Is surgery or non-surgical treatment better for cervical and lumbar spine patients? In recent years, patients and their families always ask this question when I am out of the clinic? Doctor, I went to a hospital and saw that my cervical spondylosis required open surgery, and another Chinese hospital said it did not require open surgery. It seems that this issue is of great concern to patients and their families. It is true that patients and their families will see many doctors when they are ill, especially when each doctor’s opinion differs from hospital to hospital. Today we will talk about the common cervical spondylosis and lumbar spondylosis (such as lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis) surgery. The principle of the choice of treatment method: from simple to complex Cervical spondylosis and lumbar spondylosis are a class of diseases caused by degeneration of the intervertebral disc. They cause two types of pain, one is neurological dysfunction caused by irritation or compression of nerves, including pain, numbness, weakness, or even paralysis of limbs, and urinary and fecal dysfunction, and the other is pain in the cervical or lumbar spine itself caused by spinal instability. Most of these diseases are relatively slow in development, from mild to severe. Therefore, treatment should also be chosen from simple to complex. Recently, I have seen three patients with cervical spondylosis: the first is Liu 65-year-old female 1.5 years after open internal fixation surgery for cervical spondylosis, mainly numbness and pain in the left upper limb before surgery, and has not been able to get up since the surgery, and the quality of life is seriously affected by crying all day long and also has to be taken care of by family members, you can imagine how much they suffer. The second is Mr. Gao 61-year-old male patient, a long-time hobby winter swimming two years ago winter swimming numbness and weakness of the limbs to see the doctor, after examination, the hospital to perform open internal fixation surgery, after surgery, the numbness of both upper limbs aggravated, the left lower limb weakness and limp, skeptical and rebellious attitude to surgery, and the doctor in question conflict, and now has been seeking multiple medical treatment. The third Mr. Duan, a 57-year-old male with cervical spondylosis, was seen at a well-known military hospital, and after an examination, he was requested to undergo surgery, and the patient and his family came to our hospital because they were afraid of open surgery. After careful medical history, detailed physical examination and static and dynamic assessment combined with imaging data, we discussed the treatment plan with the patient and his family, and the result of the discussion was that the patient requested minimally invasive interventional treatment first, and then according to the effect to see if further open surgery is needed. The patient is now satisfied with the treatment and is being followed up further. The consequences of the different treatment options for the three patients were completely different, and it is responsible to say that their lives were fundamentally changed due to the choices they made at that time. When it comes to the need for surgery, this is a rather specialized topic, and I guess that even if I write a bunch of things at length, we may not be able to fully understand them. So, here I just want to be more general and talk about it from a common sense perspective. If rest and exercise can relieve, conservative treatment is the first choice, surgery to the side First of all, all these diseases in the vast majority of cases should be treated conservatively, such as through changing bad habits, rest, exercise; and then can be supplemented by some medication, physical therapy. These methods are very easy and harmless, and it would be great if these simple methods could relieve the symptoms. Here, I need to clarify that the cervical and lumbar spondylosis we suffer from is not like a cold. Many patients ask, “Can I be cured? We need to know that these diseases of the spine are the result of the aging of our organism. In layman’s terms, it means that our spine is used up after decades of use, just like our skin and teeth. The body of course has a certain ability to repair itself, through the methods described above, is to delay the further aging of the spine, to give the body a chance to repair itself, but this repair can not be complete, “old” will never “young” back. This is a general principle. The pain and danger of the disease and the poor prognosis > the risk of surgery, early surgery Let’s talk about surgery. When the disease is so severe that conservative treatment is no longer effective, the issue of surgery is involved. In extreme cases, such as paralysis, urinary and fecal disorders, and painful resting positions that cannot be relieved, it goes without saying that anyone knows that surgery is necessary. But if it is not so serious, in the end, surgery or not? This is indeed something that makes most patients and their families hesitate. It is only natural that all 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. These are the things that influence a 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 think about the condition of their disease. Patients are often more afraid of surgery than of disease. We can imagine a scale where we compare the disadvantages of surgery with the dangers of your illness or disease, and if the pain and dangers of the disease are much greater than the dangers of surgery, then do not hesitate to choose surgery. On the contrary, don’t have surgery. How great are the risks of surgery? Less than most patients think How painful and risky is surgery? I am a surgeon and the main part of my job is surgery, but let me be fair and say that 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 “haunted” disc, and to remove it, we have to remove a lot of normal tissue structures, and sometimes we have to sacrifice some normal functions. Therefore, surgery is certainly not the first choice. In addition to the risks of surgery itself, other tissues and organs of the patient may also have problems during the surgery period, such as heart attacks and brain attacks in the elderly 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. Many patients ask, “Doctor, will I be paralyzed if I have surgery? I would like to ask, if 5 out of 10 people are paralyzed after a surgery, can we still call it a treatment method? The purpose of surgery is definitely to solve the problem, and the risks are, after all, few.