Spinal surgery includes surgery to any part of the spine, in any region, from the base of the skull right down to the coccyx (tail bone).

Surgery can be on disc, bone, ligaments, nerves or spinal cord and it can also involve removal of tumours.

Deformity correction is a specialised type of spinal surgery for conditions such as scoliosis (curved spine) and kyphosis (stooped spine).

Surgery on the spine may require insertion of implants such as screws and rods, plates, cages (blocks) and prostheses (artificial discs).

The surgery can be performed from the back, side or front. In many cases it may involve going through the neck, chest or abdomen. This means that spinal surgeons require a wide spectrum of surgical skills.

Who performs spinal surgery?

Modern spinal surgeons are either neurosurgeons or orthopaedic surgeons who have specifically trained in spinal surgery.

Both do essentially the same types of surgery, however some neurosurgeons operate on the spinal cord itself and some orthopaedic surgeons specialise in scoliosis surgery.

Questions that you should ask your spinal surgeon about their experience are:

  • Do you have advanced (fellowship) training in spinal surgery?
  • Can you perform all the necessary operations required to be a comprehensive spinal surgeon?
  • How many operations do you do each year?
  • What types of operations do you do?

    • If you are not happy with the answers given, get a second opinion.

    Is spinal surgery dangerous?

    Most people are terrified about surgery on their back or neck. Many of my patients ask me, “Will I be paralysed? Will I die? All my friends have said, ‘never let anyone near your spine,’ is that true?”

    The answer I give is, modern spinal surgery is generally very safe with low complication rates for most operations. The chances of serious complications such as paralysis is less than 1%, in fact it is even lower.

    There are a small number of operations that are much riskier, for example, removal of tumours from the spinal cord or correction of very severe spinal deformity. However, common operations such as lumbar disc surgery or spinal fusion are low risk.

    What spinal conditions might need surgery?

    These can be grouped into categories such as:

  • Degenerative (wear and tear): slipped disc, pinched nerves, spinal canal narrowing (stenosis), unstable spine (spondylolisthesis), severely worn discs causing pain.
  • Deformity: scoliosis, kyphosis.
  • Trauma: fractures, dislocations, spinal cord or nerve injuries.
  • Tumours: these can be of the vertebrae (bone) and are usually secondary tumours from cancer in other areas of the body. We also deal with tumours on the spinal cord itself.
  • Inflammatory: rheumatoid arthritis or other conditions causing destruction or instability of the spine.
  • Infection: Bacterial infections of discs or bone, TB.

    • Types of spinal operations

    There are many types of operations that range from very small to extremely invasive. The common operations include the following:

  • Discectomy: This is removal of disc material from the spinal canal to relieve pressure on a nerve causing sciatica. It can be done through a small key hole incision. It is most frequently performed in the low back and neck. It is a very common operation.
  • Decompression: This involves removal of bone and ligament to open up the spinal canal in cases of degenerative narrowing of the spinal canal causing pressure on the nerves or spinal cord. It is performed in almost all areas of the spine.
  • Spinal fusion: This means bonding of the vertebrae (spinal bones) together using screws and rods or plates and bone graft. It is used to treat many conditions of the spine where stability is required, for example, worn out discs and joints, trauma, scoliosis and following tumour removal. In cases of spinal deformity, such as scoliosis, large areas of the spine may need to be fused with screws and rods.
  • Disc replacement: Worn out discs can be replaced in very specific cases, particularly in the neck and to a lesser extent in the low back.

    • When is spinal surgery necessary?

    There are certain conditions where spinal surgery is the only option. Examples include tumours, trauma, spinal cord or nerve compression leading to partial of full paralysis.

    However there are many situations where surgery is an option but not the only option and it is very important that the surgeon explains clearly why surgery is indicated and what the alternatives are. A good example is disc prolapse or slipped disc leading to sciatica.

    Surgery is necessary in cases where there is a neurological deficit, but in most other cases a period of six to 12 weeks of conservative management is the correct option as 85% of people get better in this time frame. Provided they can tolerate the pain. Spinal fusion for back pain is a more controversial area and all non-surgical options must be exhausted before considering this.

    Can I return to normal activities after?

    I get asked this question every day and the answer is yes. However, correct recovery is important and rehabilitation and reconditioning is the key to long-term success. This starts day one after spinal surgery and is a team effort.

    Is life as a spinal surgeon stressful?

    Most jobs have a degree of stress and everyone handles it differently. Enjoying what you do and recognising your strengths and weaknesses is really important.

    I am fortunate that I am part of a highly skilled team that work together to achieve the best outcome for the patient.