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With so many different types of approaches to spinal surgery, how do doctors know which one is best for which patients?

In some surgeries, there isn't much of a choice as to how to do them. Some are straight forward. However, in several types, there are different ways to approach the problem, different tools to use, different techniques to use, as well as the actual preparation up to the time of surgery and the recovery period. When a surgeon makes a decision on surgery, he or she has to be sure that the patient is a good candidate for surgery. This means that the physical condition has to be taken into account. Someone who is in poor health and who would not do well in a long surgery would need the quickest procedure that is possible, yet effective. If a more involved surgery is an option and the patient is healthy enough to undergo something like that and the patient would benefit more from the more detailed surgery, then most often that is the one that would be done. That being said, there are other issues involved in deciding the surgery. The surgeon use the techniques they are most comfortable with, so they tend to lean towards those surgeries. Some surgeries need special equipment or personnel, so it depends on if this is available. The surgeon also has to weigh his or her desire against what is possible. For example, if the surgeon prefers to use a specific technique, but once the patient has been opened up sees that it won't be possible, he or she must be able to switch quickly to another procedure.

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