Back problems are arguably among the most commonly experienced issues out there, affecting people from different walks of life as well as different age groups. However, some back issues can be more severe than others.
There's a big difference between a slipped disc in your spine and a back muscle pull from too much heavy lifting the day before.
Open back surgery is often a solution for back-related ailments that are considered long-term or potentially severe but what exactly are the factors that determine whether a patient requires open back surgery?
Dr Fong Shee Yan is an orthopaedic surgeon with a special interest in initiating and expanding Minimally Invasive Spine Surgery. He explained in a DoctorxDentist answer what the most common reasons for an open back surgery were. Here's what he had to say.
Only 10% of all slipped disc conditions require surgery
According to Dr Fong, open back surgery isn't commonly needed for all natural ageing disc protrusions. Only about 10% require surgery. They are usually due to unmanageable pain and or disability.
As long as the condition isn't rapidly worsening, it can gradually be managed. A majority of them can be treated conservatively with medication, physical therapy, and injections.
Some things might cause your disc to degenerate quickly
However, there might be unforeseen acute or gradual accelerated weakening of the already pre-existing degenerated disc.
Some of the causes are injury, sports, occupation, sedentary postures, etc.
Discs can rupture and compress your spinal cord
Spinal discs can rupture like a burst tire, causing the extruded disc fragment to compress the adjacent spinal cord or nerve within the spine.
This is why you feel symptoms like pain, weakness, or numbness in the arms and legs.
Patients rarely experience end-stage paralysis from a slipped disc
Dr Fong explains that patients very rarely experience end-stage paralysis or lose control of their arms/legs/bladder/bowel control (cauda equina syndrome).
Reason being, this usually occurs gradually with plenty of warning symptoms, signs, and not to mention pain.
As long as you don't get into a major trauma or fall from a height, there's enough time for you to do an MRI scan to see the ruptured disc.
Open back surgery can manage further spinal detriment
Only open surgery is able to physically, completely and directly remove the offending disc. The aim of this surgery is not simply to treat the pain for short term.
The focus is to permanently remove the threatening disc for the long term before it has a chance to worsen further.
Without surgery, a slipped disc can lead to severe issues
Left unchecked, this problem can lead to the loss of the arms or legs and also cause issues pertaining to the bladder or bowel control.
A ruptured disc does not heal or regenerate
Dr Fong would like to emphasise that contrary to popular belief, a ruptured disc does not heal or regenerate. If the disc ever grows back, it means that you'll get the same disc slipped again!
It is alright to have a couple of missing discs
Different types of spine conditions
According to Dr Fong, we can all live without a disc or two! He explained that if you take a look at the MRIs done for the elderly aged 70-80, they will show that there are few discs left!
This is because most of the discs in the spine have worn out naturally by then.
If pain lasts longer than a month, seek specialist evaluation
Dr Fong suggests a common but important piece of advice for people suspected of needing open back surgery.
If neck/back pain lasts longer than one month without any improvement even after medication, physio, injections and other treatments, then it's best to seek a specialist's evaluation of the situation.
Article medically reviewed by Dr Fong Shee Yan.
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2. Leigh Atkinson. et al. Surgical management of low back pain. Med J Aust. May 2016.
3. B W Koes. et al. Diagnosis and treatment of low back pain. April 2006.