Surgical intervention becomes an option if two conditions are met: The intervention yields a better result than conservative treatment, and if the expected benefit outweighs the risks involved. In this case, the risk/benefit analysis tips in favour of surgery. There are several situations that call for surgical intervention.
Nerve decompression allows the pressure to be alleviated through surgery and improves the chances of healing in case of neurologic deficit. Emergency intervention may be decided on to avoid paralysis. Decompression may be paired with stabilisation.
Certain types of severe pain caused by spinal lesions are so severe that conservative treatment is not enough to alleviate them, for instance in case of severe sciatica.
Traumatic instability due to a fracture or sprain of the vertebral column may threaten nervous elements, and calls for the restabilisation of the vertebral column.
Certain tumours may also jeopardise vertebral column stability and compress nervous elements, over and above their destructive and invasive capacity. Tumour resection and the restoration of stability may be necessary.
Deformations of the vertebral column, stemming from scoliosis, kyphosis or a post-traumatic lesion may disrupt the balance of the vertebral column. This, in turn, causes pain and may even trigger nerve compression. When deformations reach a certain degree, their progress cannot be stopped without surgical intervention. Stabilisation and corrective intervention can be the solution to stopping such progression.
Pain generated by degenerative diseases stemming from a malfunctioning intervertebral disc or posterior articulations can be severe, with conservative treatment not enough to allow the patient to lead a normal life. Certain interventions, such as the insertion of a disc prosthesis or vertebral stabilisation with an arthrodesis, can alleviate such pain and restore the function of mobile structures. These procedures may alleviate pain stemming from nerve compression or the mobility of some levels.
The greater the discomfort of the patient and the longer conservative treatment has gone on without yielding any real result, the greater the chances of opting for surgical intervention. In general, the advantages, drawbacks, risks and expected development must be assessed and discussed in case of every surgical intervention, taking into account the age, general health, social and professional status and motivation of the patient.