot of surgeries that are minimally invasive at Scripps. They involve small incisions. They’re generally non-fusion surgeries.

We also have minimally invasive fusion surgeries. But most of our surgeries don’t involve a fusion, such as unpinching a pinched nerve, removing a herniated disk, taking care of a narrowing of the spinal canal via a procedure. Those are pretty quick recoveries. Most people are back to full activities within six to 12 weeks.

Generally, they are overnight stays, even outpatient stays for some of these procedures. Our fusions take a little longer. They’re a little bigger surgeries in some cases. Generally, the hospital stays are a little longer, two to three days, and a little more limitation on activities early. For those patients, I tell them it’s up to a year before they’re completely healed, but 90 percent of the healing occurs in the first three months after surgery.

What are minimally invasive options for spine surgery? Minimally invasive surgery is what most of the surgeons at Scripps are doing now. We’re trying to make smaller incisions, create less trauma from our surgical approaches, yet still achieve the same outcomes as traditional surgery in terms of getting nerves unpinched and spines to fuse where we need them to fuse. There are a varying number of techniques that we will use to achieve that, such as working through tubes, screw systems that allow us to place screws over wires under X-ray through very tiny incisions. There are all kinds of versions of minimally invasive, and we’re doing them here.

What are the risks of spine surgery? Obviously, you want to make the decision if you need to have surgery with some education and some understanding of what the risks are. The spine is a foundational structure that holds your whole body up. It’s also protecting the nerves, so unfortunately, one of the risks of doing spine surgery can be an injury to the nerves while you’re doing the surgery, and injury to the structure of the spine as well.

In a spine fusion, you can have a failure to heal despite our best efforts, which would require another surgery potentially to fix that same thing.

Risk of wound infections are now very low. We’re all using very good techniques now and our minimally invasive techniques I think have reduced our overall infection rate dramatically. Those are the common things we will see. Other things include, blood clots and pneumonia after surgery. Those are rare, but can occur as well.