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While studies show that more than half of back surgeries are unnecessary, there are times when surgery is the answer.
Common Back Surgeries
Lumbar Discectomy | Cervical Discectomy | Fusion | Laminectomy | Rhizotomy | Scoliosis Surgery | Dorsal Column Stimulation
Discectomy is the removal of the herniated portion of a
disc to relieve the pressure on nearby nerves as they exit the the spinal
canal. Contrary to myth, the disc does not slip out of position like
a watermelon seed. Instead, the disc is like a jelly donut, acting as
the functional shock absorber between two bony vertebrae.
An injury, or damage from a lifting incident may cause the jelly center
to break through the wall of the disc. When the disc herniates, the jelly
center can press on nearby nerves causing back or leg pain when the herniation
is in the low back, or arm pain if the disc is in the neck area.
In a lumbar discectomy, the surgeon typically only removes the portion
of the disc that is causing a problem, not the entire disc. If you have
a herniated disc, keep in mind that a disc has a purpose. When you remove
a disc, you may cause instability in the joint and a surgeon may have
to recommend a fusion to re-stabilize the area.
The surgeon can remove the damaged piece of disc through a traditional
incision in the back or neck, or with a surgical probe as in percutaneous
discectomy.
Depending upon the nature of your disc problem, the surgeon will recommend
the most appropriate type of surgery for you.
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Cervical is the medical term for "neck." Just as in lumbar
discectomy, the surgeon removes a piece of damaged disc tissue in the
neck area to relieve pressure on the spinal cord or nerve roots. In some
cases, by removing a piece of the shock absorbing disc that separates
the two vertebrae, the structures may become less stable. Consequently,
when the disc is removed, a surgeon may recommend "fusing" the vertebrae
to prevent instability. This fusion surgery may require a second incision
in the front of the neck to gain access to the disc area. Cervical discectomy
is best left to surgeons who specialize in spine.
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The surgeon may use bone from the patient's hip or bone
from a bone bank to stabilize two vertebrae after a discectomy. During
a fusion surgery, the disc is removed and the surgeon inserts a small
wedge of bone in between the two vertebrae to restore the disc space.
Over time the two vertebrae "fuse"
together into a solid structure. While this limits movement and flexibility,
it can also help to ease pain.
The consideration as to fuse or not to fuse can be based on the surgeon's
assessment of how much instability will occur through the discectomy,
and how much disc space to restore. Not doing a fusion, may require the
surgeon to perform a second, follow up surgery. The decision can be complex.
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Removal of part or all of the bone covering the spinal canal in order to free nerve roots, remove a tumor, bone spur or to perform certain types of fusion procedures.
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Removing the lamina (laminectomy) is much like removing
the cover on a fuse box to get access to the wiring. By removing the
lamina, the surgeon can gain access to the disc area as well as freeing
more space for the nerves inside. During the surgery, the spine surgeon
makes a one to two-inch incision in the low back. The surgeon then
chips away the lamina of one or more vertebrae to gain access to the
disc area. The surgeon will then remove any fragments that may have
broken away from the disc, as well as remove the area of disc that
is herniated and pressuring a nerve root. Not all of the disc is removed.
If the entire disc were removed, you would lose the shock absorbing
function of the disc between the vertebrae. Instead, the surgeon will
typically remove the part of the disc that has ruptured outward along
with another 10 or 20 percent of the disc to prevent future problems
arising.
Laminectomy is sometimes used with recurrent disc herniations, or where
scar tissue is involved. Laminectomy may also be used in cases of spinal
stenosis where the entire canal is narrowed like a ring on a swollen
finger.
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Rhizotomy is a procedure where the physician may
use heat or cold to intentionally damage the ability of a problematic
nerve to telegraph pain signals to the brain. While pain signals serve
a purpose, to warn us about danger or injury, sometimes a nerve can
end up in a "stuck" position, sending a continuous pain signal to the
brain.
Trying to mask this signal with drugs, however, can have damaging implications
long term. Drugs can have dangerous side effects to internal organs.
By using this surgical technique, the pain signal is turned off at the
source.
Neuroablation is another term to describe the surgical procedure to purposely
inhibit the nerve's ability to transmit a pain signal. During the procedure,
the spine surgeon can destroy the problematic nerve by cutting, or using
extreme heat or cold. This intentional "short circuit" may
be temporary or permanent depending upon the procedure.
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Through the placement of hooks, rods, and screws a spinal curve
can be corrected and stabilized, then followed by a fusion to maintain
the correction permanently. Scoliosis does not come from an injury but
rather appears without cause. Sometimes it is inherited, and often affects
women more than men. With most curves, the spine not only is bent but
also twisted... like a bent corkscrew.
Some cases of scoliosis are not serious. Over time, if a curve worsens,
surgery may be required to correct the curve. In extreme cases, if the
curve is not corrected, the spinal deformity can put pressure on internal
organs, which can shorten a person's lifespan. (Learn
more about scoliosis)
During scoliosis surgery, the surgeon may used special instruments that
hook onto various vertebra segments. Then these surgical rods are adjusted
to "de-rotate"
the twisted and bent corkscrew.
Decades ago, Harrington Rods were used to surgically straighten the spine.
This technique however did not untwist or correct the spine. Current
state-of-the-art instrumentation achieves much better correction than
older rods.
Generally speaking, the younger the patient, the more flexible the spine
and the better the result from scoliosis surgery. As the patient becomes
older, say over 40 years old, the spine is less flexible and there may
be increase risk from attempting to correct the curve. Because the spinal
cord is involved, only spine surgeons who specialize in scoliosis should
do such surgery.
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Dorsal
column stimulation, also called spinal cord stimulation, is used in complex
cases of back pain that can not be resolved either nonsurgically or with
another surgery. In most cases, it is used when leg pain is worse than
the back pain. The intent is to use an electrical signal instead of drugs
to mask pain that can not be removed any other way.
During the surgical procedure, the patient is actually still awake while
the surgeon delicately places tiny electrodes under the skin in the back.
At that point, a tiny electrical current is transmitted through the wires
to the location in the back. The sensation experienced is that of a tiny
tickle from the electrical current as it interrupts the pain signal that
may be sent to the brain from the damaged nerve. The patient is awake
during the procedure to help instruct the surgeon as to which electrical
setting and placement of wires produces the most pain relief. It is important
to note that this technique is only used in the most extreme cases of
back and leg pain, and not typically used for most cases of back pain.
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Need
more information on back and neck pain?
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