10 Things Your Spine Surgeon Should Know Before Surgery

Before you have any type of spine surgery, you and your surgeon will need to discuss a number of details about your procedure. Substantial planning takes place prior to back surgery, and some of these issues will be addressed closer to the day of your surgery, while others may be considered well before your operation is expected to take place.

Here are 10 things that your spine surgeon will want to evaluate before your surgery.

A doctor preparing before surgery

FangXiaNuo / istock 

Pre-Operative MRIs Are a Good Thing

Magnetic resonance imaging (MRI) is frequently used when deciding whether a spine procedure is needed. But that’s not the only value of this technology.

Your surgeon will refer to your films to assess your spinal anatomy, disc chemistry, the degree of degeneration present in your spine, and to determine if disc herniation is present and whether it is contained or not.

All of these factors are used in planning out the details of your procedure.

Along with MRIs, you might also have other imaging tests to supplement the visualization of your spine.

Finding the Right Surgical Procedure for You Is Key

Not all spine problems are corrected with the same surgical method. A microdiscectomy is often the surgery of choice for a simple lumbar disc herniation. But open discectomy, which is more invasive, might be the right approach for you. And if your spine is unstable, you may need an entirely different procedure altogether.

Many factors go into selecting the right procedure for your back problem. Ask your doctor why they recommended a specific procedure for you—sometimes it's based on chances of lasting improvement, and sometimes risk factors play a bigger role in the decision.

Another bit of knowledge that may be helpful is how often—and for how long—your surgeon has been performing the particular surgery that is recommended for you.

Is Your Spine Stable Enough for a Disc Surgery?

Some spine conditions are accompanied by spinal column instability. Spondylolysis is a stress fracture in a part of the spinal bone called the pars interarticularis. When a pars fracture is not treated, it may progress into a full-blown case of spondylolisthesis (disc herniation), where one spinal bone moves either forward or back of the bone below it.

How does your surgeon know whether your pain is coming from your disc or from spinal instability?

By identifying where on the nerve root the compression is occurring. This is determined with a physical examination and diagnostic studies.

According to a 2016 study published in the Asian Spine Journal, lumbar disc herniations tend to affect the lower part of the root. Spondylolysis tends to compress the upper part. Your physical examination can help pinpoint which area of the root is affected—and studies like MRI and electromyography can help as well.

Is Your Sciatica Really Caused by a Herniated Disc?

A herniated disc is a common cause of sciatica, which is leg pain due to radiculopathy (compression or irritation of a spinal nerve root).

But sciatica can have a number of other potential causes that are not related to a herniated disc. These may include piriformis syndrome, ankylosing spondylitis, facet joint hypertrophy, neuropathy, or cancer.

Your surgeon will identify the location of your disease involvement as well as the cause of your condition prior to your surgery.

Mistake-Free Preparation and Follow Up

Getting you ready for a discectomy or other spine surgery and keeping you safe during and after the procedure involves a number of steps and medical protocols.

  • Prior to your surgery, your surgeon's team will take care of a number of safety measures, including informing you of potential complications of your surgery and monitoring and managing all your pain medication (you may need to stop taking some or all of them just before you go in).
  • During surgery, your team will position you safely, coordinate your anesthesia, and make sure your repair is done carefully and that your wound is closed appropriately.
  • What you do after the surgery—like getting the right kind of post-procedure rehabilitation or physical therapy—matters to your healing. And being active too soon or not soon enough may affect your recovery too.

Other things that make a difference in how well you can get back into the swing of things include maintaining a healthy weight and keeping your wound clean. Your doctor will discuss all of the factors you need to take care of with you.

Do You Make a Good Surgical Candidate?

Mental health issues like anxiety, depression, and secondary gain can play a role in your recovery. Sometimes serious psychiatric conditions can contribute to worse surgical outcomes or issues like post-operative drug addiction.

Examples of secondary gain include having an excuse for not going to work or gaining sympathy.

Your surgeon may assess you for underlying psychological issues by giving you a specially designed questionnaire to fill out—such as the Multiphasic Personality Inventory (MMPI) or the Distress and Risk Assessment Method (DRAM).

If it turns out that your psychological condition could lead to an adverse outcome, your surgeon may decide to hold off on surgery and refer you to a mental health specialist instead.

Beware of Wrong Level

Most lumbar disc herniations are sustained at either L4-L5 or L5-S1, and surgeons are generally able to discern those levels in their patients.

But rare anatomical variations can make it more difficult to precisely locate the right area for the procedure. When a herniation occurs in an uncommonly affected level of the spine, namely L1-L4, this can also lead to a higher risk of errors in localization.

If your surgeon exposes the wrong level during your surgery, but realizes it and then proceeds to the correct level, it’s possible that you might not have any problems at all from the issue. But the exposure of the wrong level of the spine can increase your risk of having a prolonged procedure time, developing an infection, or sustaining surgically induced tissue damage.

Oops! Wrong Side

According to a 2017 study from the United Kingdom, an operation on the wrong side of the body is the most common type of wrong-site error. One study showed that over 72 percent of wrong-site surgical errors were due to surgery being done on the wrong side of the body.

And a 2014 study found a factor that contributes to this type of error—the side of surgery can be missing from the paperwork that travels with you on your medical journey. Paperwork includes your clinic letter, your consent form, or other documents. You can make things a little safer for yourself if you look for this critical information in your consent form before you sign it. The study also advocates that surgical teams use the WHO (World Health Organization) surgical safety checklist. According to the authors, this checklist has been very effective in minimizing the wrong site surgery at the NHS. You might ask your surgeon about that, as well.

Marking the area with a sharpie is another tactic used by surgical teams before surgery—so don't be surprised if your doctor writes on your body. But don't hesitate to ask about it and make sure that everything everyone is saying about the location of your surgery matches up to what you have been told.

Back Pain Doesn’t Always Mean Disc Surgery

Just because you have back pain doesn’t mean you need disc surgery. Other problems that don't require surgery may be causing the pain. Perhaps the best example is degenerative changes in your discs, a common condition that may resolve with physical therapy and medical management.

A herniated disc in your lumbar spine can be very painful. The good news is it often resolves with conservative treatment, which generally consists of physical therapy in combination with pain medication and/or muscle relaxers. If non-invasive treatments such as these don’t fully do the trick, you may still be able to avoid surgery with a steroid injection.

After six weeks of non-invasive care without satisfactory results, it may come down to surgery. In this case, a discectomy may be all you need to achieve the relief you seek.

Keep It Simple

In general, if you have more back pain than leg pain and/or your diagnosis includes Modic endplate changes, you may be a candidate for more in-depth surgical procedures. Otherwise, a simple disc herniation may only require a microdiscectomy.

Speak honestly with your doctor to assess your options and consider a second opinion if you are intimidated by the prospect of extensive surgery and a prolonged recovery.

A Word From Verywell

Well, phew! That was quite the list. If your head is spinning or you’re wondering how to keep track of all those questions, don't worry! Your medical record will have the answers to these questions as your doctor works through your assessment. And your surgeon, primary care doctor, physical therapists, and nurses are all there to guide you and to make sure you understand everything so you can take the steps before and after your surgery to make it a beneficial procedure.

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