Spine surgery is not required or is not urgent in many spine conditions. Studies suggest similar results with and without spine surgery in cases of Disc prolapse and Spinal stenosis.
Common causes of spine problems:
- Disc prolapse or disc protrusion: Occurs mostly in people younger than 50 years age. It can cause pain, paresthesia like tingling sensation, numbness, reduced power. But usually single level disc prolapse rarely causes all these problems except for pain and some tingling. Most patients improve with pharmacological management with neuropathic medication and some life style modifications and proper exercises. Occasionally, Minimally Invasive Pain and Spine interventions[MIPSI] may be required. Very few patients require spine surgery.
- Cauda equina syndrome: Complete loss of power and sensation in lower limbs and numbness in sacral area, called saddle anesthesia. It is an indication for emergency surgery.
- Spinal canal stenosis: Occurs mostly in older people. It can be central or foraminal. Nerves inside the spinal canal or while coming out of foramen are compressed because of narrowing due to several reasons, leading to pain and numbness. Usually, patient is comfortable in forward bending position, as the canal widens, thereby giving more room to nerves. Many patients improve with medication, back strengthening exercises and if required MIPSI procedures. Again surgery is not required in many.
- Spine fractures: Usually happen in older patients with osteoporosis or patients on long term steroids and metastatic cancers. Surgery is not indicated unless there is compression of spinal cord. Initial management is conservative with medication, rest, lumbar belt etc. If surgery is indicated, Kyphoplasty or vertebroplasty can be done in most of the patients, which are day care and minimally invasive procedures.
- Cancers and metastatic cancers: Metastatic cancer of the spine is more common. Surgery may be indicated in some cases, but if the problem is metastatic fracture, injecting bone cement by Kyphoplasty or vertebroplasty is all that is required.
- Infection: Appropriate antibiotics after culture sensitivity examination may cure infection; surgery with fixation of the spine may be required in a small number of cases.
Conclusion:
In short, surgery is not mandatory in all spinal conditions. MRI may show big herniation, but, many patients will improve conservatively. Likewise, even in moderately severe spinal stenosis cases, conservative management is sufficient in most of the patients.
