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The vertebral column, or spine, can be broken down into three main sections:

- the cervical spine allows us to move our head around,

- the thoracic spine works with the ribs to play an important role in breathing, in particular,

- the lumbar spine is mainly used for the flexion and extension of the torso.

 

Vertebrae are separated from each other by intervertebral disks made of a fibrous ring surrounding a viscous nucleus. These disks act as shock-absorbers. The loads borne by these disks vary greatly according to the position and the effort made:

25 kg - 50 kg - 140 kg - 150 kg - 200 kg - 300 kg
 

The effects of stress are also concentrated on the spine.

 

Indications
Damage to vertebral disks is either degenerative or traumatic in origin. The decision to treat and the type of treatment depends primarily on the functional impairment. First-line treatment should always be medical, and based on physical therapy, rest, anti-inflammatory drugs and where necessary one to three spinal injections. Surgery must also be discussed following well-managed medical treatment which involved at least one spinal injection.
Surgical techniques
All surgical techniques are conducted with the same aim: to relieve nerve root compression. Several surgical techniques may be proposed:

- Discectomy of the herniated disk
The surgeon removes a small or significant part of the nucleus which has slipped out of the disk and cleans it. This technique, previously conducted through a 10-15 cm incision in the skin is now increasingly achieved through microsurgery, which minimizes the extent of the operation.

- Replacement of the intervertebral disk
This much more recent technique is not practiced in all countries. Some have not yet certified the disk prosthetics used. While this technique is set to become more widespread in lumbar spine surgery, the indication remains more limited for the cervical spine. Only one lumbar disk must be replaced.

- Arthrodesis (spinal fusion)
This technique involves fusing vertebrae together. It is a major operation which requires a hospital stay of 8 to 10 days and a lumbar corset must be worn for three months post-surgery.
The risks
All surgical operations have short- or long-term risks:

- Infection
While more limited in microdiscectomies, infections may be very serious following arthrodesis.

- Bleeding
In particular when inserting a disk prosthesis or in arthrodesis surgery.

- Continued pain known as "failed back surgery syndrome" (FBSS)
This complication may arise regardless of the technique used and may reflect an incorrect diagnosis of the origin of the pain. Scar tissue may also form around the nerve root, an inflammation related to the prosthetics inserted.

- Anesthesia
As for any type of surgery, there are risks inherent to anesthesia.
Post-operative effects
In many cases, surgery will immediately relieve pain.
However, the skin heals in around three weeks, while deeper tissue takes much longer to heal.

Regardless of the type of surgery, time off work is required, ranging from a few days in the event of microsurgery to at least two months following arthrodesis.

For the first three weeks, prefer sitting in an upright position to avoid lower back pain (bar stool, a height-adjustable chair, etc.).
- Avoid sitting on a sofa or armchair. Only use hard chairs which are straight-backed and not too low.
- You must adopt an upright sitting position for the first six weeks following arthrodesis.
- To sit down, start on the edge of the seat and slide your buttocks right to the back. Then, lean against the seat back, keeping your feet firmly on the floor. Try not to cross your legs.
- Do not remain seated for extended periods.
- Bend your knees to pick something up from the ground.
- Do not carry heavy objects in the weeks following surgery.
Our recommendations
- The decision to undergo surgery must be taken after deliberate consideration, when all recourse to non-surgical medical treatment has been exhausted.
- In some countries, it is not the practice to offer pre- or post-surgery physical therapy sessions. Such sessions are, however, necessary, provided they are performed by an experienced practitioner.
- Any pain that cannot be identified on a CAT scan or MRI scan which reveals a real conflict with a nerve root must result in the suspension of all types of surgery.
- If the decision to operate is taken, ask for a second opinion.
- Back surgery is not performed on teenagers, with the exception of rapidly progressing severe scoliosis.
How can MSH International support you?
If you have back pain for a prolonged period of time, do not hesitate to contact our medical team, which, in accordance with the treatment already offered, will refer you to a specialist near your place of residence.

As part of any back surgery precertification request, MSH INTERNATIONAL will organize a second opinion with reputed specialists. To do so, we will ask you to provide a report from your surgeon which outlines previous treatment and includes the CAT scan or MRI scan images.
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