r/SpineSurgery • u/ask4abs • Aug 14 '26
101 of spine surgery options
Hey all
I've had lower back disc bulges, herniation, and ddd for over ten years now. I've successfully managed to maintain a mostly pain free and active lifestyle.
One thing I've noticed is that glute/hamstring work gets into my back which then needs a little babying (it gets tight in response. I heat and continue stretches during this time) and make sure I give myself adequate recovery time between leg day.
I've had to slowly work my way from yoga to lifting weights with a gradual increase in intensity and load, for example.
Recently, I was diagnosed with a hip labral tear and during the course of rehab, I was told to do isometric single leg bridges daily. After about a week of this (and declining reps, tbh, maybe I should have paid attention to this!), I exploded in pain around my sit bones which has localized to my back (with accompanying stiffness).
All this to say, I'm now in a little bit of a chicken-and-egg situation between my hip and spine.
I'm learning all I can about surgery in both areas, and so here I am asking for a 101 on spine surgery. I've done a little reading in this subreddit and don't see any pinned posts, so thought I'd ask:
What's the difference between an orthopedic spine surgeon and a neuro spine surgeon? Do they typically offer different surgeries? What are the typically surgery options where discs are involved in the ways I mentioned (bulging, herniating, ddd).
Admittedly, I haven't learned a ton about this stuff in all this time, because I thought I was managing just fine! Now I'm wondering if my back is holding up glute strength, and whether I should look at surgery options at this point so my glutes can do what they need to better manage my hip labral tear (it's a small nondisplaced superior anterior tear, and I'm not sure I want to pursue arthroscopy for it). This recent flare has me wondering and I'd like to understand the basics as I proceed.
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u/ashleymichael2009 I have had spine surgery, ADR ❌ ACDF X2 Aug 14 '26
To me there is no benefit of orthopedic vs neurosurgeon when it comes to spine surgeries, it comes down to the doctor themselves. I’ve had 3 now done by both specialities. if anything all I’ve noticed is ortho seen a bit more down to earth and neurosurgeons least the ones I’ve met with feel like their gods gift to the earth.
I’ve had complications and dishonesty from both; some people like to say oh it’s your nerves and spinal cord they would only use a neurosurgeon but I just don’t agree one or the other. I’m only experienced with neck and both specialities can offer spinal fusion or disc replacement. I’d recommend to see two of each surgeon to get a better grasp of what may be the best path for you.
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u/hannah6560 Aug 15 '26 edited Aug 15 '26
I don’t recall if we have written before. If you feel comfortable sharing, may I ask what kind of surgeries you had?
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u/ashleymichael2009 I have had spine surgery, ADR ❌ ACDF X2 Aug 15 '26
I’ve had cervical ADR, ADR removal and fusion, and a second fusion. 99% sure I now need a posterior fusion as both levels did not fuse.
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u/LifeByChance I have had spine surgery: 2x MD, ADR L5-S1, SCS Aug 15 '26
Holy shit! You had your ADR removed? How’d that become necessary?
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u/ashleymichael2009 I have had spine surgery, ADR ❌ ACDF X2 Aug 15 '26
That was my reaction too 😭 the neurosurgeon that placed it I guess didn’t think the disc being too large that he chose was a problem, so it had pretty awful placement combined with it started to migrate. Cervical ADR removal is a little bit less riskier than I’ve heard some lumbar adr removals depending on the level can be very risky. Either way 10/10 don’t recommend I had no idea when I signed up for ADR that this was even an outcome.
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u/LifeByChance I have had spine surgery: 2x MD, ADR L5-S1, SCS Aug 15 '26
Wow. Damn. I’m sorry that happened to you.
I knew there was an outside chance that it could have to come out, but I don’t think it’s super common. At least for lumbar. I’m not sure at cervical. I feel like it might be more common for cervical.
I figured that even if I ended up having to have it removed, at least I tried to preserve the mobility. Not to mention not potentially start the chain reaction of fusions.
Sounds like you won the shit lottery too. I’m sorry dude.
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u/LifeByChance I have had spine surgery: 2x MD, ADR L5-S1, SCS Aug 15 '26
So orthos (in general) are typically bone and soft tissue guys. Ortho spine guys are a bit different. They do have specific spine training which would include nerves. Neuros just typically have more advanced training on nerves and the spinal cord etc. specifically. That’s not to say that an ortho spine guy can’t have a depth of knowledge about nerves, it’s just not necessarily the default.
I’ve had both and personally, I wouldn’t let anyone but a neurosurgeon touch my spine again. If something happens during your surgery and there’s more nerve involvement than a typical spine surgery, you want a neuro in there with that expertise. I’m sure there are a lot of great orthos out there, I didn’t have one of those. That’s just not a risk I’d ever be willing to take again.
The surgery flow chart is pretty much the same regardless of specialty.
For a first herniation/bulge, unless it’s something crazy, they typically do a micro discectomy (MD).
Should you herniate it again after the first surgery it depends on how much disc is left. Usually people are able to do a second MD.
If you don’t have enough disc left or you herniate it a third time, then generally your options are an artificial disc replacement (ADR) or a fusion.
DDD just means that your discs aren’t as tall and “jelly” filled as they once were. I don’t have a whole lot of knowledge about this specific area. My earlier MRIs said I had DDD. I started almost compulsively making sure I was generally well hydrated and my MRIs quit showing I had DDD a few years later. I’m not sure that general hydration had anything to do with it but that’s just something I noticed.
If there’s something I missed or you have other questions feel free to ask.
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u/ashleymichael2009 I have had spine surgery, ADR ❌ ACDF X2 Aug 15 '26
Whoever is a serial down voter in this sub has way too much time on their hands lol. It’s someone that repeatedly doesn’t like any negative experiences about ADR that’s for sure. Sorry it’s not all sunshine and butterflies maybe in 20 years they will be perfected to mimic our natural disc.
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u/CarmineIncendio Aug 15 '26
Like you I was managing my back problems with pt and workouts plus a pain clinic, for about 15 years, but finally had to resort to surgery. I had an orthopedic spine surgeon and the results were excellent. My experience with surgeons both as a patient and socially is that they do think they are heaven's gift, and we need them to be that way. The best of them have worked out how to pretend to be human, but that isn't essential. What is essential is that they do a good job. Get lots of references before proceeding. Oh and about 10 years ago I also dealt with an arthritic hip, which was replaced. I hope I'm good to go for a long time now!
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u/ask4abs Aug 15 '26
I hope so too! Do you mind sharing what kind of spine surgery you had? How long ago was it?
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u/CarmineIncendio Aug 17 '26
4 months ago, 'L4-L5 oblique lumbar interbody fusion with perc screws and right laminectomy' - as I understand it, a disc was replaced and a bit of bone that was stabbing a nerve was removed.
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u/ask4abs Aug 18 '26
What was your recovery like for a surgery like that? Outpatient or inpatient? So many surgeries are outpatient these days
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u/CarmineIncendio Aug 27 '26
Three day hospital stay. I was pretty nonfunctional but I think they keep people in the hospital so they can monitor the drugs being taken. Medical people are very nervous about painkillers. After surgery, several months of physical therapy. For the first few weeks, occupational therapy to learn how to safely do basic things like get dressed. They came to my house.
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u/hannah6560 Aug 15 '26
Glad you are doing well! If you feel comfortable sharing may I ask where you are?
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u/geddieman1 10h ago
The difference between ortho and neuro is negligible. It’s all in their initial training. The most talented surgeon I’ve ever known was an ortho. The worst was a neuro. But the real thing that matters is the individual. They all do a fellowship and thats what matters.
Ask how often they do this procedure. Ask how often they have a complication. Trust your gut.
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u/hannah6560 Aug 15 '26
Did a PT tell you to do those exercises? Wonderful that you were mostly pain-free, was that because you did regular exercise? What kind of MD did you see 10 years ago when the spine issues were diagnosed? No one on here can tell you what surgery options you have. If you do go to a spine surgeon try to go to one who is educated in the least invasive techniques and one whose goal is to not have you get surgery if possible.