If you've struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Sometimes, surgery is the only treatment.
Open surgery vs. minimally invasive surgery
Traditionally, spine surgery is usually performed as open surgery. This entails opening the operative site with a long incision so the surgeon can view and access the spinal anatomy. However, technology has advanced to the point where more spine conditions can be treated with minimally invasive techniques.
Because minimally invasive spine surgery (MISS), does not involve long incisions, open manipulation of the muscles and tissue surrounding the spine is avoided, therefore, leading to shorter operative time. In general, reducing intraoperative (during surgery) manipulation of soft tissues results in less postoperative pain and a faster recovery.
Spinal fusion: This is the most common surgery for chronic nonspecific back pain with degenerative changes. The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch. But it probably won’t limit your activity. It’s rare, but the bones don’t always fuse completely. Smoking can make this complication more likely. If it happens, you may need another operation to fix it.
Laminectomy: This is the most common surgery for lumbar spinal stenosis. In this procedure, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness, but the procedure can make your spine less stable. If that happens, you’ll probably need a spinal fusion as well. Doctors sometimes do the two procedures together.
Foraminotomy: This surgery is used to relieve pain associated with a compressed nerve in the spine. The surgeon cuts away bone at the sides of your vertebrae to widen the space where nerves exit your spine. The extra room may relieve pressure on the nerves and ease your pain. Like a Laminectomy, this procedure can also make your spine less stable. So the surgeon may do a spinal fusion at the same time. That’ll increase the amount of time you need for recovery.
Diskectomy: Sometimes a disk, the cushion that separates your vertebrae, can slip out of place, press on a spinal nerve, and cause back pain. In a diskectomy, the surgeon removes all or part of the disk. He may have to make a big cut in your back, or he may be able to do it through a small one called microdiscectomy. Microdiscectomy is performed with an operating microscope through a smaller incision than open discectomy and has become the standard surgical procedure for lumbar disc herniation. Sometimes a diskectomy is part of a larger surgery that includes laminectomy, foraminotomy, or spinal fusion.
Disk replacement: A surgeon removes the damaged spinal disk and inserts an artificial one between your vertebrae. Unlike fusion, this lets you continue to move your spine. Recovery time may be shorter than for a spinal fusion, too. But there is a slight chance the new disk could slip or fall out of place and require repair.
Interlaminar implant: This is a minimally invasive alternative to more invasive laminectomy or laminectomy plus fusion surgery. The surgeon implants a U-shaped device between two vertebrae in your lower back. It helps keep the space between them open and eases pressure on your spinal nerves. It can be done at the same time as a laminectomy. Unlike spinal fusion, the implant provides stability and lets you move your back almost like normal. You may not be able to bend backward as easily in that area.
The biggest risk of back surgery: Not knowing for sure if it’s going to help with your pain. The best thing you can do is talk openly with your surgeon so he knows what’s going on with your health and you know what to expect before you go into the operating room.