A to Z of Therapies
Surgery for Back Pain
December 19th, 2009
Bad backs are a frequent reason people opt for surgery, but when surgery is not clearly indicated it can lead to increased and even chronic pain, worse than previously experienced.
In certain cases, surgery can significantly help back pain sufferers. For many, it can completely abolish the pain; for others, it can greatly reducing the level of pain suffered daily. But surgery is always a treatment of last resort, offered when conservative treatments have failed (unless there is an emergency indication for surgery).
It is important to be well informed about your condition “ including risks involved “ before you elect for surgery and to get more than one opinion from a Neurosurgeon or Othopaedic Surgeon.
Reasons for Surgery:
- Surgery is an option in the case of a proven herniated disc that is causing the pain. Treating a herniated disc involves decompressing the nerve in the back that is causing the pain.
- Traumatic conditions such as fractures of the spine and dislocations may require surgery.
- Painful spondylolisthesis where one vertebra slips forward on the one beneath it, may also be a reason for surgery.
- Neurological warning signs, for example - loss of an ankle reflex or loss of bladder control.
Types of Surgery:
Discectomy treats herniated discs. A discectomy involves removingthe soft gel-like material typically herniated out of the disc andcompressing a spinal nerve. This returns the disc to a more normalshape and relieves the pressure on the nearby spinal nerve.
Laminectomy (removal of the entire lamina) or a Laminotomy (removalof part of the lamina) are surgical procedures used to treat manyspinal disorders including spondylolisthesis, spinal tumors, and spinalstenosis; a common cause of back pain particularly in older people.The lamina is a bony plate that is part of each vertebral body. Itis located at the back of the spine and protects the spinal canalor entrance to the spinal cord and other nerve structures.
Foraminotomy treats pinched nerves. This procedure relieves spinalnerve compression by surgically increasing the size of the openingwhere spinal nerves exit the spine. This opening is call the foramenor neuroforamen.
Spinal Fusion often includes instrumentation andbone graft to stabilize the spine. Instrumentation refers to medicaldevices such as cages, plates, screws, and rods. There are differenttypes of bone graft materials including the patient's own bone (autograft),donor bone (allograft), and bone morphogenetic protein (BMP). A spinalfusion may be included with another surgical procedure such as a discectomyor laminectomy.
Ongoing Research
A great deal of research is being performed to help doctors betterunderstand and treat back pain. Some of the more exciting researchincludes new forms of disc replacement that may be injectable, andresearch into gene therapy that may someday allow doctors to providemore efficient and effective ways of achieving important medical needssuch as spinal fusion, disc repair or regeneration, or even regrowthof spinal cord and nerve cells.
American OrthopaedicAssociation
www.aoassn.org
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