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What is Orthopaedic Spine Surgery

Wayne B. Bauerle, MD

Written By: Wayne B. Bauerle, MD

Orthopaedic spine surgery is a distinct subspecialty within the specialty of Orthopaedic surgery. It deals with the diagnosis and treatment, both surgical and non surgical, disorders of the cervical (neck), thoracic (mid-back) and lumbar (low-back) spine.

The most common problems that orthopaedic spine surgeons treat include arthritis of the spine, disc herniations in the neck or back, scoliosis and its associated symptoms, spine fractures (broken bones) infections and tumors that involve the spine. Though some patients with infections, fractures and tumors of the spine eventually require surgery to help alleviate their problem, most others are effectively treated without surgery.

Arthritis of the spine is very common. Approximately 50% of people with significant arthritis involving their hips and / or knees will have spinal arthritis. Generally affecting people over 50 years old, the symptoms associated with spinal arthritis are numerous and depend on which region of the spine is affected. Arthritic involvement of the facet joints as well as the resultant nerve root pressure that develops from arthritic bone spurs and thickening of the spinal ligaments and joint capsules – so called spinal stenosis. The symptoms include neck or back pain and/or stiffness, numbness, pain or weakness in the arms and legs which usually increase with activities such as walking or exercise, and sometimes even bowel and / or bladder dysfunction. Non-surgical treatment methods have all proven to be very effective when instituted in the appropriate fashion. Surgery is indicated for those individuals who have not obtained adequate relief through non surgical methods in a reasonable time frame and in those individuals whose symptoms have gotten progressively worse.

Disc herniations are frequently seen in people who often have very little if any arthritis of their spine. The symptoms that result from the herniated disc depend not only on which region of the spine herniation is located but whether or not a nerve root is being compressed or “pinched”. A disc herniation in the cervical spine (neck) may produce symptoms (pain, numbness or weakness) that start in the neck and radiate down the arm. Disc herniations in the lumbar spine (low back) may produce symptoms starting in the low back or buttocks which then radiates down the leg (sciatica). As with spinal arthritis non-surgical treatment can be very effective for treating the symptoms associated with disc herniation. Many patients do require surgery to relieve the symptoms due to disc herniations. When performed by well trained spine surgeons, surgical procedures have proved to be very effective.

Scoliosis; or curvature of the spine, may be seen in children or adults. There are several different types of scoliosis but the most frequent encountered are idiopathic and degenerative. Idiopathic scoliosis, for which there is no known cause, is curvature of the spine generally seen in childhood to late adolescence. The vast majority of these patients do not require surgery to correct their curvature but do require at least yearly spinal examination to monitor the curve for possible progression to a more severe deformity. Should progression beyond a certain degree of curvature develop, then bracing or even possibly surgery may be warranted. Degenerative scoliosis, which is curvature of the spine that develops from long-standing arthritis of the spine, is generally seen in the 50 years old and up group. Of the numerous symptoms that these patients may complain of, the most common are back pain, radiating pain or numbness in the legs and even weakness in the legs. Progressive worsening of the scoliotic curve may also occur, which in some individuals will require surgery to prevent severe complications.

Spinal fractures may be the result of trauma, osteoporosis, or tumor involvement of the spine. Treatment depends on the cause of the fracture and the degree of spinal instability present, and can range from close observation to bracing or surgery.

Although not all spinal problems require surgery in order for patients to return to their previous activity level, when spine surgery is needed, the orthopaedic spine surgeon is the best choice for your health.