Spinal surgery abroad

Spinal surgery abroad covers a small set of planned operations on the back and neck: removing a prolapsed disc that is pressing on a nerve (microdiscectomy), taking pressure off the spinal canal in spinal stenosis (laminectomy), replacing or fusing a worn disc in the neck (cervical disc disease), and correcting scoliosis. People travel for the same two reasons as in the rest of orthopaedics, waiting time and price, and for a third that is particular to the spine: a surgeon at home has said no, or has offered a fusion, and the person is looking for someone who will offer something else.

That third reason is where the honest page has to start. Most back pain does not need an operation and does not improve with one; the operations that work are the ones done for a specific structural problem, seen on imaging, that matches the symptoms and has not settled with time and rehabilitation. A surgeon abroad who offers surgery for pain that a surgeon at home would not operate on is not necessarily more skilled; often they are simply less constrained. This page explains which spinal operations travel well and which do not, where people go, how the trip works, the risks that belong to the trip and what a quote needs to contain.

Germany has the densest concentration of dedicated spine centres and is where complex and revision cases go, at prices close to home prices for most Europeans and with European Union reimbursement possible with prior approval. Turkey offers spine units inside large private hospitals with neurosurgeons and orthopaedic spine surgeons, short flights and low prices, with follow-up at a distance. Poland and Romania are European Union options closer to home for many; Cyprus a small English-speaking one. Mexico serves the United States, where the price of a fusion at home drives much of the travel.

• Turkey. Spinal surgery in Turkey: spine units in private hospital groups in Istanbul and Ankara, both neurosurgical and orthopaedic, with intraoperative imaging and navigation in the larger centres; low prices, follow-up by message and by your own physiotherapist.
• Germany. Spinal surgery in Germany: specialist spine centres and university hospitals, chosen for complex, revision and deformity surgery; high prices, European Union reimbursement rules.
• Poland. Spinal surgery in Poland: inside the European Union, private neurosurgical and spine units used to foreign patients, at prices between Germany and Turkey.
• Romania. Spinal surgery in Romania: inside the European Union with lower prices and a smaller private sector; check the unit's volume of your operation.
• Cyprus. Spinal surgery in Cyprus: a small English-speaking private sector where a few surgeons do most of the spinal operations.
• Mexico. Spinal surgery in Mexico: private hospitals for patients from the United States and Canada, where the home price of a fusion is the reason to travel and distance still allows a return visit.

• Surgery for the wrong reason. Operating on imaging findings that do not explain the pain leaves the pain in place; the commonest bad outcome in spine surgery, and the one a looser threshold abroad makes more likely.
• Nerve injury and spinal fluid leak. Rare, serious, and properly managed by the operating team, which is a flight away.
• Infection and wound problems. Deep infection around implants is a spine emergency that appears after you get home.
• Failed fusion and adjacent segment disease. A fusion that does not knit, or wear at the level above, declares itself months later; revision far from the surgeon is expensive and often declined by others.
• Clots and flying. Long operations and long flights; prevention and timing belong in the plan.
• Rehabilitation that does not happen. Without a physiotherapist and a protocol at home, function does not return.
• Home services and insurance. Public systems treat emergencies but may decline to revise or follow surgery done abroad; travel insurance excludes planned treatment.

• A spine unit, not a general department. Neurosurgeons or orthopaedic spine surgeons who do spinal operations weekly, with intraoperative imaging and, for deformity, neuromonitoring.
• A threshold for surgery. Ask what proportion of the patients who write to them are told not to have surgery; a unit that operates on everyone is telling you something.
• Implant documentation. Manufacturer and model of cages, screws and disc replacements, in your file before you fly.
• Rehabilitation and the stay. Physiotherapy from the first day, a written protocol for home, and a minimum stay set by the surgeon.
• Complication and revision cover. What is included, for how long, and who pays the return trip, in writing.
• Records in both directions. Imaging in; operation note, implant details and X-ray schedule out.

• National Institute for Health and Care Excellence, guidance on low back pain and sciatica: assessment and management, including when surgery is considered.
• British Association of Spine Surgeons, patient information on spinal operations and on surgery abroad.
• North American Spine Society, patient guides on disc herniation, spinal stenosis, cervical disc disease and spinal fusion.
• Scoliosis Research Society, patient information on adolescent and adult deformity surgery.
• NHS England, guidance on going abroad for planned medical treatment and the treatment of complications.