1. Spine Surgery WHO NEEDS IT?
M. Gordon Whitbeck Jr., MD
April 28, 2018

2. Common Spine Problems:
Low back pain
Neck pain
Disc herniation
Spinal stenosis
Spondylolisthesis
Scoliosis
Fractures

3. Causes:
Genetic factors
Environmental factors

4. Common Symptoms: Neck pain/stiffness
Axial
Appendicular
Neck pain/stiffness
Upper or lower back pain/stiffness
Radiating leg(sciatica) or arm pain
Numbness or tingling
Weakness
Clumsiness of hands
Loss of balance

5. Common Signs: Deformity Decreased range of motion
Axial
Appendicular
Deformity
Decreased range of motion
Tenderness to palpation
Pain on percussion
Decreased sensation
Weakness on formal strength testing
Atrophy
Abnormal tone
Abnormal reflexes
Unstable gait
Tension signs

6. Diagnosis: History Physical examination Imaging studies
Electrodiagnostic studies

7. Treatment: Observation Physical therapy Chiropractic treatment
Nonsurgical
Surgical
Observation
Physical therapy
Chiropractic treatment
Medication
Injections
Massage therapy
Accupuncture
Discectomy
Laminectomy
Corpectomy
Fusion
Disc replacement

8. Natural History: Cervical radiculopathy- 75% will not require surgery
Lumbar disc herniation- 85% will not require surgery
Cervical myelopathy-15% will not require surgery
Lumbar stenosis % will not require surgery

9. MOST SPINE PROBLEMS DO NOT REQUIRE SURGERY

10. Indications for Surgery:
Moderate or severe myelopathy on presentation or progressive myelopathy during observation
Severe radiculopathy on presentation or progressive radiculopathy despite nonsurgical treatment treatme
Spinal deformity or mechanical instability
Axial symptoms that have not responded to prolonged nonsurgical treatment

11. MOST SURGERY SHOULD BE PERFORMED FOR NEUROLOGIC SYMPTOMS

12. Who needs decompression?
Spinal cord compression with symptoms/signs
? Severe spinal cord compression without symptoms/signs
Nerve root compression with profound symptoms/signs
Nerve root compression with symptoms/signs not responsive to nonsurgical treatment

13. Who needs fusion?
Neurologic symptoms(usually appendicular) with mechanical instability(spondylolisthesis, scoliosis, fracture)
Correction of deformity or stabilization of mechanical instability
Axial symptoms(neck or low back pain) related to degenerative disc disease

14. FUSION FOR AXIAL SYMPTOMS SHOULD BE LEGAL BUT RARE

15. Results: Results:
Surgery for myelopathy generally prevents progression, often results in improvement
Surgery for radiculopathy generally results in improvement
Axial symptoms respond much less well to surgery(fusion,disc replacement)
Response depends on many factors

16. Managing Expectations:
Not all symptoms can be explained
Most neck pain and back pain cannot be explained
Most common spine problems do not require surgery
YOU must be part of the solution even when surgery is needed and ESPECIALLY when it is not

17. Managing Expectations:
Surgery is a treatment not a cure
You did not have a normal spine prior to surgery and will not have one after
Thoughtful patient selection, meticulous surgical technique, and diligent aftercare will maximize pain relief and recovery of function

18. COMPREHENSIVE SPINE CARE

19. ?