Is your elderly mother beginning to walk with a wobble? Is she losing dexterity in her hands? Or feeling pain in her arms?
The symptoms may seem to point away from an ailment in the back. But many times, that’s exactly what it is, says Dr. Bob Svagr, spine surgeon at Tanner Clinic.
Elderly patients, particularly, may lose their stability and balance, as well as coordination. The result, says Dr. Svagr, is “they might think it’s something else.”
The symptoms may actually be occurring because of “long-standing compression of the spinal cord,” which disrupts the signals the arms and legs are sending to the brain. This feedback, he says, “doesn’t work well, so you’re not able to coordinate your motions.”
Nearly 90 percent of the patients who come to Dr. Svagr suffer from degeneration of the spine. Sometimes this degeneration is caused by age, sometimes by lack of movement, sometimes by a long-ago trauma. The other 10 percent of Dr. Svagr’s patients have received a spine injury.
Dr. Svagr’s practice sees a wide range of conditions, including fractures and carpal tunnel disorder. More commonly, however, Dr. Svagr sees patients with disc herniation, which he describes as a “focal narrowing and impingement of the nerves,” caused by an offending disc.
Spine as a specialty
Dr. Svagr’s specialty takes in all three areas of the spine: cervical (the small vertebrae in the neck); lumbar (the five vertebrae in the lower back between the rib cage and the pelvis); and thoracic (the vertebrae in the middle back).
He also performs both anterior and posterior approaches to the spine. An anterior approach — which basically means from the front (as in the side of the neck) — lends itself to many conditions requiring surgery, such as stenosis and disc herniation. This type of surgery has many advantages because it’s done microscopically, resulting in a smaller incision, says Dr. Svagr. Also, anterior surgery does not disturb the muscles that stabilize your neck; it lowers overall risk and reduces recovery time.
There are times, however, when a posterior approach from the back — usually the lumbar region, or lower back — is required. Posterior surgery usually involves the use of metal implants, such as screws.
The severity of spine surgery is measured in “levels” ⁚ a level-3 surgery, for instance, would be the fusion of three discs. Surgery of a level 4 or higher usually requires the posterior approach, said Dr. Svagr.
Technologies in spine surgery are advancing, particularly, he says, “with the development of surgeries with a smaller incision and less collateral damage, so you don’t expose the patient to such a long recovery.”
Despite these advances in scientific know-how and the reputation of Dr. Svagr as a skilled surgeon, the idea of spine surgery remains scary to many patients. In fact, the question Dr. Svagr is most often asked by his patients is concerning the safety of the surgery.
Cervical spine surgery produces good results. Dr. Svagr sees a 95 percent success rate. “Few surgeries will give you that good of an outcome,” he says.
Consider, however, that while the head weighs 10 to 15 pounds — a relatively small impact on recovery from cervical spine surgery — the torso weighs maybe 10 times more. As a result, surgery on the lower back has somewhat higher complication rate, said Dr. Svagr.
Although many factors apply, Dr. Svagr may recommend surgery when there is severe compression of the nerves, when patients are having difficulty walking or when they cannot control bowels or bladder.
When considering posterior surgery, he adds, “You have to decide whether you really need to do surgery. You need to be really careful about it.”