In South Africa a neurosurgeon is a specialist who deals in the diagnosis and surgical treatment of neurological conditions from structural disorders that people are born with, to accidents and trauma, infections, tumors, age related diseases of the spine, and certain strokes. Though many people think of us as purely brain surgeons, the majority of operations performed by neurosurgeons across the country are spine surgeries as we do train in microscopic techniques to relieve pinched nerves and also the more extensive bone fusions of the spine if necessary.

That would be Spondylosis… this is an umbrella medically term used to describe pain from degenerative conditions of the spine.
Most spondylosis symptoms result from spinal osteoarthritis, but there may be other causes as well. It is a progressive cascade whereby one anatomical change occurs, which leads to more degeneration and changes in your spine’s structures… creating a self-perpetuating cycle of wear and tear that comes with aging… this is normal but at times in certain individuals may manifest as painful problems in the back and neck. Spinal arthritis affects the joints and discs and as these break down, the spine loses its normal gentle curvatures, it becomes stiff and the bones shift abnormally against one another which ultimately can cause pain through inflammation of the region, or they may narrow the spine and pinch upon surrounding spinal nerves leading to issues like sciatica.

There are risks associated with any type of surgery or medical intervention. Particularly with regards to neurosurgery these risks may include weakness, numbness, and strokes… bleeding and infection can also be complications that are possible especially when one suffers from co-existing illness.

The surgeon will discuss risks specific to your condition with the timing and type of surgery that is right for you. Surgery is only resorted to where compelling indications are present. Reassuringly, when the correct surgical option is performed with defined goals and expectations around an appropriate diagnosis, the chosen surgery has good odds having the desired favorable outcome for the chosen individual. Death as a result of brain or spine surgery is not common but possible.

What needs to be especially contemplated is revision surgery of any sort as the risks of complications increase exponentially while the chances of success diminish with each further surgery in the same region and hence many surgeons are rightfully tempered in their approach before embarking on repeat surgeries; unless there is a specific and readily addressable cause for the patient’s problems.

Many of the conditions we treat can be managed without surgery, at least initially. Especially with degenerative conditions, the adage of less is more is sometimes applicable. However, other times, there are clear indications for surgery and then this needs also to be respected. But if appropriate, we always attempt to treat conditions conservatively with this philosophy of first trying to do no harm. Alternative treatments include changes of lifestyle(weight, stop smoking, physical activity), medical management to control symptoms through pain killers, joint injections or spinal epidural injections, or to be patient and follow up with watchful waiting as some diseases that observed with regular scans and clinical reviews to ensure they remain stable.

Surgery is indicated for multiple problems of the spine, including, but not limited to, the slipped discs, spinal narrowing with pinched nerves, abnormal curvatures and instability of the spine to the less common, tumors and fractures.  Surgery is typically recommended for patients who have failed conservative treatment and are still having significant symptoms, which inhibit their lifestyle. You should be evaluated for surgery right away if you develop weakness in your arm/s or leg/s, a change in bowel or bladder function or loose feeling in a limb.

Should I have spine surgery and what type of surgery slipped discs or pinched nerves?

Yes, when appropriate.

Contrary to common belief, spinal surgeries can have a good rate of success but with the rising rate of spinal interventions more cases of persistent and recurrent symptoms will inevitably be seen.

Complications are a reality considering the nature of these disease and do not necessarily reflect on surgery as being a “failure”. Providing that the due measures are taken, “failures” are minimised and should not be responsible for the poor reputation that sometimes accompanies surgery as no disease treatment can possibly have a guarantee.

The types of surgeries that are done range from removal of the offending disc material or bone that is compression the nerve to more extensive modifications of the spinal column when more extensive disease is present, and this may require the use of screws and rods to help stabilize the spine through a fusion.

Furthermore, there is a whole gambit of minimally invasive surgeries and spinal devices that are driven by the trade to be a holy grail solution. Not all of them are proven or established as standard of care through scientific rigor or requisite evidence and hence a cautionary philosophy is necessary to combine cutting edge contemporary care, anecdotal experience, logical principles, and research-based medicine.

So, whether deciding on surgery or the type of thereof, the decision and approach is best individualised and not applied generically based on what may seem in-vogue on the internet.