What are the most common reasons for an open back surgery in Singapore?

Open back surgery is not commonly needed for all neck/back pain - only 10% of all neck/back conditions require surgery, the majority 90% can be treated conservatively successfully with medications, physical therapy (physio, chiro, osteo, tcm), injections (including radiofrequency or "laser") as long as the conditions do not worsen rapidly as they are being slowly and gradually managed.

These include majority of symptoms arising from degenerated neck/back discs (also known as cervical/lumbar spondylosis) which are natural aging processes in the first place (if there is no pre-existing congenital spinal abnormality).

There are 2 main reasons surgery is required.

1) Disc injuries

10% of the abovementioned population with "natural" spondylosis unfortunately can experience accelerated weakening of their disc (from injury, sports, occupation, sedentary, etc). It ruptures like a burst car tyre, with disc fragment compressing the adjacent spinal cord or nerve within the spine resulting in pain/weakness/numbness in arms/legs.

Only open surgery can remove the disc fragment and decompress cord/nerve before it worsens further to loss of arms/legs/bladder/bowel control (emergency).

2) Cancer/infection

Second reason for surgery is any serious "unnatural" pathology in the spine -

• Tumour
• cancer secondaries
• infection
• unstable spinal "slippage"
• fracture or
• dislocation

Although rare, they can only be detected by more advance investigation like MRI scans, and if missed/untreated will have devastating consequences of disability, paralysis and even death.

Hence the common but important advice to seek specialist evaluation if neck/back pain lasts longer than 1 month without any improvement despite medications, injections, physio, chiro, tcm, etc.

Thanks for your question. The most common reason for a spinal operation would be significant symptoms and changes on an imaging study such as and MRI or CT scan.

Significant symptoms includes intractable pain, persistent neurology or “red flags” such as difficulty in controlling adder or bowel symptoms, numbness around the anus or night pain.

When I mention “significant” on imaging I mean to say disc prolapses causing spinal cord or nerve compressions, fractures to the vertebral bodies or pars intra-articularis and perhaps tumours. Depending on the access required by you surgeon, they may opt for an open operation to limit the number of surgeries you require.

Surgeons will always try to perform the least invasive surgery possible, provided they have had the correct training and have the necessary equipment.

I hope this helps.

Bw

Dr Dinesh