When exactly do the usual cervical and lumbar spine diseases (such as lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis) require surgery?
Choice of treatment method: from simple to complex
Cervical spondylosis and lumbar spondylosis are a group of diseases caused by the aging of the intervertebral discs. They cause two types of pain: neurological dysfunction caused by irritation or compression of nerves, including pain, numbness, weakness, or even paralysis of the limbs and urinary and fecal dysfunction, and pain in the cervical or lumbar spine itself caused by instability of the crest.
Most of these diseases are relatively slow in development from mild to severe. Therefore, treatments are also chosen from simple to complex.
Medication, rest, and exercise provide relief, not surgery
First of all, all these diseases should be treated conservatively first in the vast majority of cases, such as by changing bad habits of life and work, resting, and exercising; and then some medication and physical therapy can be supplemented. These methods are very easy and harmless, and it would be great if these simple methods could relieve the symptoms.
However, the cervical spondylosis and lumbar spondylosis that we suffer from are not like the flu. Many patients ask, “Can I be cured?
We need to know that these diseases of the crest are caused by the aging of our organism, which, in layman’s terms, means that our crest is used up after decades of use, just like our teeth.
Of course, the body has a certain ability to repair itself, and through the above methods, we are only delaying the further aging of the crest, giving the body a chance to repair itself, but this repair cannot be complete, and the “old” will never “young” back. This is a general principle.
Pain and danger of disease > risk of surgery, let’s operate
When the disease becomes so severe that conservative treatment is no longer effective, surgery is involved. In some extreme cases, such as paralysis, urinary and fecal disorders, it goes without saying that everyone knows that surgery is necessary. But if it is not so serious, is surgery necessary or not? This is indeed something that makes most patients hesitate.
Normal people are afraid of surgery. The risks, the pain, the expense, the need for care, and the delay in work are all things to consider. It is also these things that sway the patient’s decision.
I would like to remind patients who are faced with the decision to have surgery that in addition to thinking about the disadvantages of surgery, they also need to consider the condition of their disease.
Patients are often more afraid of surgery than of their disease. We can imagine a scale where we put the disadvantages of surgery and the dangers of your illness or disease at both ends of the scale. If the pain and dangers of the disease are much greater than the dangers of surgery, then do not hesitate to choose surgery. Conversely, do not have surgery and continue with conservative treatment.
How risky is surgery? Much lower than the vast majority of patients think
How painful and risky is surgery? As a surgeon, the main part of your job is surgery, but to be fair, surgery is not a perfect art. Surgery is a crippling art.
For example, if a patient has a herniated disc that is causing nerve compression, we do not operate to give the patient a new, normal disc, but to remove the broken disc, and to remove it, we have to sacrifice some normal tissue structure and sometimes some normal function. Therefore, surgery is certainly not the primary option.
There are risks associated with surgery. In addition to the risks of surgery itself, other tissues and organs of the patient may also have problems during this time of surgery, such as the elderly being prone to heart attacks, brain attacks, or whatever during the perioperative period.
How big are these risks? It is difficult to give an exact number, but it is certainly lower than most patients think. Especially with the development of medical imaging, surgical instrumentation and equipment, and advances in treatment concepts (e.g., more minimally invasive), the risk factor for surgery for crestal disease has been greatly reduced. Many patients ask, “Doctor, will I be paralyzed if I have surgery? In fact, if a surgery is performed on 5 out of 10 people or even 1 person who becomes paralyzed, can it still be called a treatment? The purpose of surgery is certainly to help you solve the pain of the disease, the risk is, after all, a minority. The doctor is not sure, generally will not lightly say surgery. But the premise is that the hospital and the doctor must be qualified for crestal surgery and have extensive clinical experience
Ask yourself how far will it hurt to walk? Does it affect the quality of life?
Well then, here’s what the patient needs to weigh up. Think about the pain their disease is causing them and the pain it may cause in the future, and then think about the pain of surgery. Put the two under the scales and weigh them.
As an example, in patients with lumbar spinal stenosis, these patients often have leg and back pain from walking too much. The results of conservative treatment are very limited and as a result, they are faced with the option of surgery. At this point I tend to ask, “How far do you walk before you feel pain? Is this pain very disruptive to your life? If it is an elderly person in his 70s, who is not usually in good health, walking 500-600 meters will only cause pain and is not very life threatening, then I suggest that the patient can continue conservative treatment, which cannot completely eliminate the pain, but can at least reduce it, or slowly adapt to it. If you are an active person, just retired at the age of 50-60, you want to enjoy your life, but then you can’t walk, you can’t walk 500-600 meters or even less, you have to sit down and rest, you can’t climb mountains, you can’t travel, you can’t walk around with your grandchildren, and then you think about the fact that this disease may be heavier in 10 years, not to mention the delay of 10 years, and by then your body will not be as good as it is now. The risk of surgery is even greater.
So, on balance, I think we should choose surgery. The pain, inconvenience, and poor quality of life caused by the disease are far greater than the pain and risk of surgery. Most situations can be applied to this example. Of course, the level of risk regarding the specific disease and the risk of surgery needs to be analyzed specifically and needs to be discussed with your physician.