What conditions benefit from spine surgery?
While many people visit a doctor for back pain or neck pain at some point in their life, they will more than likely be treated successfully with non-surgical treatments such as physical therapy or medications. For back pain and neck pain patients who do not respond to conservative treatments, spine surgery may be an appropriate treatment and your primary care physician may refer you to a spine surgeon. New spine surgery procedures such as minimally invasive spine surgery can offer faster recovery in many cases.
Conditions that may benefit from spine surgery include:
• Spinal stenosis – this narrowing of the spinal canal may be treated with surgery due to greater improvements in pain reduction and function when compared to more conservative treatments.
• Bulging disc – bulging discs are sometimes called disc protrusions. They may cause pain if they press on an adjacent nerve root or the spinal cord.
• Cervical or lumbar disc herniation – disc herniation is most often caused by degenerative disc disease, but can also be caused by twisting or turning while lifting, or by injury or a traumatic event such as a fall. Surgical treatment of a herniated disc may result in less pain and greater long-term improvement than conservative care for this condition, which is sometimes called a slipped disc, ruptured disc or a pinched nerve.
• Degenerative disc disease (DDD) – one of the most common causes of lower back pain, DDD is usually treated conservatively. Disc replacement surgery may be required in rare cases.
• Spondylolisthesis – a condition where the bone in the lower part of the spine slips out of its proper position onto the bone below it. Surgery to fuse the slipped bones back into place in many cases may provide relief if a patient is symptomatic and treatments such as physical therapy, traction, or anti-inflammatory medications don’t work.
• Myelopathy – a condition in the neck or mid back in which the spinal cord is irritated or injured.
• Synovial cyst – a fluid-filled sac in the spine that has developed as a result of degenerative disc disease (DDD) and may compress nerves like a herniated disc.
• Facet arthropathy – a type of arthritis that affects the joints in the lower back. It can occur if joints in the spinal area become compressed or if there is inflammation in the fluid-filled disc that helps to protect bones located in the spine.
• Loss of motor or bladder control – conditions such as cauda equina syndrome, a rare condition that affects the nerves in the lumbar area, benefit from surgery. Surgery for these conditions reduces the likelihood of long-term issues.
What are the most common types of back surgery?
There are many types of spine surgery, but they all fall into one of two main categories:
1. Decompression spine surgery relieves leg or arm pain being caused by pressure on or pinching of spinal nerves.
2. Stabilization spine surgery provides strength and stability to the spine by eliminating motion, and often improves back or neck pain.
Back decompression surgery helps relieve pressure on a nerve along the spinal cord that is being pressured or pinched. Some common decompression spine surgery types include:
• Discectomy/Microdiscectomy: If you have suffered a herniated disc or any type of condition that results in a spinal disc compressing a nerve, your spine surgeon may need to perform a discectomy or microdiscectomy to relieve your pain. During a discectomy, your surgeon will remove a small portion of one of your facets, the connecting tissue between the vertebrae, to both relieve pressure on your nerve and provide access to the damaged disc. From there, your surgeon will remove the pieces of the disc that have herniated or protruded into the spinal column. Your spine surgeon also may need to cut a small hole in your lamina, the roof of the spinal canal.
• Facetectomy: The facet joints are the connections between the bones of the spine. Each spinal vertebra has four bony protrusions called facets. Two facets face upward and two face downward, and each interlocks with the vertebrae around them. The nerve roots pass through these joints to go from the spinal cord to the arms, legs and other parts of the body. These joints also allow the spine to bend and twist, and they keep the back from slipping too far forward or twisting without limits. Over time your facet joints can become misaligned and rub or pinch your spinal nerves, leading to facet joint pain. This condition often is caused by a type of arthritis called facet arthropathy.A facetectomy is a type of spine surgery to remove part of these facets to relieve pressure on your spinal nerves. Your spine surgeon will begin by removing a small piece of your lamina to get access to your facets The surgeon will then remove the smallest possible amount of bone to relieve the pressure on your spinal nerves.
• Foraminotomy: In some cases, a foraminotomy may be performed alongside a facetectomy. This procedure helps to relieve pressure on your spinal nerves, which exit your spinal cord through small holes called neuroforamina. Over time, these neuroforamina may get smaller, pinching the root of your spinal nerves. During a foraminotomy, your spine surgeon will examine the neuroforamen to figure out what’s blocking it. This may be bone, disc material, or other tissue that has grown into the passage over time. Your surgeon will remove enough of this material to relieve pressure on the nerve that’s being pressured.
• Laminectomy and Laminotomy: If the lamina, the bony arch of the vertebrae, is compressing your nerve, your spine surgeon may recommend one of these two types of spine surgery. A laminectomy removes the part of the lamina that is compressing the nerves in your spine. This procedure also may be performed in combination with another type of back surgery. A laminotomy creates small, targeted holes in your lamina above and below a compressed nerve to help relieve pressure.
Stabilization Spine Surgery Types
Stabilization spine surgery is performed to reduce or eliminate the motion between the vertebrae that is causing pain. Stabilization procedures often involve the placement of plates, rods or screws. The two most common types of stabilization spine surgery are fusion and disc replacement.
Spinal Fusion: Spinal fusion is a tremendously common type of back surgery to treat back and neck pain. In particular, this treatment works when you have a vertebra that has become so degenerated that it isn’t supporting your neck or back anymore. Your spine surgeon will remove the damaged vertebra, leaving a gap between the two that surround it.
In order to keep those two surrounding vertebrae from collapsing into each other, doctors will put a piece of bone where the previous vertebra was. They’ll affix this in place with screws and metal plates, and as the body naturally heals, it will grow new bone around the graft. Within a few months, the two surrounding vertebrae and the graft will be joined into one solid piece of healthy bone.
Spinal fusion can be performed on just one vertebra, or level, or multiple levels. If fusion is performed to treat lower back pain, it is called lumbar fusion. Lumbar fusion can be further broken down into four primary types depending on how the surgeon accesses the spine: anterior lumbar interbody fusion (ALIF) is performed through the abdomen; posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are both performed through the back and differ by what structural changes to the spine are made; and extreme lateral interbody fusion (XLIF) is performed through the side.
Anterior cervical discectomy and fusion, or ACDF, is the most common type of spine surgery that is used to treat neck pain caused by unstable or damaged vertebrae. SI joint fusion is a procedure that is used to stabilize the sacroiliac joint which can cause low back pain when it moves excessively.
Artificial disc replacement is a newer type of spine surgery that is growing in popularity. In between each of your vertebrae, you have a fibrous disc that helps to cushion and pad your vertebrae. In some cases, while your vertebrae may be healthy enough, your discs may have broken down and stopped properly padding the bones of your spine. When this happens, your spine surgeon might recommend disc replacement instead of spinal fusion.
During this procedure, your spine surgeon will remove the degenerated disc through a small incision in your neck or back. The surgeon will then insert a new custom-made artificial disc and attach it to the vertebrae that surround it. These artificial discs are usually made of two metal end plates with a plastic spacer in between. Artificial disc replacement is most commonly performed in the cervical region for neck and arm pain but is also being used more frequently in the lumbar region to treat lower back pain caused by degenerative disc disease.
What are spine surgery techniques?
Spine surgery is performed in several ways.
• Open surgery: The majority of spine surgery procedures are still performed traditionally as open surgery, with an incision that allows the surgeon to work directly on the spine.
• Minimally invasive spine surgery: About 30 percent of spine surgery procedures can be performed with minimally invasive techniques, including endoscopic spine surgery. Minimally invasive spine surgery also may be referred to as less invasive spine surgery or endoscopic spine surgery. (Sometimes, minimally invasive surgery is incorrectly labeled laser spine surgery or laparoscopic spine surgery.) When performing minimally invasive spine surgery, the spine surgeon makes a small incision (typically less than one-inch). The surgeon then uses special tools such as retractors, endoscopes, and microscopes that he controls to see into the incision and perform the actual procedure. Minimally invasive spine surgery typically results in less damage to the muscles around the spine, which can help reduce pain after surgery and lead to a quicker recovery.
• Laser spine surgery: Patients often do internet research using the term “laser spine surgery” due to heavy consumer advertising using this term. However, spine surgery performed with lasers is rare and used only in very specific cases. Most centers advertising laser spine surgery are actually offering minimally invasive spine surgery.
What is the difference between minimally invasive spine surgery vs. laser spine surgery?
As noted previously, minimally invasive spine surgery often is mistakenly called laser spine surgery by consumers. However, in most cases the actual procedure a consumer is researching is a minimally invasive surgery that does not involve a laser at all. Minimally invasive spine surgery is appropriate in about 30 percent of cases of back pain or neck pain. It involves the surgeon performing the procedure through a small incision with a miniature camera and specialized instruments. Because muscles are not disturbed during minimally invasive spine surgery, pain is often reduced and recovery times tend to be shorter.
Minimally invasive spine surgery is an option for many traditional spine surgeries, including discectomy, spinal decompression, and transforaminal lumbar interbody fusion (TLIF). Though laser spine surgery is a term commonly researched by patients, true laser spine surgery is used very rarely and never for degenerative spine disease, which involves spinal discs and accounts for the vast majority of back pain.