If you have had back pain for awhile, you may wonder if spine surgery is the only thing that may help you. In some cases, spine surgery is the only option. But there’s good news. Most back disorders can be helped with treatments that don’t involve spine surgery. These are referred to as conservative therapies or non-surgical treatments.
Trauma, aging, improper use of body mechanics and structural abnormalities can all damage your spine. These lead to back pain and other symptoms like pain in your legs or numbness and even weakness in your legs. Chronic back pain may often require a team of professional health care providers to diagnose and treat your condition. Before deciding to have spine surgery, consider obtaining the opinion of a few different spine specialists. The time you invest gathering information will help you make a decision that best supports your desired level of physical activity and lifestyle.
What is the last resort?
As with all non-emergent surgeries, a trial period of conservative treatment should be attempted before spine surgery is considered. Conservative treatment may include interventions like bracing, physical therapy and the use of pain medications, preferably using anti-inflammatory drugs. The length of the trial period of conservative therapy may vary, but from six weeks to six months is a typical time frame.
Your physician may recommend spine surgery if conservative methods like physical therapy and anti-inflammatory medications fail to relieve your symptoms. Surgery is usually only considered when the exact source of the problem can be identified, such as in the case of scoliosis, spinal stenosis or a herniated disc.
Minimally Invasive Surgery
Spine surgery is traditionally performed as “open surgery.” This means the operative site is opened with a long incision enabling the surgeon to view and have access to the spine and its various parts. But today’s technology allows more spinal conditions to be treated with techniques that are minimally invasive.
Since minimally invasive spine surgery (MISS) does not require the surgeon to make a long incision, the muscles and tissues surrounding the spine do not need to be manually manipulated. This leads to shorter operations, less pain following spine surgery and a quicker recovery.
Imaging During Surgery
During spine surgery procedures, surgeons can view the structures of the spine with much more clarity using computer-assisted image guidance techniques than is possible using traditional techniques. Surgical implants, such as screws and rods can be placed with higher accuracy than is typically possible with conventional surgical techniques.
Using computer-assisted image guidance, pre-operative images are merged with those taken while the patient is undergoing spine surgery. This creates real-time images of the operative site during the procedure. Prior to surgery, computed tomography (CT) images and real-time x-ray are most often used during the procedure as these give surgeons the ability to operate with high levels of safety and precision.
MISS procedures are not appropriate for every patient. The surgeon needs to be relatively certain that the same or even better results will be achieved if MISS techniques are used as would be possible with open spine surgery.
Surgical Approaches
The spine can be accessed by the surgeon using different approaches, whether a minimally invasive procedure or a tradition spine surgery is being performed. The various approaches include:
- Anterior approach: In this approach, the spine is accessed through the abdomen or the front side of the body,
- Posterior approach: In this approach, the surgeon gains access to the spine through the back,
- Lateral approach: In this approach, the surgeon accesses the spine through the side of the body.
Common Surgical Procedures
Many different conditions can lead to the need to have spine surgery. Different spinal procedures include:
- Discectomy or Micro-discectomy: This procedure is commonly performed to remove a herniated disc in order to relieve pressure from a spinal nerve. A Micro-discectomy is a minimally invasive spine surgery procedure.
- Laminectomy: This procedure relieves pressure on the spinal cord or nerves by making more room in the spinal canal. It is the removal of the lamina, which is the bony plate-like arch on the back of a vertebra.
- Laminotomy: This is similar to a laminectomy, but only a portion of the lamina is removed in this spine surgery.
- Decompression procedures take pressure off a spinal nerve. The laminotomy and laminectomy are both decompression spine surgery.
- Foraminotomy: This procedure is also decompressive. It removes bone or other tissues from the passage where the nerves exit the spinal column to provide more room.
- Disc replacement: In this spine surgery, a disc that has been injured is replaced with an artificial disc.
- Spinal fusion: This is a procedure in which two bones of the spinal column are joined together to form one long piece of bone. It may involve the use of instrumentation, for example, surgical screws and plates or rods. A bone graft is placed where an injured disc is removed and the fusion is accomplished using different approaches:
The following spine surgeries are all related to fusion of the lumbar spine to add stability to the spine of the lower part of the back. They eliminate movement between the vertebrae:
– ALIF: Anterior Lumbar Interbody Fusion,
– PLIF: Posterior Lumbar Interbody Fusion,
– TLIF: Transforaminal Lumbar Interbody Fusion. This procedure is done approaching the vertebrae through the foramen,
– LIF: Lateral Interbody Fusion. This is minimally invasive spine surgery.
Spinal Instrumentation
Spinal instrumentation involves the use of bone screws, plates, interbody devices, and rods as examples, but there are other types of surgical devices a surgeon may recommend using in specific types of disorders. The goal of instrumentation performed during spine surgery is to provide stability for the spine until fusion is complete.
- An interbody cage: This prosthetic device is left in the body following spinal decompression surgery to maintain the height of the space between two adjacent vertebrae.
- Interspinous process devices (ISP): These devices take the load off of the vertebral joints, maintain the height of the space between the vertebrae, and make the spine more stable. They are used in minimally invasive spinal surgeries because they do not require a large incision be made in order to insert them.
- Pedicle screws: These are used in spine surgery with instrumentation to provide stabilization for the vertebrae until they fuse together.
If spine surgery recovery is your only treatment choice, minimally invasive spine surgery has multiple benefits. Patients who are still young and active, as well as those who are elderly or have major problems with their spine many times reach a higher level of functioning after their symptoms are relieved.
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