Surgical Options for Back Pain
Surgery for back pain is a last resort treatment. There are
basically two reasons for surgery for back pain:
- Neural element compression (or squeezing of nerve roots or nerves)
or pressure on the dura mater (the sac that surrounds the spinal cord
and nerve roots), and
- Back pain. Back pain itself has two main causes: muscle spasm and
What is a muscle spasm?
Muscle spasm is essentially a muscle pull or charley horse of
the back muscles. In this situation, the muscles of the back are tender to the
touch. Bed rest or inactivity does not usually relieve the pain significantly.
Muscle spasm, as an isolated entity, is a non-surgical problem.
What is mechanical pain?
Mechanical pain is a pain that is deep and agonizing in nature.
It is not related to muscle spasm, and activity worsens the pain whereas
inactivity (such as bed rest) improves the pain. This pain syndrome is
significantly different than that of muscle spasm. It is potentially a surgical
problem in that instability can cause mechanical pain. This is akin to a
degenerative hip in an elderly person in whom the pain is deep and agonizing in
nature, is worsened with walking, and improved with sitting or lying.
What is sciatica?
Sciatica and some central back pain problems can be related to
neural compression. Sciatica is caused by a disc herniation or bulge that
compresses or squeezes a nerve as it exits the spinal canal. This pain usually
is in the distribution of the nerve (where the nerve goes in the body). Anterior
dura mater pressure can cause central back pain because of the rich innervation
(nerve supply) of this portion of the dura mater.
Discectomy is a treatment of choice for the problems mentioned
above. Laminectomy might occasionally be helpful. A discectomy is usually
performed through a small bony window.
What are the surgical procedures for back pain?
A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. At its most minimally invasive, the procedure requires only small incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact.
Discectomy is surgery to remove lumbar (low back) herniated disc material that is pressing on a nerve root or the spinal cord.
It tends to be done as microdiscectomy, which uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut (incision), causes less tissue damage and speeds recovery.
Spinal fusion is a process during which a number of vertebrae are made to grow,
or "fuse" together. Mechanical back pain is usually treated with exercise and
the strengthening of the support system of the spine (muscle and ligaments).
These treatments stabilize the spine in a physiological manner. However, spinal
fusion occasionally might be needed in patients who truly have mechanical pain
and who have failed an aggressive non-operative program.
Many controversies exist regarding fusion:
- Should the fusion be performed as an entity in and of itself or with
- Should the fusion be anterior or posterior in location?
- Should cages or screws be used to supplement the fusion?
- How long should a fusion be?
- Should it incorporate one motion segment (disc), or two or three
All of these questions are appropriate and very difficult to answer.
Remember, "spine surgery begets spine surgery." At least 20
percent of people who undergo an initial "simple operation" for back pain or leg
pain will undergo one or more additional operations; these are usually people
with chronic back pain.
Knowyourback.org (North American Spine Society).
Srinivasan RC, Tolhurst S, Vanderhave KL. Chapter 40. Orthopedic Surgery. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e. New York, NY: McGraw-Hill; 2010.
American Association of Neurological Surgeons.
Patient Information: Herniated Disc
American Academy of Orthopaedic Surgeons.
Minimally Invasive Spine Surgery
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www.clevelandclinicflorida.org. This document was last reviewed on: 7/22/2014... index#8416