Your bones, joints and spine are at the core of every movement. An injury or illness in any of these areas can disrupt your routine and lead to a less active lifestyle.
If you have back pain and are considering surgery the Emory Orthopaedics & Spine Center in Atlanta has world-renowned spine physicians that use a team approach to ensure the ideal treatment plan for every patient. When spine surgery is called for, our board-certified spine surgeons have the expertise and cutting-edge technology at their fingertips to ensure you get the very best spine care.
In this informative segment, you can learn if spine surgery might be right for you with guest Scott Boden, MD. He is a professor of Orthopedic Surgery at Emory University School of Medicine and director of the Emory Orthopedics & Spine Center. He is a sought-after and accomplished spine surgeon, award-winning researcher and considered a visionary in the treatment of musculoskeletal ailments.
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Spine Surgery at Emory Orthopedics & Spine Center
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Learn more about Scott Boden, MD
Scott Boden, MD
Scott Boden, MD, is a professor of Orthopedic Surgery at Emory University School of Medicine and director of the Emory Orthopedics & Spine Center. He is a sought-after and accomplished spine surgeon, award-winning researcher and considered a visionary in the treatment of musculoskeletal ailments.Learn more about Scott Boden, MD
Transcription:
Bill Klaproth (Host): If you’re suffering from chronic back or neck pain and are considering spinal surgery, there are certain things you need to know. Here to talk with us about that, is Dr. Scott Boden, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopedics and Spine Center at Emory Healthcare. Dr. Boden, thank you so much, for your time today. Let’s jump into this. When is it time to be evaluated by a Spine Surgeon?
Dr. Scott Boden (Guest): Well, over 90% of spine-related problems usually resolve on their own or with some simple nonoperative treatment. Relatively few people actually need to get into the hands of a surgeon. Some of the things that might suggest it’s time is if you’ve got radiating pain down your arm or down your leg that hasn’t been getting better for at least two to three weeks or you’ve developed some new weakness or new numbness in the arms or the leg.
Bill: So, radiating pain or weakness in the arms or legs. And then this would be traditionally after someone has been to physical therapy, as well?
Dr. Boden: Sometimes people might go to physical therapy usually for the pain that just starts in the back but doesn’t radiate down the legs, physical therapy is usually going to help it resolve sooner. It tends to be the time that you want to think about being evaluated by a surgeon is if you’ve got radiating pain and it’s not resolving on its own within a relatively short time.
Bill: So, radiating pain is the key to look for?
Dr. Boden: I think that’s one of the keys. There is a small segment of people that just have non-radiating back pain that might need a surgeon, but that’s usually going to be when another physician is going to refer them, and it wouldn’t be something they would necessarily do on their own because most patients that have just plain back pain are going to be able to be handled without any kind of surgical intervention.
Bill: Um-hum. So, then who is a good candidate for spine surgery?
Dr. Boden: Well, there’s – based on age, if you look at the under 50 age group, one of the most common problems that could lean to spine surgery is a herniated disc. That is when the soft cartilage that’s the shock-absorber or the cushion between the spinal vertebrae bone protrudes out and pinches a nerve root. If that doesn’t resolve with nonoperative treatments, then that patient with that problem is usually an excellent surgical candidate, assuming that their main symptom is persistent radiating leg pain or arm pain.
Bill: For someone then that is a good candidate for spine surgery, what type of tools or techniques are generally involved?
Dr. Boden: Well, again, it depends on what their specific spine problem is. One of the more common problems as I mentioned, is a herniated disc. For that surgery, it’s usually going to be almost an outpatient surgery with a very small incision, and it’s going to be just surgically removing the herniated piece of disc cartilage and taking the pressure or unpinching the nerve. In older patients, you can have other types of problems. Whereas we all get older, our spinal canal gradually gets narrower and narrower, and that can result in nerve root pinching, and that can cause problems with pain down the legs with standing and walking. Usually, that’s seen in patients over the age of 50 years, and in those situations, it may require a little bit more involved surgery over a larger segment of the spine, but again, it usually involves unpinching or decompressing the nerve roots. In some cases, if the spine is unstable, it may require fusing two or more bones together to prevent them from having excessive motion.
Bill: Is this generally done as outpatient surgery? Is there ever a time when a hospital stay is recommended or needed?
Dr. Boden: Depending on the extent of surgery, it’s not uncommon for some of those fusion surgeries to require hospitalization. It really depends on the health of the patient and the amount of surgery that’s being done.
Bill: And what’s the general recovery time after a spinal surgery?
Dr. Boden: Well, for something like a simple discectomy in a younger patient, the recovery time might be as short as three or four weeks before getting back to work and six to twelve weeks before getting back to some athletic and physical activity. On the other hand, in the case of the spine fusion, depending on how many levels of the spine are being fused, it could be more on the order of several months before people get back to their normal, daily activities, and between six and nine months for the bone to heal adequately to enable them to start pursuing vigorous physical activities like certain types of exercise or sports.
Bill: And does everybody go to physical therapy after spinal surgery, then?
Dr. Boden: Not necessarily. A lot of patients now can just do home stretching programs and strengthen programs, and in other cases, physical therapy is fairly routine. It partly depends again on the patient and what their situation was before the surgery, as well as what the surgery was done for, and then their – just access, and availability, and time to be able to go to physical therapy.
Bill: So, Dr. Boden, is there ever a time when spinal surgery is not recommended?
Dr. Boden: There are quite a number of instances where spinal surgery is not recommended. One of the challenging things is somebody who has excruciating back pain and assumes that their pain is so intense and so debilitating that there absolutely must be a surgery or operative solution. That logic is flawed because in fact, there is a relatively limited subset of spinal problems that respond very well to surgery and then there’s a whole host of other spinal pain syndromes that actually don’t respond well to surgery or are very unpredictable – meaning sometimes surgery works, but it’s very hard to know when it’s going to work and when it’s not going to work. And then there are even some rare situations where somebody has surgery that really shouldn’t have it, and it can actually make their pain syndrome worse.
Bill: Hm, very interesting. So, for someone considering spine surgery, what else do they need to know?
Dr. Boden: Well, I think a couple things. First, make sure that they’ve exhausted nonoperative spinal treatments and they’re not just rushing to surgery as a quick-fix and a first step. The second thing is if somebody is recommended surgery, it’s probably a good idea to get a second opinion from another specialist and ideally, you want to find somebody who really specializes in spine surgery as their entire practice as opposed to somebody that does some spine surgery and some other types of surgery. Nowadays, people tend to subspecialize and even within spine there are some people that specialize in neck surgery as compared to low back surgery or complex deformity surgery like scoliosis and a curved spine.
Bill: And for someone considering spine surgery – I have friends that have done it, and I know one of the big concerns is I don’t want anybody operating on my lower back, or my neck, or my spine. What happens if they do something wrong and I get paralyzed? I do hear this, but I never hear it happening to anybody. Is that a real concern? Should somebody be concerned about that or is something like that a complication?
Dr. Boden: Yeah, so, the “Am I going to be paralyzed after spine surgery,” I would liken that to “Am I going to get hit by lightning if I go out when it’s raining?” We all know that people get hit by lightning. We’ve read about it. Most of us have probably fortunately never seen it happen, but we know it happens. Similarly, although it’s an exceedingly rare phenomenon getting hit by lightning. If it happens to you, it’s a very bad problem. I would liken that paralysis situation in spine surgery to almost the same thing. For most of us, we’ve never seen it happen, but you hear about instances and cases and usually when it does happen, it’s a series of events and all things have to kind of go wrong to make that sort of thing happen. It’s usually not just a single mistake by a surgeon. There are usually other factors involving bleeding by the patient or an already very compromised spinal cord or some other things. But for the most part, in routine spine surgery, especially in the lower back, the likelihood or chances of paralysis is exceedingly and exceptionally small.
Bill: And are there any things that somebody should know what would be a normal risk or something that we think of the – we fear the greatest catastrophe of paralysis and you just debunked that – but is there a normal risk or anything else that we should be aware of?
Dr. Boden: Yeah, for the most part, the main risks associated with spine surgery are actually more related to the risks of general anesthesia and being asleep for several hours rather than the spine part of the surgery. Those can include things like blood clots, heart attacks, strokes, any of those things that could happen to you while you were home sleeping or exercising. There’s also always the possibility of a surgical site infection. At many hospitals, those infection rates are exceedingly low – less than 1%. Even at the best hospitals, it’s still not zero, so there’s always a small chance of a surgical site wound infection, which can cause significant inconvenience after surgery.
Bill: Well, Dr. Boden, thank you for spending some time with us today talking about spinal surgery. We appreciate it. For more information, please visit EmoryHealthcare.org, that’s EmoryHealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): If you’re suffering from chronic back or neck pain and are considering spinal surgery, there are certain things you need to know. Here to talk with us about that, is Dr. Scott Boden, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopedics and Spine Center at Emory Healthcare. Dr. Boden, thank you so much, for your time today. Let’s jump into this. When is it time to be evaluated by a Spine Surgeon?
Dr. Scott Boden (Guest): Well, over 90% of spine-related problems usually resolve on their own or with some simple nonoperative treatment. Relatively few people actually need to get into the hands of a surgeon. Some of the things that might suggest it’s time is if you’ve got radiating pain down your arm or down your leg that hasn’t been getting better for at least two to three weeks or you’ve developed some new weakness or new numbness in the arms or the leg.
Bill: So, radiating pain or weakness in the arms or legs. And then this would be traditionally after someone has been to physical therapy, as well?
Dr. Boden: Sometimes people might go to physical therapy usually for the pain that just starts in the back but doesn’t radiate down the legs, physical therapy is usually going to help it resolve sooner. It tends to be the time that you want to think about being evaluated by a surgeon is if you’ve got radiating pain and it’s not resolving on its own within a relatively short time.
Bill: So, radiating pain is the key to look for?
Dr. Boden: I think that’s one of the keys. There is a small segment of people that just have non-radiating back pain that might need a surgeon, but that’s usually going to be when another physician is going to refer them, and it wouldn’t be something they would necessarily do on their own because most patients that have just plain back pain are going to be able to be handled without any kind of surgical intervention.
Bill: Um-hum. So, then who is a good candidate for spine surgery?
Dr. Boden: Well, there’s – based on age, if you look at the under 50 age group, one of the most common problems that could lean to spine surgery is a herniated disc. That is when the soft cartilage that’s the shock-absorber or the cushion between the spinal vertebrae bone protrudes out and pinches a nerve root. If that doesn’t resolve with nonoperative treatments, then that patient with that problem is usually an excellent surgical candidate, assuming that their main symptom is persistent radiating leg pain or arm pain.
Bill: For someone then that is a good candidate for spine surgery, what type of tools or techniques are generally involved?
Dr. Boden: Well, again, it depends on what their specific spine problem is. One of the more common problems as I mentioned, is a herniated disc. For that surgery, it’s usually going to be almost an outpatient surgery with a very small incision, and it’s going to be just surgically removing the herniated piece of disc cartilage and taking the pressure or unpinching the nerve. In older patients, you can have other types of problems. Whereas we all get older, our spinal canal gradually gets narrower and narrower, and that can result in nerve root pinching, and that can cause problems with pain down the legs with standing and walking. Usually, that’s seen in patients over the age of 50 years, and in those situations, it may require a little bit more involved surgery over a larger segment of the spine, but again, it usually involves unpinching or decompressing the nerve roots. In some cases, if the spine is unstable, it may require fusing two or more bones together to prevent them from having excessive motion.
Bill: Is this generally done as outpatient surgery? Is there ever a time when a hospital stay is recommended or needed?
Dr. Boden: Depending on the extent of surgery, it’s not uncommon for some of those fusion surgeries to require hospitalization. It really depends on the health of the patient and the amount of surgery that’s being done.
Bill: And what’s the general recovery time after a spinal surgery?
Dr. Boden: Well, for something like a simple discectomy in a younger patient, the recovery time might be as short as three or four weeks before getting back to work and six to twelve weeks before getting back to some athletic and physical activity. On the other hand, in the case of the spine fusion, depending on how many levels of the spine are being fused, it could be more on the order of several months before people get back to their normal, daily activities, and between six and nine months for the bone to heal adequately to enable them to start pursuing vigorous physical activities like certain types of exercise or sports.
Bill: And does everybody go to physical therapy after spinal surgery, then?
Dr. Boden: Not necessarily. A lot of patients now can just do home stretching programs and strengthen programs, and in other cases, physical therapy is fairly routine. It partly depends again on the patient and what their situation was before the surgery, as well as what the surgery was done for, and then their – just access, and availability, and time to be able to go to physical therapy.
Bill: So, Dr. Boden, is there ever a time when spinal surgery is not recommended?
Dr. Boden: There are quite a number of instances where spinal surgery is not recommended. One of the challenging things is somebody who has excruciating back pain and assumes that their pain is so intense and so debilitating that there absolutely must be a surgery or operative solution. That logic is flawed because in fact, there is a relatively limited subset of spinal problems that respond very well to surgery and then there’s a whole host of other spinal pain syndromes that actually don’t respond well to surgery or are very unpredictable – meaning sometimes surgery works, but it’s very hard to know when it’s going to work and when it’s not going to work. And then there are even some rare situations where somebody has surgery that really shouldn’t have it, and it can actually make their pain syndrome worse.
Bill: Hm, very interesting. So, for someone considering spine surgery, what else do they need to know?
Dr. Boden: Well, I think a couple things. First, make sure that they’ve exhausted nonoperative spinal treatments and they’re not just rushing to surgery as a quick-fix and a first step. The second thing is if somebody is recommended surgery, it’s probably a good idea to get a second opinion from another specialist and ideally, you want to find somebody who really specializes in spine surgery as their entire practice as opposed to somebody that does some spine surgery and some other types of surgery. Nowadays, people tend to subspecialize and even within spine there are some people that specialize in neck surgery as compared to low back surgery or complex deformity surgery like scoliosis and a curved spine.
Bill: And for someone considering spine surgery – I have friends that have done it, and I know one of the big concerns is I don’t want anybody operating on my lower back, or my neck, or my spine. What happens if they do something wrong and I get paralyzed? I do hear this, but I never hear it happening to anybody. Is that a real concern? Should somebody be concerned about that or is something like that a complication?
Dr. Boden: Yeah, so, the “Am I going to be paralyzed after spine surgery,” I would liken that to “Am I going to get hit by lightning if I go out when it’s raining?” We all know that people get hit by lightning. We’ve read about it. Most of us have probably fortunately never seen it happen, but we know it happens. Similarly, although it’s an exceedingly rare phenomenon getting hit by lightning. If it happens to you, it’s a very bad problem. I would liken that paralysis situation in spine surgery to almost the same thing. For most of us, we’ve never seen it happen, but you hear about instances and cases and usually when it does happen, it’s a series of events and all things have to kind of go wrong to make that sort of thing happen. It’s usually not just a single mistake by a surgeon. There are usually other factors involving bleeding by the patient or an already very compromised spinal cord or some other things. But for the most part, in routine spine surgery, especially in the lower back, the likelihood or chances of paralysis is exceedingly and exceptionally small.
Bill: And are there any things that somebody should know what would be a normal risk or something that we think of the – we fear the greatest catastrophe of paralysis and you just debunked that – but is there a normal risk or anything else that we should be aware of?
Dr. Boden: Yeah, for the most part, the main risks associated with spine surgery are actually more related to the risks of general anesthesia and being asleep for several hours rather than the spine part of the surgery. Those can include things like blood clots, heart attacks, strokes, any of those things that could happen to you while you were home sleeping or exercising. There’s also always the possibility of a surgical site infection. At many hospitals, those infection rates are exceedingly low – less than 1%. Even at the best hospitals, it’s still not zero, so there’s always a small chance of a surgical site wound infection, which can cause significant inconvenience after surgery.
Bill: Well, Dr. Boden, thank you for spending some time with us today talking about spinal surgery. We appreciate it. For more information, please visit EmoryHealthcare.org, that’s EmoryHealthcare.org. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.