Your Spine Surgery Questions Answered by Dr. Scott Boden

Having spine surgery is a big decision, and it’s in your best interest to ask questions so you know how to prepare, and what to expect both immediately after the surgery and long-term. A week ago, we asked you to send us your spine surgery questions through Facebook Messenger. Below are Dr. Scott Boden’s responses to the questions we received.

Your Spine Surgery Questions Answered

Question: I had spine surgery in March 2015. There’s something wrong in my L4 & L5 disks that cause me severe unbearable pain. The spine doctors don’t see anything wrong other than desiccation on the MRIs. I have nerve and muscle spasms constantly, can barely walk, and severe pain in my lower back and legs. I’m on Medicaid and can’t get the help I need because spine institutes don’t accept Medicaid. What can I do?

Dr. Boden:  It’s unfortunate that your type of insurance might limit your access to care.  There are physicians and centers that will accept your insurance.  With that said, if you have radiating leg pain but don’t have severe pressure on the nerve roots on your MRI, then it is much less likely that surgery will help and you may be better served visiting a pain management specialist rather than a spine surgeon.

Question: How do you alleviate severe spine pain? How do you restore broken cartilage of the spine?

Dr. Boden:  Unfortunately, there is currently no way to restore, repair, or replace damaged cartilage in the disc structures which are located between each of the spinal vertebrae bones.  Back pain can often be lessened through a variety of medications, exercises, and special pain treatment modalities.  Also, as the spine ages and naturally becomes less mobile, some of the painful causes of back pain in middle-aged patients will remedy themselves over time.  If the situation is associated with significant pain radiating down one or both legs, then surgery may be an option.  If the pain is due to a fracture, tumor, infection, or excessive mobility of the spine, then surgery may be an option.

Question: Are there any new advancements in scoliosis surgery? Is it still metal bars and being in a body cast for months?

Dr. Boden:  There are many new advancements in scoliosis surgery including less invasive surgical approaches, better ways to minimize blood loss, and use of biologics to improve the healing of bone necessary for scoliosis surgery to be a success.  With that said, metal rods, screws, hooks, and cages are still part of the process.  Use of body casts is much less common, but removable custom molded plastic braces are sometimes still utilized.

Question: I have disc degeneration at all lumbar levels, can surgery be performed, if not, what else can be done to relieve pain?

Dr. Boden: When there is disc degeneration at all levels and the primary symptom is back pain (and not radiating leg pain), we would typically not suggest surgery. You would have to come in to see a spine specialist to fully address your pain and specific situation, though.

Question: If less than 10% of patients who experience back or neck problems are candidates for surgery, why is that?

Dr. Boden: The majority of back or neck problems will resolve with time or non-operative treatments such as physical therapy or medications. Only a very small percentage will require or benefit from surgery.

Question: Could you walk us through a general sequence of determining whether or not a patient should consider surgery following a disc herniation, PT and epidural steroid injections? Having a hard time sorting out the difference between patience to allow healing and delaying and inevitable surgery now 2 years post injury

Dr. Boden: In general, a disc herniation might need surgery if the primary symptom is radiating leg pain rather than just low back pain. The majority of disc herniations – over 90% – resolve on their own within three months. During that time steroid injections, physical therapy and medications can be tried to help relieve pain while the body heals the disc. If the leg pain persists longer than 3 months than the ideal surgical window is between 3 and 6 months after the leg pain started. You can still get acceptable results after 2 years, but the likelihood of success is slightly smaller.

Question: When is it time to be evaluated by a spine surgeon?

Dr. Boden: Over 90% of spine related problems usually resolve on their own or with some simple non-operative treatment. Relatively few people need to get into the hands of a surgeon. If you have radiating pain or weakness down your arms or legs that has not been getting better within a short amount of time, is an indicator to be evaluated by a spine surgeon.

Question: Who is a good candidate for spine surgery?

Dr. Boden: Based on age, looking at the under 50 age group – one of the most common problems that could lead to spine surgery is a herniated disc. If that does not resolve with non-operative treatment, then that patient with that problem is usually an excellent surgical candidate assuming their main symptoms is persistent radiating arm or leg pain.

Question: What type of tools or techniques are generally involved with spine surgery?

Dr. Boden: It depends on what the patient’s specific spine problem is. For a herniated disc, it will be an outpatient surgery with a small incision that removes the herniated piece of disc cartilage and unpinch the nerve. For older adults (50+), our spinal canal eventually gets more narrow that causes pinching. In these situations, it involves surgery that will unpinch or decompress the nerve roots.

About Dr. Scott Boden

Scott D. Boden, MD, is Professor of Orthopedic Surgery and Director of the Emory Orthopaedics & Spine Center. Dr. Boden started practicing at Emory in 1992. During his fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory University Orthopedics and Spine Hospital (EUOSH).

Dr. Boden’s Clinical Interests
Dr. Boden’s areas of clinical interest include surgical and nonsurgical management of adult degenerative spinal disorders including herniated discs, spinal stenosis, and spondylolisthesis in the cervical and lumbar spine. He was recently named in another Becker’s list of Top 50 Spine Surgeons in the U.S. and is a skilled surgeon with techniques of microdiscectomy, laminectomy, spinal fusion, and laminoplasty.

Medical School: University of Pennsylvania School of Medicine, Philadelphia, PA 1986
Internship: George Washington University Medical Center, Washington, D.C. 1987
Residency: George Washington University Medical Center, Washington, D.C. 1991
Fellowship: Case Western Reserve University Hospital, Cleveland, OH 1992

Dr. Boden is the proud father of triplets who graduated first and tied for second in their high school class. He is also a baseball aficionado and coaches high school and travel softball teams.

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