Ask the Expert: Spinal Revision Surgery... Second Time's the Charm!
Joseph O'Brien, board-certified orthopaedic surgeon
I’ve been having chronic back pain and don’t know where to start looking for treatment. How would I know if I should see a spine surgeon?
Patients often come to see me because they have severe pain in their back or in their neck. Sometimes the pain is caused by a pinched nerve and it can radiate down an arm or leg. You can also have associated weakness in your arms and legs due to a pinched nerve. In some cases, people have reported being clumsier or off balance. Rarely, you could have other severe side effects.
My husband told his primary care physician about his back pain, but his doctor didn’t advise him to see a spinal surgeon. Why would I not want to consult with a spinal surgeon?
Many patients have a fear when it comes to seeing a spine surgeon. What they do not know is that we like to make sure that patients have exhausted non-surgical treatments such as physical therapy, anti-inflammatory medicine like Motrin or seeing an injection specialist to get a cortisone shot in the spine, before making a recommendation for surgery.
My wife keeps complaining of a pinched nerve, but her pain goes down to her leg so I don’t think that is correct. What are signs of a pinched nerve?
A pinched nerve can be very painful for a patient. Sometimes it results in a pain radiating down the leg with burning or a deep ache. It can also be associated with weakness in limbs. For instance, Peyton Manning had a pinched nerve in his neck and it made his triceps muscle go to sleep, which caused him to not be able to throw a football. He opted to have minimally invasive spine surgery that fixed his pain and got him back to playing and winning the Super Bowl two years later.
My son had spine surgery a couple of years ago, but now he is being told to get spinal revision surgery. What are the risks of him getting this procedure done?
People often ask, “what are the risks of getting revision spinal surgery versus the first-time spine surgery?” Interestingly enough, with minimally invasive surgeries we found that the risk of spine surgeries, even in revision settings, are actually lower than open spine surgeries. In some cases, open spine surgery can have a complication rate upwards of 30 percent. Minimally invasive surgeries have a complication rate less than 10 percent. With modern instruments and technology that we have at Suburban Hospital, we can accomplish these minimally invasive surgeries very easily and limit the risk to each patient.
My friend got his pinched nerve fused and now I have a pinched nerve as well. I’m looking for other treatment options. Is fusion the only solution for it?
No, as stated above, there are non-surgical treatment options, but if you have tried them, then I would highly consider fusion. It’s important to recognize that a minimally invasive fusion is much different than an open spinal fusion. Patients can go back to work 10 days after they have had minimally invasive spinal fusion. Additionally, we do a significant number of disc replacements and micro decompressions to relieve the stress from the nerve, both of which are non-fusion. Disc-replacement is a modern technology that offers the patient the same benefits of a fusion surgery, but with disc replacement it can be done in the low back as well as the neck. We generally prefer to do it in the neck because the outcomes and data supports that it is stronger to do it in the lower neck than the low back, but both are an option for the patient.
What kind of minimally invasive surgeries do you do?
Microdecompression, which is usually done for a herniated disc, minimally invasive fusions and disc replacements. We can now do minimally invasive scoliosis surgery for selected patients, which I’ve done for a number of patients at Suburban Hospital.
How is it possible to have scoliosis as an adult?
Well it’s important to recognize that there are many different kinds of scoliosis. The most common one that we see is adolescent idiopathic scoliosis, which is in teenagers. It’s important to note that in your 50s, 60s and 70s you can develop lower back scoliosis, which tends to shift bones and pinch nerves in the low back. Though there are many different types of scoliosis, there are still minimally invasive surgeries to solve them.
My sister was just diagnosed with scoliosis (she is an adult). How long would the recovery be if she got surgery?
Open scoliosis surgery for adults can be anywhere from 6 to 8 months. With minimally invasive treatments, recovery time is cut down to 1 to 2months. It’s important to understand that the minimally invasive route can’t treat all forms of scoliosis. For instance, curves greater than 70 to 80 degrees would have to be done open. If the scoliosis has gotten too far, then it’s hard to treat minimally invasively, but curves with low magnitude can get treated minimally invasively. Patients who have minimally invasive scoliosis surgery are usually off of pain medicine within a month and can get back to work within 6 to 8 weeks as well.
What other issues can be treated with minimally invasive spine surgery?
Some cancer patients whose cancer has spread to their spine, whether in the neck, low back or in the trunk, can benefit from minimally invasive surgery to enhance their recovery and get them back to their normal life. Patients with a fractured spine can also be treated minimally invasively. It’s important to recognize that there are a number of good options for patients with even the most complex situations.
Surgery for my back pain is the last thing I want to do. Are there any other treatment options that don’t include surgery?
Only about 20 percent of patients that I see need to have spine surgery. We usually recommend a lot of non-surgical treatments to help you. If I don’t think a patient needs spine surgery, I refer them to see physiatrists and physical therapists to help with their problem. If you’re feeling that you don’t need surgery, I am still happy to see you and make other recommendations for your pain.
At what point do you decide between operating open or minimally invasive. And secondly, in how many cases do you go in with the intent of minimally invasive and then have to revert to open?
Generally, 95 percent of what I do is minimally invasive, including revision surgery and scoliosis surgery. After viewing the patient’s standing X-rays and MRI studies during a clinic visit, I decide what the options are based on those results.
While there can be mitigating circumstances for any given surgery, I have not converted to an open surgery during the 10 years that I have been in practice. Generally, I formulate a preoperative plan that will lead to success using the minimally invasive surgical methods.
Dr. O' Brien's Office
Phone: (301) 251-1433
Address: The Orthopaedic Center, P.A.
9420 Key West Ave. Suite 300
Rockville, MD 20850