FAQ's (Frequently Asked Questions) - Greater Baltimore Neurosurgical Associates
Each of our patients is unique, with his or her own set of special concerns and questions. Yet because they share similar conditions, they also often have similar basic questions. Here are some of the Greater Baltimore Neurosurgical Associates' most frequently asked questions, with answers from Dr. Davis and his colleagues.
For the vast majority of patients these days, spine surgery does not mean the beginning of one surgery after another. A few patients do experience the need for additional surgery, generally from a new condition and in rare cases from the original surgery though that happens less and less as we use new, minimally invasive techniques.
We know this is a major concern for many spine surgery patients. In this practice, we've performed more than 2,000 operations and none have ever resulted in paralysis. When we look at the medical literature, we see that paralysis is very, very rare. That's why it is important that your surgeon have surgical team have a great deal of experience. As with most health treatments, experience is the best indicator of a good result for you.
What we see is that when our patients know they need medication for pain, they take it. When they don't need it for the pain, they safely discontinue it. While we've all learned to be careful with medication that can become addictive, addiction is really quite rare among patients. When it occurs, it usually has to do with other, often complex, underlying causes and conditions common to addiction to any substance.
The discs between the vertebrae in your spine may bulge or balloon as part of the aging process, and may even bulge slightly during normal activities. Since this bulging often does not cause pain and seems to be associated with the natural aging process, we can think of it as normal. When the bulging does cause pain-- the point at which we usually call it herniated-- it should not be viewed as normal. Your pain can, and should, be treated. As many as one-third of all adults have bulging/herniated discs.
It is probably simplest to think of bulging and herniated as points on a continuum. When the disc between the vertebrae bulges enough to cause a tear on its surface and to put pressure on a nerve root or spinal cord, we call it herniated. That is generally the point at which patients experience back pain caused by degenerative disc disease. And that's the time to seek treatment.
When patients ask this, it generally means they know that arthritis in the spine is a degenerative disease for which there is no cure. If there is no cure, then that can sound like there's nothing they can do about their pain. And that's not true. Patients don't just have to grin and bear it. Today, there are a whole range of things patients can do-- especially exercise and muscle strengthening-- to minimize and relieve the pain. Medication can help. And in some instances, where the pain is severe and we can clearly identify the source, surgery may be an option.
In most cases, we think about surgery as an option when other steps to relieve back pain have not worked. We also consider surgery in those rarer cases in which a patient is at risk for paralysis or is experiencing loss of bladder or bowel control. Finally, surgery is the option for infections of the spine and for cancer. In the cases where we do need to consider surgery, we always consider first the least invasive and painful forms of surgery.
Of course, any surgery entails some risk, including the possibility of infection or extensive bleeding or a secondary injury from the surgery itself. Probably the greatest risk from spine surgery is that a patient will not achieve the relief from pain that he or she had hoped for. All these risks can be reduced by careful consideration of what is appropriate for a specific patient, by the preparation of the surgeon and by the skilled practice of the surgeon.