Success of spinal surgery depends on the proper diagnosis

By Annika Graf Dec 12, 2005, 3:03 GMT

Munich - Any wrong move can mean a lightning shot of pain up and down the back when the spine's discs and vertebrae are misaligned.

Slipped or herniated discs are responsible for many of these problems. When these discs begin to deteriorate they can move out of position and scrape the spinal cord. Alternately, a failing disc can allow the spine's vertebrae to rub against one another.

Surgery is an option for both problems.

'About 800,000 disc injuries are diagnosed a year in Germany,' says Michael Mayer, German lecturer and president of the European Spine Society.

MRIs, X-rays, modern medical diagnoses and computerized 3-D imaging mean a slipped disc is impossible to miss these days, explains Professor Claus Carstens, director of the German Society for Spinal Research in Heidelberg.

Slipped or herniated discs occur when the gelatinous centre seeps out of a damaged or porous spinal disc and begins to push on the nervous tissues in the centre of the spine. That can lead to intense pain, but also to handicapping of the legs, intestines or bladder. In such serious cases, experts agree the disc problem has to be fixed surgically as soon as possible.

Less invasive treatments can also be attempted. These range from physical therapy to shots of anaesthetic. Homeopathic medicines, cortisone and electrotherapy, where patients are submerged in a bath and subjected to light electrical shocks are also accepted treatments to ease pain. But if they do not show progress after a few weeks, experts often recommend surgery.

Studies show that patients who get surgery and those who choose less invasive procedures have about the same results five years later. However, the patients who opted for conservative treatments suffered from pain for a longer time.

Doctors can use microsurgical or minimally invasive procedures when attempting spinal surgery. During microsurgery the herniated disc is removed through the vertebral canal. An endoscope is used in minimally invasive surgery.

'It depends on the location and size of the herniated disc,' explains Mayer. The incision used for endoscopy is smaller, but there is always the risk the surgery will have to be repeated. Odds of a repeat are three to eight times higher than with microsurgery.

'An endoscopic approach is also very technically limited. It often happens, that the herniated disc is not completely removed,' says Mayer.

Many kinds of spinal injuries are inoperable. But, in the cases where it is an option, spinal surgery can have a success rate of 80 to 90 per cent, said Carstens. If the herniated disc can be completely removed, then the patient is usually free of pain after the surgery. He says the risk of paralysis is small, even after a surgery along the sensitive spinal column.

'I've never experienced someone becoming wheelchair bound.' Still, the disc injury can damage nerve endings, leading to loss of sensation or slight handicapping, for example in the legs.

Not every problem with a disc can be traced back to a herniated disc. 'Until one's 40th or 50th birthday, the most common complaint about discs is slippage,' said Carstens. Older people suffer more commonly from disc deterioration, which leads to similar symptoms.

'The discs lose water during the course of their lives,' explains Carstens. Without the liquid cushion, the vertebrae are subjected to arthritic conditions as the bones of the spine begin to rub against one another.

Patients walk hunched forward and often have to stand still because movements lead to pain. If the degeneration of the spinal discs leads to spinal instability, it might be necessary to fuse together vertebrae or to install artificial prosthetics.

Fusing or reinforcing requires multiple vertebrae to be joined together with a kind of bracket to restore spinal stability, even if discs have been damaged. Artificial discs allow the spine to retain its mobility.

But not every patient is eligible for artificial discs. For example, osteoporosis sufferers are immediately ruled out. But prosthetics have the advantage that they allow patients to play sports again, said Mayer. 'That isn't possible after fusing.'

Still, there is no long-term data available for the success of these new treatments. Every prosthetic carries risks, says Carstens. It is questionable if such a procedure is useful for older people. Often the decision is based upon the amount of pain the patient suffers.

'People who remain active into their later years, can be helped with such an operation.'