When is surgery for back pain done?

Surgery for back pain is a last resort treatment. There are basically 2 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).
  • Back pain. Back pain itself has 2 main causes: muscle spasm and mechanical pain.

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.

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