Fundamentally, spinal surgery is the last resort.
This is the theme that emanates from these meetings at the International Society of the Advancement of Spine Surgery in Vancouver this week. I have been attending the lectures in discussions of what surgery to do with each individual case and time and time again, debates surface as to who has the best of the best technique. What is eminent is the minimalistic approach to spine surgery. Surgeons often boast about how little blood loss occurs during surgery and that seems to be one of the key elements. Minimally invasive spine surgery is the way of the future but it still comes with risks. Especially when they don’t know exactly where the pain is coming from always.
I always like to listen to these surgeons who have done thousands of procedures. Discussions almost always narrow down to the disc as the problem. It is where the problems start and often finish. When the seasoned panel is asked to what clues they use in determining what structure to surgically repair, it very often comes down to disc height loss. Remember that the discs are the cartilaginous cushions that keep vertebrae separated from one another in the spine. A healthy disc is one that maintains its height.
When we are born, the disc heights are super tall as the spine is mostly cartilaginous. And as the spine starts the grow, the discs change shape and begin to flatten. And as time goes on, the weight of the human frame begins to compress them. It is only when they reach a threshold loss of compression when they begin to become painful. Discs are loaded with nerves and they get aggravated when compressed too much.
Treatment under my hands always includes a decompressive theme with regeneration repair as the target. If I can share strategies with patients to keep their discs tall, like that seen in children, spines are happier. It is pure anatomical spacing. Remember, spine surgery is the last resort.
Jerome Fryer BSc DC