Back surgery may be indicated in your particular condition depending on the particular problem that you have. While there are usually non-surgical options available, back surgery may be the treatment of choice for certain conditions, especially if conservative treatments have failed. For example if your pain is unrelenting, continues to reoccur, interferes with your social activities and/or your work activities or interferes with your sleep you may be a candidate for surgery.
For the most part there are a few specific sub-sections of back pain sufferers that may benefit from surgery. One group suffers from chronic unrelenting back pain and sciatica and typically has a condition associated with a disc, spinal stenosis, a fracture or a spondylolisthesis. The other group has advanced spinal arthritis and severe back pain but not sciatica. There is a severe narrowing of disc space and facet hypertrophy or overgrowth. In either case the probable outcomes may or may not be good, however research does show that surgery is typically more successful for leg pain then general back pain.
Below is a list of the common conditions that may respond to spinal surgery.
A herniated disc is a condition where the central portion of the disc (the nucleus) migrates outward through the out disc fibers (the annulus). The material can then compress or irritate the nerve and cause back pain and sciatica.
Spinal Stenosis is a condition where the spinal canal (the central portion that runs the length of the spine and houses the spinal cord and nerves) narrows. This is usually as a consequence of arthritic changes and a thickening of the ligaments and facet joints. This can cause compression on the spinal cord in the cervical and thoracic areas and a compression on the spinal nerves in the lumbar area, resulting in back pain and pain in the legs.
This condition can be either congenital or acquired. If someone is born with a spondylolisthesis it usually stems from a non-union of the posterior elements of the vertebrae. If it is acquired it is usually the result of severe degeneration and a slippage or a trauma causing a fracture. In both cases the vertebrae slips forward and can cause a pinching and narrowing of the areas where the nerves exit.
A spinal fracture is a fracture in the vertebrae causing a collapse of the spine. This can be secondary to osteoporosis or from trauma.
Degenerative Disc Disease
This condition is a result of the wearing out of the disc and a breakdown of the disc material leading to narrowing of the disc space and arthritic changes taking places.
Now that we understand some of the conditions that may warrant surgery, let’s take a look at some of the most common surgical procedures.
Herniated Disc Surgeries
In this procedure the posterior elements of the vertebrae are removed and the herniated disc material is taken out to take the pressure of the structures that are involved.
This procedure is similar to the laminectomy/discectomy but doesn’t involve the large incision or the removal of the posterior elements to get to the disc. A smaller incision is made and the surgeon utilizes a microscope to locate the disc and perform the surgery. The thought is that by utilizing a smaller incision less tissue damage occurs and a smaller scar is left instead of an large incision.
Laser Spine Surgery
One of the newest and most popular surgeries is laser spine surgery. This technique involves the insertion of needle into the disc and through that needle laser energy is delivered to destroy the disc tissue and relieve the pressure on the nerves. This procedure has become more popular because of the shortened recovery time.
Spinal Stenosis Surgeries
The primary issue surrounding spinal stenosis is that the spinal canal narrows due to excessive bone growth and ligament thickening. This procedure removes the posterior elements in hopes that more room will be created for the spinal structures affected.
Spinal Fusion-When a person has a slippage of one vertebra on another and a compromise of neural tissues a spinal fusion is often recommended. Non-surgical management can take a patient so far, but once pain and neurological deficits become progressive or unrelenting a fusion may be necessary. A fusion requires the surgical connection of two or more vertebra together. Usually pedicle screws, rods and bone graft either from a cadaver or the patient are utilized. The goal is to mechanically stabilize the area so that no further slippage can occur. Some advances have been made and certain proteins are now used to stimulate both growth at the surgical site, which has decreased the need for bone grafts.
Vertebral Fracture Surgery
This surgery is utilized primarily after a person has suffered a spinal fracture from osteoporosis. A cement like substance is injected into the vertebra to relieve pain and stabilize the fracture.
This procedure is done in 2 distinct steps. In the first step the surgeon inserts a balloon into the vertebra in an effort to restore height and shape to the vertebra. The second step involves the injection of the cement like substance to stabilize the fracture.
Disc Pain Surgeries
Intradiscal Electrothermal Therapy
(IDET) Is a procedure where a coil is inserted into the disc and heated. The premise is that the heat will reconfigure the collagen fibers and strengthen them. Many patients have a long recovery after this procedure and recent studies are not favorable.
Much like the spondylolisthesis surgery the fusion is performed to stabilize the spine. In this case it is performed when a disc is severely degenerative and the recommendation is to remove the disc and fuse the spine. The goal is to remove the painful disc and create a more stable environment.
Disc Replacement Surgery
This procedure is an alternative to a standard discectomy. Here an artificial disc is placed in the space where the damaged disc used to be. The goal here is to restore disc height and overall spinal movement.
As with any surgery spinal surgery has extreme risks. If you are considering surgery please make sure to exhaust all of your non-surgical resources and have a long discussion with your doctor so that you are fully informed