Trauma, aging, improper body mechanics, and normal wear and tear can all lead to injury of the spine. Damage to any part of your back or pressure on the nerves in your spine can cause sevear back pain and other symptoms. If you have persistant back pain, back surgery may be an option for you.
Most back problems can be taken care of with nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy. When conservative treatments don’t help, back surgery may offer relief.
Benefits of Back Surgery
The primary reason for most back surgeries is to get relief from back pain. And for many people, the result is less pain.
Less pain comes with many additional benefits, including:
- Increased activity
- Better physical fitness
- Improved mood
- Less need for pain medicines with fewer drug side effects
- Ability to go back to work
- Increased productivity at work
Back Surgery Candidates
- If you have a condition that compresses your spinal nerves, causing debilitating back pain or numbness along the back of your leg.
- In some instances when you have bulging or ruptured (herniated) disks — the rubbery cushions separating the bones in your spine. However, many people with bulging disks have no pain.
- If you have broken bones (fractured vertebrae) or other damage to your spinal column from an injury that leaves your spine unstable.
- If you have vertebral fractures and an unstable spine related to osteoporosis.
- If you’ve first tried conservative measures and they fail to relieve your back pain or other symptoms.
- Scoliosis, a curvature of the spine
- Kyphosis, a humpback deformity
- Spondylolisthesis, the forward slippage of a segment of the spine
- Spinal stenosis, narrowing of the spinal canal typically from arthritis
- Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
- Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear
Types of Back Surgery
Each type of back surgery comes with its own risks and benefits.
Spinal fusion is the most common surgery for back pain. In a spinal fusion, a surgeon joins spinal bones, called vertebrae, together. This restricts motion between the bones of the spine. Fusion also limits the stretching of nerves.
Reduced spinal motion does not significantly limit activity for most people. One risk unique to spinal fusion surgery is incomplete fusion of the vertebrae. That can require additional surgery. While incomplete fusion is uncommon, smoking does increase the risk. Smoking also increases the risk of infection after back surgery.
In a laminectomy, a surgeon removes parts of the bone, bone spurs, or ligaments in the back. This relieves pressure on spinal nerves that may be causing pain or weakness.
A laminectomy, however, can cause the spine to be less stable. If the spinal bones become unstable, a spinal fusion is usually performed. Spinal fusion may also be performed at the same time as laminectomy.
During a foraminotomy, a surgeon cuts away bone at the sides of vertebrae to widen the space where nerve roots exit the spine. The enlarged space may relieve pressure on the nerves, thereby relieving pain.
A foraminotomy can sometimes result in reduced stability of the spine, similar to what happens in a laminectomy. A spinal fusion may be done at the same time. Doing so increases the amount of time needed for recovery but also prevents the spine from becoming unstable. If the spine becomes unstable after a foraminotomy, a spinal fusion can be done to correct the problem.
A bulging or “slipped” disc, the cushion that separates vertebrae, may press on a spinal nerve and cause back pain. In a discectomy, the surgeon removes all or part of the disc. A discectomy can be done through a large incision or through a smaller incision using tools from outside the body. A discectomy may be part of a larger surgery that includes laminectomy, foraminotomy, or spinal fusion.
In artificial disc replacement, a surgeon removes a damaged spinal disc and inserts an artificial disc between the vertebrae. Disc replacement permits continued motion of the spine. It is gaining popularity as an alternative to spinal fusion.
Recovery time for a disc replacement may be shorter than for a spinal fusion in many people. As with any foreign object placed inside the body, there is a small risk of the device dislodging or failing.
For most people, the main risk of back surgery is not gaining good relief from back pain after the surgery. Unfortunately, this risk is hard to predict or avoid. Talking openly with your surgeon can help you know what to expect from back surgery.
During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar but more expensive procedure — called kyphoplasty — a balloon-like device is inserted to attempt to expand compressed vertebrae before bone cement is injected.