Lower back and spinal disorders are among the leading problems that reduce quality of life for many people today. For patients who consult a physician with complaints such as severe lower back pain, numbness radiating down the leg, or difficulty walking, one of the greatest fears is the possibility of surgical intervention. Word-of-mouth claims like “having a plate put in your back,” “screw surgery,” or “if I have surgery my movement will be restricted” can be quite anxiety-provoking for patients.
So, is it mandatory to place screws in the spine for every back disorder? Or can back surgery be performed without screws?
The short answer: Yes, contrary to popular belief, many back surgeries can be performed entirely without screws and without the use of any hardware. Let’s take a closer look at the details of this important topic in spine surgery, the situations in which screwless surgery is preferred, and the advantages it offers to patients.
What Is Screwless Back Surgery (Non-Instrumented Surgery)?
Surgical procedures that do not use titanium or special-alloy implants such as screws, rods, or cages—referred to in medical terminology as “instrumentation”—are commonly known as screwless back surgery. The fundamental aim of these surgeries is to intervene only on the tissue causing the problem (for example, a ruptured disc herniation) without disturbing the natural structure, load-bearing column, and flexibility of the spinal anatomy.
Thanks to advancing medical technologies and microsurgical techniques, it is now possible to touch the muscles and bones around the spine to a minimal degree and clean only the regions compressing the nerves under high-magnification microscopes.
In Which Conditions Can Screwless Back Surgery Be Performed?
As long as the spine’s own mechanical structure and durability are intact, there is no need to add external support (screws). The conditions in which screwless surgery is most frequently and safely applied are as follows:
Herniated Disc (Lumbar Disc Herniation): “Microdiscectomy” operations, in which the herniated disc fragment that compresses the nerve root and causes leg pain is removed, are today the gold standard and are performed entirely without screws.
Mild to Moderate Spinal Canal Stenosis (Lumbar Spinal Stenosis): In cases where the canal through which the nerves pass narrows due to aging, if there is no significant slippage in the spine, simply widening the canal (decompression) is sufficient and can be performed without hardware.
Spinal Cysts and Small Benign Tumors: In removing such masses that press on the nerves, screwing is generally not required because the spinal structure is not disrupted.
In Which Conditions Is Placing Screws (Hardware) in the Spine Mandatory?
Of course, the clinical picture of every patient is not the same. In some disorders, the durability and load-bearing mechanical structure of the spine is already compromised, or will necessarily be compromised during surgery. In these cases, supporting the spine with titanium screws and rods (fusion surgery) is a medical necessity so that the patient’s spine does not collapse and they can move safely.
The main situations in which the use of screws is essential are:
Spondylolisthesis (Slipped Vertebra): When the vertebrae slip forward or backward over one another, the spine becomes “unstable” (mobile and unsafe). Screws are essential to stabilize the spine.
Serious Spinal Trauma and Fractures: Cases in which the integrity of the spine is severely compromised as a result of traffic accidents or falls from height.
Spinal Curvatures (Scoliosis and Kyphosis): Hardware systems are used to correct the curvature and fix the spine in the correct position.
Advanced Spinal Tumors and Infections: In cases where a large portion of the spinal bone is destroyed and must be removed, establishing a new load-bearing system is mandatory.
The Advantages of Screwless Back Surgery for the Patient
If your medical condition is suitable for a screwless operation (for example, herniated disc surgery via microsurgery), this method offers patients many significant advantages:
Very Small Incision and Minimal Tissue Damage: It is performed through a small incision of only 1.5–2 cm. The muscles are largely not cut, only separated.
Rapid Recovery and Getting on Your Feet: Patients can usually stand up and walk within a few hours after surgery and are often discharged the day after the operation.
Preservation of Natural Mobility: Because the spine is not fixed with screws, after the post-operative recovery period the patient experiences no restriction whatsoever in movements such as bending, standing up, turning, and playing sports.
Less Pain: Because there is less intervention on muscle and bone tissue, post-operative wound-site pain is minimal.
Low Risk of Infection and Bleeding: Thanks to the microsurgical techniques used, the operation time is short and bleeding is negligible.
Conclusion
The notion that “if I have back surgery they’ll definitely put a plate in me, and my movement will be restricted for the rest of my life” has largely lost its validity in today’s modern spine surgery. With the advancement of technology and surgical experience, screwless surgeries that preserve the natural flexibility of the spine are being applied extremely safely and successfully in suitable cases.
However, it must not be forgotten that in medicine there is no disease, only the patient. Which surgical method is the most correct, safest, and most lasting for you should be decided together with your physician, based on your complaints, your clinical examination, and detailed MRI/X-ray investigations.
Frequently Asked Questions (FAQ)
How long does screwless herniated disc surgery (microsurgery) take?
Screwless herniated disc operations performed with the microsurgical method, although they vary depending on the location and size of the herniation, are generally completed within 45 minutes to 1 hour.
When can you walk after screwless back surgery?
Patients can mostly stand up and walk without support within 3–4 hours after surgery, right after the effect of the anesthesia wears off.
Are operations with hardware more guaranteed than screwless operations?
No. The success of the surgery depends not on whether or not hardware is placed, but on applying the right surgical technique to the right patient. While placing screws is a mandatory and reliable method for a patient with a slipped vertebra, placing screws in a patient who only has a herniation and whose spine is intact is a completely unnecessary procedure.
Does the herniation recur after screwless herniated disc surgery?
After every herniated disc operation there is an average recurrence (relapse) risk of 3–5%. This risk is directly related not so much to whether the surgery is performed with or without screws, but to how carefully the patient attends to their post-operative lifestyle (weight control, not lifting heavy objects, exercise).
Prof. Dr. Mehmet Şenoğlu — Brain and Nerve Surgery Specialist, İzmir