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 disk 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 disk 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 instrumentation?
- 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 1 motion segment (disc), or 2 or 3 motion segments?
All of these questions are appropriate and very difficult to answer.
Remember, "spine surgery begets spine surgery." At least 20% of people who undergo an initial "simple operation" for back pain or leg pain will undergo 1 or more additional operations; these are usually people with chronic back pain.