Back Surgery FAQ's

What are common causes of back pain?
There are numerous causes for back pain ranging from muscle strain, trauma, arthritis, disc herniation, muscle spasm, facet joint pain, and cumulative effect of poor body mechanics.

How do disc injuries cause back pain?
When the disc bulges or herniates into the spinal canal, the nerves in that area can become inflamed or agitated, creating both back pain and pain in the area where that nerve carries impulses. The muscles surrounding the injured disc can become fatigued and spasm.

What is the difference between a herniated disc and a bulging disc?
A bulging disc is a slight protrusion of the center of the disc (nucleus pulposus) into the spinal canal. In a bulging disc, the annulus fibrosus (outer ring) has not been ruptured. A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the back, buttocks, hips, or legs.

Is it true that a bulging disc can be normal?
Bulging discs are very common, and may not produce any symptoms.

How did I herniate my disc?
As we age, the disc may lose hydration and develop small tears and bulges. The herniation can occur due to a lifetime of poor body mechanics, a trauma, or by lifting, bending or twisting the wrong way at the wrong time.

What are the symptoms of a herniated disc?
The classic symptoms of a herniated disc include back pain, hip pain, and any combination of burning, numbness, tingling, or pins and needles in the legs.

What is the treatment for herniated discs?
A herniated disc is treated with conservative therapy unless there is a spinal deformity or neurologic deficit. Conservative therapy can include physical therapy, chiropractic care, acupuncture, Pilate's, ultrasound, pain medication, muscle relaxants, and a short course of steroids. If these do not work, the next steps include a steroid epidural or facet joint block. Surgical intervention is the last resort. If surgical intervention becomes necessary, a microdiscectomy is the most common procedure.

Does non-surgical spinal decompression work?
There are many services advertised that offer "non-surgical" spinal decompression. These treatments may not be covered by insurance companies. And there is no published information to suggest that a disk can be unherniated. In my opinion, the results are equal to inversion therapy.

What is degenerative disc disease (DDD)?
Degenerative Disc Disease refers to the loss of loss of hydration in the disc and weakening of the annulus (outer lining of the disc). Trauma can cause the annulus to tear and disc material leaks out and presses on a nerve. Degenerative disc disease is very common in the human population but is not always symptomatic.

What is lumbar instability?
Lumbar instability occurs when there is unnatural movement of the vertebras. This can be a result of degeneration of the discs, a spinal deformity such as spondylolisthesis, or occur after a decompression procedure.

What is spinal stenosis?
Spinal Stenosis is an abnormal narrowing of the spinal canal which holds the spinal cord or the nerves. The narrowing may be caused by age related changes of the spine such as disc degeneration and arthritis causing a bone buildup in and around the canal and nerve holes producing nerve compression. The compression of the nerves causes arm or leg symptoms such as numbness, weakness, or pain.

What is the treatment for spinal stenosis?
Conservative therapy may relieve the symptoms of spinal stenosis. If not, a spinal decompression is necessary. This is the removal of the bony narrowing around nerves. The operative strategy will depend not only on the location of the spinal narrowing, and the relative stability and condition of the spine as a whole.

My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Is this true?
Generally, the pain associated with arthritis can be managed with conservative therapies, exercise, and medication. Read more about conservative therapies for back pain.

When is surgery necessary for patients with spine problems?
Surgery is only indicated if conservative therapy fails, the patient becomes dysfunctional, or the patient should experience progressive neurological problems.

What is a laminectomy?
A laminectomy is the removal of a small portion of the vertebra, (lamina) around the affected area. This is done to relieve pressure on the nerve roots.

My spinal specialist said I need a fusion. Is that true?
A fusion is recommended if there is spinal deformity or instability, or if the spine will become unstable due to the removal of the disc or bone.

If I have a fusion does that mean I will never be able to bend?
No. Very little bending capacity comes from the spine. It is from the hips.

My spinal specialist said he would be using implants in my spine. Is this really necessary?
The spinal instrumentation serves two purposes. First, it allows the surgeon to restore the alignment and balance of your spine. Secondly, the instrumentation acts as an internal brace, stabilizing the spine while the bone fusion grows.

Does it matter what screws and rods my surgeon uses?
There are differences in the instrumentation on the market. Your surgeon will select the instrumentation based on the procedure.

Will fusing my spine cause damage to adjacent areas?
That is an excellent question. In a one level fusion, there is little impact on the spine. In a multi-level fusion, the major concern about a fusion is adjacent segment degeneration. The discs act as shock absorbers between the vertebras. When the spine is fused, the discs above or below the fusion may absorb the sheer force from every day motion, and thus wear out. When the fusion is performed it is essential that the balance of the spine is maintained. If this is done, the adjacent segments are at less risk of degeneration.

What are the risks associated with spinal surgery?
There are risks associated with any surgical procedure. The risks for spine surgery include but are not limited to: inter operative complications, infection, bleeding, and hardware failure.

Do I need to wear a brace after surgery?
I always prescribe a brace if a patient is at a high risk for not fusing.

Does my insurance cover low back surgery?
In most cases insurance will cover spine surgery. Your insurance benefits will be verified and explained prior to surgery.

How quickly can I expect to recover from surgery?
Recovery from surgery is individualized, and depends on the surgical procedure. Regardless of the procedure, patients are walking within 24 hours of surgery.

I have heard people talk about less invasive back surgeries. What are these? How do I know if I am a candidate?
Minimally invasive surgery is an option for certain conditions, when performed by a spine specialist. It is not an option for Idiopathic Scoliosis. Your physician will explain the treatment options and the pros and cons of each.

Will I have to have physical therapy? If so, for how long?
Your physician will determine if you need physical therapy. In general, I prescribe physical therapy for my patients between 4 and 12 weeks post-surgery. Core stabilization, stretching, and muscle conditioning are very important to a patient's long term health.

Will I have to take medication for pain? Are there any medications I should be concerned about?
Pain medication is administered in the hospital following surgery. Patients typically require oral medication for a period ranging from 1-4 weeks, depending on the individual and the procedure performed. If a fusion has been performed, it is important to avoid anti-inflammatory medications, including aspirin products, until cleared by the physician. These medications will inhibit the growth of the bony fusion.

I hear that men should not have fusion surgery. Is this true?
No. There is an additional risk for men during any surgery involving the abdomen. When an anterior fusion is performed on male, there is a small chance that the nerve that controls ejaculation can be damaged, resulting in retrograde ejaculation. If this occurs, the patient will still be able to become erect, and orgasm, but will not produce semen.

What are some of the complications associated with fusion surgery?
There are potential risks with any surgical procedure. The complications specific to a fusion surgery, while rare, include failure to fuse, hardware failure, infection, excessive bleeding, and adjacent segment degeneration.

How many times will I need to see my surgeon after surgery?
Post-operative visits will depend on the procedure and your surgeon. In my clinic, I see patients that have had a fusion one week post-operatively, and then at intervals of one month, three months, six months, 9 months, and 12 months post-op.

Why do some surgeons approach the spine from the back and others through the abdomen?
The surgical approach is determined by the physician based on the diagnosis and symptoms of the patient. The anterior (front) and posterior (back) combination increase the surgical success rate dramatically.

What are the risks from going in from the front?
The anterior (front) approach to the spine is generally accompanied by a skilled vascular surgeon. The major complications associated with this procedure are blood vessel damage and sexual dysfunction in males.

What are the risks from going in from the back?
The risks of a posterior (back) surgical approach include: nerve damage, bleeding, infection, cerebral spinal fluid leaks, failed hardware, and a failure to fuse.

My doctor said he would be using a bone graft. What does this mean? What is a bone graft?
A bone graft is a bony substitute for a disc, which grows over time to stabilize two or more vertebra together. There are two categories of bone grafts, allograft (donor bone) or autograft (bone used from your body, generally the iliac crest.) The type of bone graft used is based on the procedure, the amount of bone needed, whether the patient is a smoker, and the patient's overall health.

My spinal specialist said he will take the bone graft from my hip. How big is that incision compared to the spine surgery?
The incision for your spine surgery is correlated with the number of spinal levels that are fused. The incision for the bone graft can vary, but is generally 1 ½- 2 inches long. Dr. Pashman rarely uses bone taken from the patient's hip during surgery.

Are there any alternatives to having a bone graft taken from my hip?
The alternatives to using a bone graft from the patient's hip are to use local bone, cadaver bone, or a bone graft substitute.

What are the differences between bone taken from my hip and donor bone?
The bone taken from the patient's hip has a higher fusion rate than donor bone.

I have heard people talk about the pain associated with harvesting bone from the hip. Does this happen to everyone and how long does it last?
I rarely harvest bone from a patient's hip. There is pain associated with any surgical procedure. In the majority of patients the pain is resolved in a short period of time and they do not require medication. There are a small percentage of people who do suffer chronic pain following this bone harvesting.

Are there any potential complications with harvesting bone from my hip?
There are potential complications with any surgical procedure. The complications most often associated with harvesting bone include: infection, bleeding, or chronic pain.

My spinal specialist said that he will perform the fusion from my back and will harvest bone from my hip without a separate incision. Will I be able to tell the difference between that pain and the main procedure pain?
Most patients can distinguish between the pain generated from the procedure and the bone harvesting.

I have heard people talk about hip pain after harvesting lasting up to two years or longer. Is that true?
The majority of patients do not experience long term pain, but it is possible for patients to experience long term hip pain following harvesting.

Can I have an MRI or CT scan after fusion surgery?
MRI or CT scans are performed on patients that have had spinal fusion with titanium instrumentation to rule out re-herniation or to aid the physician in diagnosing a new problem. Always inform the imaging technician performing the MRI or CT scan that you have spinal instrumentation.

Will my surgery be photographed or video taped?
Occasionally Dr. Pashman will take interoperative pictures for educational purposes. The photos or video do not show any identifying features (such as name or your face). This is covered in your surgical consent form. If you have a preference about being photographed, please let Dr. Pashman know when you sign the consent form.

After spine surgery, do I need antibiotics before getting my teeth cleaned?
According to a joint study by AAOS (American Association of Orthopedic Surgeons) and the American Dental Association. At this time antibiotics are recommended for two years following an implant procedure. Notify your dentist when scheduling an appointment. The dentist will prescribe the recommended antibiotic if necessary.

After a spinal fusion, will the instrumentation in my body set off the alarm at the airport?
It is recommended, but not mandatory that you advise the TSA officer of an implanted medical devise. With the current screening system, patients have not reported setting off the alarm. With the advent of full body scanners, this may change.

Should I donate blood before surgery?
There are pros and cons in donating blood prior to surgery. Generally, Dr. Pashman does not require patient's to donate blood prior to a surgical procedure. More information about the pros and cons of donating blood can be found here.

Related links:
Why a Spine Surgeon
Spinal Balance and Adjacent Segment Degeneration
Web MD Chat: Cage Implants for Degenerative Disc Disease
Web MD Chat: Treatment for Spine Conditions
Web MD Chat: Spine Surgery