How does spinal or spinal disc degeneration occur?

Disc degeneration begins around the age of 25 and worsens with age. In addition, factors including excessive weight, physically demanding work involving impacts, bending over, lifting heavy objects, and smoking significantly accelerate the disease onset. Genetics also play a significant role in this condition.

Is it true that people who are generally healthy can find out they have degenerated bones or spinal discs?

Degeneration of the bones and spinal discs is a natural human condition. Studies involving healthy athletes with no symptoms, who underwent Magnetic Resonance Imaging (MRI), found that 23% had spinal disc degeneration, and the number increases to 90% in individuals over 60 years old. Therefore, one should not worry upon diagnosis of spinal degeneration.

* Ref: Lowrence Js. Disc degeneration: its frequency in Relationship to symptoms. Annals Rheum Dis 1969;28;121 – 37.

What other diseases related to the spine require surgery besides spinal degeneration?

Other conditions that may require surgery include spinal tumors, spinal infections, compression fractures from osteoporosis, and scoliosis or deformity of the spine.

How can you know if you need spinal surgery?

Indications that suggest the need for surgery include one or more of the following:

• The patient opts for surgery due to unbearable pain.
• Signs of nerve damage, such as progressively weakening muscles.
• Loss of bowel or bladder control.
• The patient has received comprehensive treatment for 6 – 8 weeks without improvement or inability to return to normal daily activities.

Can surgery be avoided? Are there any non-surgical methods?

Doctors often recommend other treatments such as physical therapy and intervention spine treatment, especially in cases of spinal degeneration or non-severe spinal conditions, to alleviate pain without surgery. However, the effectiveness of each treatment varies. When the disease progresses to a certain point, surgery becomes a highly effective last-resort option that is internationally recognized.

Is minimally invasive surgery possible?

There are many different techniques for spinal surgery, and minimally invasive surgery is just one option. Spine surgeons at the Bangkok Spine Institute prefer the smallest possible incisions that yield successful outcomes and the least damage, enabling patients to return to their daily activities as quickly as possible.

Is endoscopic surgery better than non-endoscopic surgery?

Endoscopic surgery is just one method for magnified visualization during surgery, allowing surgeons to operate with a clearer view. However, not all surgery types require an endoscope, e.g., surgery for correcting scoliosis. Various equipment, including endoscopes, microscopes, or even magnifying glasses, can enhance the surgeon’s visibility. Nonetheless, treatment success depends not only on the use of such devices but also on adequately addressing the pathology.

How long does the surgery take?

Surgery generally takes 1 – 2 hours. However, surgeries involving metal implants or multiple levels may take approximately 3 – 4 hours and perhaps longer for patients with complex conditions.

Can elderly people undergo surgery?

Elderly patients can undergo surgery, but a thorough examination by a physician is necessary to assess overall health and the functioning of vital organs such as the heart, kidneys, and lungs. Surgery is permissible if they are deemed healthy enough.

How many days must you stay in the hospital after surgery?

Typically, patients may need to stay in the hospital for 1 – 2 days for minor surgeries, while multiple-level surgeries may require a 3 – 5 day stay. However, patients with less physical strength or those who are elderly, have other chronic conditions, are recovering slowly, or need continued physical therapy may need to stay in the hospital for 7 – 10 days or longer.

Will surgery completely cure the condition?

Most patients who undergo spinal surgery at the Bangkok Spine Institute are satisfied with the outcome. However, the extent of recovery depends on:

• The nature and severity of the disease: Some spine diseases can be completely healed, such as nerve compression by the spine, whereas some conditions may only be improved, such as spinal tumors.
• Duration of the disease before treatment: If the nerves have been compressed or damaged for a long time, the outcomes might not be as good as in patients who have had the condition for a shorter period.
• The surgical technique used: Choosing the appropriate surgical technique can benefit the patient greatly by minimizing risks.
• Physician’s expertise: The surgeon must be genuinely skilled and experienced to make appropriate decisions.
• Post-operative self-care: Patient cooperation in physical therapy, exercise, avoiding exacerbating factors, avoiding movements that cause improper posture, and lifting heavy objects, maintaining an appropriate weight, etc.

How can surgery be successful?

Incidents of patients not recovering as expected occur in hospitals worldwide, which can be minimized by:

• Choosing surgery by a genuinely skilled and specialized spine surgeon.
• Choosing the correct surgical technique.
• Having a fully equipped treatment facility with a closely monitored medical team.

Is there significant blood loss during surgery?

Surgery generally involves minimal blood loss, and blood transfusions are not usually necessary. However, in cases involving significant bone removal or multiple-level surgeries, blood loss may increase. Patients will receive close monitoring and may receive fluid or blood transfusions if needed.

How long will the surgical wound be?

The length of the surgical wound depends on the number of levels operated on and the surgical technique used, as well as the thickness of the subcutaneous fat layer. Generally, a single-level surgery will result in a wound measuring about 2 – 7 cm. A two-level surgery may produce a wound about 10 – 12 cm long. The incision could be smaller if minimally invasive surgery is possible for that patient.

Is the surgical wound very painful?

The nature of wound pain typically involves pain during the first 1 – 3 days after surgery. The intensity of pain varies depending on the type of surgery and the size of the incision. However, all patients will receive pain relief medication both during and after surgery to reduce pain as much as possible, closely monitored by an anesthesiologist. Additionally, there is a system for administering pain relief medication intravenously that is controlled by the patient (PCA, Patient Controlled Analgesia), which is very effective in managing post-operative pain and is an international standard.

What are the side effects of spinal surgery?

As with any major surgery, several systems may experience side effects, including:

• Side effects from anesthesia: Possible sore throat, hoarseness, confusion, headache.
• Circulatory system side effects: Such as unstable blood pressure, risk of blood clots.
• Side effects from medications used during treatment: Such as drug allergies.
• Respiratory system side effects: Such as mucus accumulation, infections, or pulmonary edema.
• Surgical site infections.
• Significant blood loss or hematoma formation.
• Side effects from metal or artificial implants: Movement or breakage.
• Tissue and nerve side effects: Leading to numbness or muscle weakness.
• Failed spinal fusion: Leading to persistent pain and possibly requiring repeat surgery.

However, choosing surgery by a skilled medical team in a facility equipped with modern medical devices, with close monitoring and standards adherence, combined with patient cooperation, minimizes the chance of these issues occurring. Healthcare, and even daily life activities, carry risks. However, the risk of complications in spinal surgery has significantly decreased over time due to the collaboration of experts in various specialties caring for patients, along with practices to minimize side effects as much as possible. Currently, the risk of complications in spinal surgery is considerably lower than in the past and generally acceptable.

What types of metals are used to support the spine, how do they differ, and what are their pros and cons?

Some patients may be advised to use metal to support the spine. If classified by the country of manufacture, it can be divided into two types: metals produced abroad and those produced domestically. If classified by the materials used for production, it can be divided into stainless steel and titanium metals, which are recognized for titanium having superior properties over stainless steel. Currently, titanium is often preferred because it is stronger and allows for MRI examinations. The choice of screws for securing the spine will be explained to patients for joint decision-making. The screws serve to stabilize the spine while waiting for the body to permanently fuse the joints. Normally, fusion without metal has about a 60-70% success rate, but with securing materials, the success rate increases to 90-100%.

What are the possible complications of inserting metal to support the spine?

• Metal is misplaced: Causing pressure on nearby nerves and tissues.
• Metal shifts or loosens: Detaching from its position after some time post-surgery.
• Metal breakage: After long-term use and unsuccessful joint fusion.

However, the use of the O-ARM computerized x-ray machine to create three-dimensional images during surgery, combined with the Stealth Navigation System, can help avoid the incident of misplaced metal and reduce neural complications.

Will long-term metal insertion cause problems? How long does the metal last? Do they need to be removed, and will they rust if not removed?

The metals inserted into the body have been tested and proven to be safe for lifelong presence without causing harm.

What happens when metal screws are inserted into the body during cold weather?

There’s a common belief that having metal in the body can feel cold, especially during cold weather. However, studies have shown that having metal inside the body does not affect body temperature.

Preparing mentally before surgery

• You must be mentally prepared, understanding the disease you have, knowing the treatment options, including the necessity of undergoing surgery.
• Be fully aware of the surgical procedure, what to expect before and after surgery. Cooperate when asked by a doctor or nurse to do anything.
• You may be asked your name repeatedly by multiple staff members as a standard identification procedure before undergoing any operation, such as blood draws, blood or fluid transfusions, or marking before surgery.
• Trust the medical team and nurses to perform their duties to the best of their abilities. Every staff member is trained to care for patients as if they were family.
• You may be encouraged to stand or walk even if you still have significant pain. This prevents and reduces the risk of other complications that may arise.
• Most patients are satisfied with the surgery’s outcome. In cases of complex diseases, patients who have undergone previous surgeries for correction, chronic conditions, significant pathology, or permanent nerve pathology, surgery may not solve all issues.

How to prepare the body before surgery

• Get enough sleep before surgery, avoid smoking, or drinking alcohol before coming to the hospital.
• Have a relative who can take care of you and coordinate with the staff.
• Bring your current medications every time, and if you have any drug allergies, inform the staff or doctor.
• Avoid bringing valuables to the hospital. You will have to remove all jewelry before surgery.
• Wear loose clothing and easy-to-remove shoes.
• Clean your body, shower, wash your hair, brush teeth, trim nails, remove nail polish.
• Avoid wearing makeup, hair clips, or contact lenses. You must also leave dentures with relatives. If you have loose teeth, notify the doctor.

How many hours before surgery should food and water be withheld?

6 – 8 hours.

Medication needed to be continued until the morning of surgery includes

• High blood pressure medication.
• Heart vessel dilation medication.
• Bronchial dilation medication, etc.

Medication that must be discontinued before surgery includes

• Diabetes medication should be discontinued on the morning of surgery.
• All medications that affect blood clotting, such as aspirin, Plavix, Coumadin, Heparin, etc., including herbal medicines, ginkgo biloba, and ginseng, must be stopped at least 7 days before surgery.

Why meet a rehabilitation medicine specialist and a physical therapist before surgery?

• Pre-surgery preparation, especially correctly training to expand the lungs, helps prevent post-surgery complications.
• Appropriate posture and daily activities for spinal surgery patients in all movements: standing, walking, sitting, lying down, and working.
• Wearing a suitable spinal support device for each individual or learning to use different walking aids correctly and taking care of those devices.

To reduce

• Pain caused by spinal, muscle, and nerve conditions through techniques, methods, and physical therapy tools.

To enhance

• Balance in strength, endurance, and flexibility of muscles to perform daily activities efficiently, correctly, and continuously.

What you should know after completing surgery

• The patient will wake up from surgery with various tubes attached, such as for saline infusion, urinary catheter, surgical site blood drainage, and devices recording vital signs from different organs.
• The patient will be neurologically assessed immediately after waking up, such as being asked to move the ankle or the big toe.
• Patients not required to stay in the ICU post-surgery will be moved to a recovery room to monitor symptoms for about 1 – 2 hours.
• Patients needing close symptom observation, like the elderly, will be advised to stay in the Intensive Care Unit (ICU) for one day before moving to a regular patient room.
• After surgery, some techniques may require further withholding of food and water for a while, but general patients will be allowed to consume soft food within 24 hours.
• If there is post-operative pain, notify the nurse to receive pain relief medication. Pain significantly decreases after 2 – 3 days.
• Patients who have had anesthesia and intubation might experience a sore throat, dry mouth, or post-operative nausea and vomiting.
• Patients who have had spinal block or nerve block may not immediately lose the effects of the anesthesia. Be cautious of impacts or exposure to very hot or cold objects in the area still numb.
• If unable to urinate post-surgery, notify the doctor or nurse, which may require temporary catheterization.

Can you start walking immediately the day after surgery?

Typically, patients can stand and start training to walk on day 2 or 3, along with removal of the urinary catheter and blood drainage. However, the doctor will consider what is suitable for each patient.

When can the wound be exposed to water?

The wound can be exposed to water once it has thoroughly healed, usually taking about 10 – 14 days. The doctor will re-evaluate the wound and inform you again before discharge.