Lower Back Surgery Procedures
'Every Once In A While, Only Surgery Will Help'
The Short Answer –
Back surgery is the absolute last resort for those suffering with severe lower back pain. If no other lower back pain treatment has worked, then a variety of surgical options are available.
Lower back surgery procedures are not without considerable risk and there is no guarantee of success. In this article we look at when, why and what options are available to you for lower back surgery.
Normal Treatment Protocols
Thankfully the vast majority of lower back pain is what is known as ‘mechanical’ meaning that is stems from poor posture or poor usage – resulting in muscular strain.
A short period of reduced activity with a couple of natural treatments and possible over the counter painkiller will soon put you back to normal.
If your back pain is a little more severe you may consider visiting a doctor, or if you start exhibiting some of the ‘red flags’ that suggest a bigger problem, then a visit to accident and emergency is probably the best route.
However, in a limited number of cases you will have exhausted all your normal options for pain relief including painkillers and a range of other therapies, most likely even had some steroid injections and still nothing has worked.
The other likely route to surgery is if you may have been involved in a serious physical accident (such as a car crash/ collision during contact sports) or have a serious spinal condition for which lower back surgery is the only option.
Types Of Back Pain That Can be Helped By Various Lower Back Surgery Procedures –
The National Institute of Arthritis and Musculoskeletal and Skin Diseases cite 3 key types of lower back pain for which surgery can be helpful –
Herniated discs (aka a slipped disc)
Herniated discs occur when a piece of the soft cushion between the bones in your spine is pushed out and presses on your nerves in the spinal canal.
Most Common Cause – Aging Or Impact Injury. As we get older the discs in our back get older and start to deteriorate (‘disc degeneration’). This makes us much more likely to suffer with disc rupture from even a minor strain.
In younger people, this is likely to take a much more serious twist or impact to cause the same effect.
This occurs when your spinal column narrows and starts to apply pressure to your spinal cord.
Most common cause – Old Age. As you body ages, tissues in your spine start to thicken and your bones get bigger, causing the compression of the nerves. Rheumatoid and osteoarthritis can also contribute to speeding up the onset of spinal stenosis.
Spondylolisthesis takes place when one or more spinal discs slip out of their designated place in your back.
Most Common Cause – Bone disease or fractures. Arthritis can also cause abnormal wear on the spine, leading to slippage. This is much more common in women than men, due to hormonal influences.
There are also two other circumstances in which surgery may be required (beyond that of a response to a serious immediate injury).
This is literally a fractured bone. The vertebrae are the block-like bone sections of your spine. Like any bone in your body, under certain circumstances they are prone to fracture.
Most Common Cause – Osteoporosis or impact injuries such as car accidents.
Cauda Equina Syndrome
This is the compression of nerves in your spine caused by a tumour or severe ruptured disc.
Most Common Cause – A severe ruptured disc (as above) or a narrowing of the spinal canal (stenosis)
Which type of back surgery bests suits your lower back pain, will be a matter for agreement between you and your surgeon.
This will depend on the outcome of scans, your likely prognosis and a range of other factors, including the risks involved on the rest of your health.
These risks include those from anesthesia and pain management afterwards. I will cover these below under ‘additional risks’
Lower Back Surgery – Types Of Procedure.
There are a wide range of potential surgical procedures open to your consultant, when considering how best to treat your lower back pain. These include –
As the name suggests, two or more pieces of your spine (vertebrae) that have slipped from their normal position, are joined together. This is done by removing the disc between your vertebrae and then securing them together normally with metal devices.
Artificial Disc Replacement Surgery
This takes place when a single spinal disc is badly damaged and can be removed and then replaced with a synthetic one.
This operation is carried out to reduce the pressure on spinal nerves. A laser is used to produce burning spurts of power through a needle to melt away parts of a damaged disc.
By reducing the size of the disc, surgeons can reduce the pressure from the disc pushing on to your spinal nerves.
This is a procedure during which special needles create lesions (small areas of damage) along selected nerves in your back. The needle heat your nerves to approx. 80degrees Celsius and after 2-3 minutes of application, that nerve should not be able to carry pain signals any longer.
A laminectomy is designed to treat spinal stenosis by removing any bony spurs or reducing the bone walls. This again is designed to increase the space in the spinal column and therefore reduce pressure exerted on the nerves.
This lower back procedure involves the removal of a part of your herniated disc to relieve pressure on the nerves in your spinal canal. A microdiscectomy is the same basic procedure, but using a smaller incision (cut).
It is very common for surgeons performing a discectomy to also perform a laminectomy at the same time.
A foraminotomy is a very specific procedure whereby surgery is used to clean out and widen the area that is used by the nerve roots to leave the spinal canal. Once again, the objective is to reduce painful pressure on the nerves can be reduced.
The procedure of a foraminotomy is most commonly used to treat spinal stenosis.
Vertebroplasty and Kyphoplasty
Used to repair compression fractures caused by osteoporosis. Both procedures involve strengthening your existing bone by injecting a glue-like cement.
Plasma Disc Decompression (or Nucleoplasty)
Similar in many regards to radiofrequency lesioning, except that a surgeon inserts the needle into the disc in your back. A plasma laser is then used to vaporise tissue is the disc, which reduces it’s size and creates more room for your pressurised nerves.
The Dangers With Lower Back Surgery Procedures.
There is inherent risk in any form of surgery, but with back surgery this is particularly heightened.
There are 3 main areas where risks of spinal surgery are increased….
Complexity of Surgery
1) The surgery itself is more complicated and risky when it involves the lower back principally because of the close approximation of your spinal cord and the delicate, interwoven nature of your central nervous system.
Any potential mistake (or just pure bad luck) could lead to paralysis or even fatal infection.
2) Then there are extra dangers associated with the anaesthesia (above the normal risk levels) used during surgery, because you will likely be lying face down on your front.
The change to lying on your front actually alters your body’s ‘hemodynamics’ (the process of how blood flows through your body).
Lying face down also alters the anaesthetist’s normal access to your airways, which although they will be experienced in managing, still adds extra complications including repositioning equipment etc
3) Finally, there are the risks associated with a particularly long rehabilitation period and considerable pain during the recovery. You will need to consider a number of options and work closely face to face with a pain management specialist.
Opioids will be the most effective initial pain treatment, but the large side effect profile and extreme addictiveness of the drugs, will make other alternative therapies even more important.
The Final Word –
Lower back surgery procedures are never without the considerable added risk that comes with working so close to the spine and it’s complex nervous system.
For these reasons, surgery is almost always the last option even for people in agony.
If you do have to go for surgery though, there are plenty of options available to you and your surgeon – ranging from the minimally invasive to a much more substantial reconstruction.
Hopefully with clever preventative treatment and good pain management, you will never need spinal surgery – but if you do, hopefully this has helped to outline your basic options.
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