The Geriatric Spine Syndrome: Whither Surgery

By | June 16, 2011

Some neurosurgical procedures can be done through a one inch incision in a day surgery setting. Ask your doctor if a procedure like this is right for you.

Having established that neurosurgery has a place in the care of the geriatric spine, the real issues are scope and focus. I practice this comes down to two very simple questions. Is the spine unstable? And is there a short, simple out patient procedure, which will dramatically improve the patient’s condition? If the answer to either of these questions is yes, then surgery may very well be indicated.

 

Let’s examine the first question in a bit more detail. When we speak of stability, it is not simply in reference to pain, but rather with respect to function. If the spine is so unstable that paraplegia or a cauda equina syndrome is eminently likely, surgery should be undertaken expectantly rather than in response to an existing catastrophe.

 

The second question is more of a judgment call, but procedures such as Micro-Lumbar Discectomies, single level foramenotomies and X-Stop spacers can be done in less than an hour in an outpatient or day surgery setting and have high rates of success. Even if these procedures do not relieve all of the pain, and it is not likely that the will, they often turn an extremely difficult pain problem into a fairly simple one.

 

These are not simple decisions and can only be made after consultation with an experienced spine surgeon and with the help of a pain physician who knows you, your back and your overall condition. While we at Schlesinger Pain Centers do not practice neurosurgery, I think that managing the neurosurgical consultative process is one of the most important things that we do.

 


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