Spine surgery
The smallest operation that solves the actual problem
Most spine problems are treated without surgery, and these pages say so where it is true. Where an operation is the right answer, the choice between them turns on your anatomy and your alignment rather than on a preference for one technique.
Our approach
How the decision to operate is made
What is known about how a procedure performs for your particular problem, rather than what tends to get done. Where the evidence is weak, that is said rather than glossed over.
Starting with non-operative care, and where surgery is needed, the approach that achieves it with the least disruption — provided it can achieve it. A smaller operation that does not solve the problem is not the lesser option.
The operation is one part of the result. Rehabilitation, conditioning and the treatment of contributing factors are planned with it rather than arranged afterwards.
When surgery enters the conversation
Problems that may lead to surgery
Each of these can usually be managed without an operation. Surgery enters the conversation when the compression, instability or deformity is causing symptoms that have not settled, or when function is being lost.
All conditionsProcedures
Procedures Dr. Long performs
Motion-preserving
3 procedures
A worn disc replaced with an implant that moves, keeping motion instead of fusing.
Hinging the bony arch open to make room for the cord, without a fusion.
A mobile implant instead of a fusion, for a narrow group of patients.
Minimally invasive
5 procedures
Removing the fragment pressing on the nerve. Reliable, and quick to recover from.
Working through a tube that parts muscle rather than cutting it.
Fusing a lumbar level through small incisions, sparing the muscle.
Through an endoscope and an incision under an inch, usually as a day case.
Fusion with endoscopic visualisation, through very small incisions.
Fusion, deformity and revision
6 procedures
Removing the disc from the front and fusing the level. Reliable for arm pain.
From the back of the neck, for multi-level compression, instability or deformity.
Removing a vertebral body where compression spans more than one disc space.
Open and anterior lumbar fusion, where alignment or extent demands more access.
Reached from the side, allowing a large implant and good correction of alignment.
Realigning the spine after failed surgery or for adult deformity. Planned in detail.
Other procedures
3 procedures
Stabilizing a collapsed vertebra with cement through a needle.
For SI joint pain confirmed by injection, after non-operative care has failed.
Making room for the cord in the mid-back, by the approach the pathology dictates.
The path
What to expect, from first appointment to recovery
A history, an examination, and your imaging reviewed by Dr. Long rather than read from the report alone. The examination is what connects a scan finding to your symptoms; a finding that does not match it is usually not the cause.
For most people this is the whole of the treatment. Physical therapy, activity modification, medication and targeted injections, given enough time to work before an operation is considered.
If surgery is recommended you should leave able to say what is wrong, what the operation is intended to fix, what it will not fix, and what happens if you do nothing. If any of those is unclear, ask again before you consent.
Medical optimization, a review of blood thinners and other medications, and planning for the recovery at home. Stopping smoking matters more than most people expect — it affects whether a fusion heals.
Most spine operations now involve a short hospital stay or none at all. Walking usually begins the same day or the next, with structured therapy afterwards and imaging at intervals where a fusion needs to be followed.
Common questions
Before you decide
Still unsure? The consultation is the place to ask.
Request a consultation
Not sure an operation is the right answer?
Neither is Dr. Long, until he has seen you. Bring your imaging and any previous operative notes.
One number for all six offices