Back Pain Surgery - Spine Surgery
Back surgery takes place on the spinal cord and is categorized into two different areas. The cervical area is the upper spine and the lumbar area is the lower spine and back. Spinal surgery can require extensive healing time after the surgery is completed, while there are less invasive options like kyphoplasty and vertebroplasty, a great deal of physical therapy and postoperative care will be needed. Back surgery does have a rate of failure and can lead to postoperative, chronic and neuropathic pain. Before having spine surgery it is recommended that different non-surgical strategies are tried before the ultimate decision is made for invasive back surgery. Speaking with a health care professional who specializes in spine and back surgeries will be the most helpful when reaching this important and life changing decision.
Cervical Spine Surgery
Cervical spine surgery can either be a decompressive laminectomy or a spinal fusion. Spinal fusion surgery is performed when there is instability of the spine, using a bone graph to fuse two vertebrae together creating one long bone that is stronger and more stable. A decompressive laminectomy surgery is done when the nerves or bone in the cervical area become compressed and pinched due to spinal stenosis. Cervical spine surgery can be performed from the back (posterior approach) or from the front (anterior approach). It is preferred by most surgeons to perform a anterior cervical spine surgery due to least amount of disruption of the musculature surrounding the spine.
Lumbar Spine Surgery
Surgery on the lower back is called lumber spine surgery. Surgery that is performed on the lumbar region can also be performed on the cervical area and both consist of two main types of surgery. Decompressive laminectomy back surgery and spinal fusion surgery are the two types generally used on the lumbar portion of the back. Decompressive laminectomies remove a portion of the vertebra bone to relieve pain associated with a pinched nerve providing more room for it to heal. Spinal fusion is a back surgery that uses a bone graph to fuse together two vertebras and stop motion in the spinal segment.
Artificial Disc Surgery
Artificial disc surgery is not for all patients that suffer from lower back pain. 90% of sufferers can use non invastive techniques to alleviate the pain, with artificial disc surgery as a end all option. This surgery has become a replacement for spinal fusion surgery, which creates a union between vertebrae to strengethen the spine, which lessens back pain. Artificial disc placement uses a disc made of two pieces of chrome with a plastic center that is attached to the vertebrae and locked into the spinal cord. The affected spinal disc is removed and replaced with the artificial disc, giving strength to the spine and allowing for more movement. This surgery is relatively new and has seen good short term results, with a few reports of the artificial disc slipping after surgery.
Benefits to Artificial Disc Surgery include:
Faster recovery time
Stress is reduced on adjacent discs
No harvesting and need for a bone graph
Increased spine mobility
Complications after the surgery include
Possible need for additional spine surgeries
Broken implants or allergic reaction to the implant
Spinal pain and discomfort
Tears in the dura (the protective tissue covering the spinal cord)
Spinal Fusion Surgery or Lumbar Spinal Fusion Surgery
Lumbar spinal fusion surgery or fusion surgery became common to limit the mobility at a painful vertebral segment in the spinal cord. The surgery requires a bone graph to be placed in between the two vertebral segments, which sets up a biological response in the body to cause the bone graph to grow, fusing the two vertebrae together. This stops the motion in the segment of the spine that is causing the pain and increases strength to the lower back or lumbar region.
After the body sends its biological response to the bone graph causing it to grow, the vertebral bodies form one long bone limiting the motion in that specific area. Spinal fusion surgery is most successful for patients with only one set of vertebral problems, fusing more than two sets of vertebrae is unlikely to provide relief from back pain due to the stress that the newly formed bone will place on other the other vertebral segments.
Lumbar spinal fusion surgery can be very helpful in reducing the motion and back pain caused by certain conditions like degenerative disc disease, isthmic (degenerative or postlaminectomy spondylolisthesis), fractures, scoliosis and a weak or unstable spine due to infections or tumors.
There are several types of spinal fusion surgery options, with patient options to have the surgery done from the back or through the abdomen. Posterolateral gutter fusion and posterior lumbar interbody fusion are done through the back. Anterior lumbar interbody fusion is done from the front and anterior/posterior spinal fusion is done from the front and back. The term interbody fusion includes removing the disc in between the two vertebrae and inserting the bone graph into the remaining space. Simple fusions surgery leaves the disc in place with the bone graph attached to the two vertebrae and allowed to grow around the disc.
Decompressive Laminectomy Spine Surgery
Used to treat spinal stenosis, a condition that causes the spine to narrow and pinch nerves, decompressive laminectomy relieves pressure on the spinal cord and spinal nerve roots. Spinal stenosis can create persistent back pain, numbness in the lower extremities, pain of the buttocks or limping. While decompressive laminectomy is mainly used to treat spinal stenosis, it can also be used to treat other injuries to the spinal cord such as a herniated disc or a growth/tumor. The laminectomy removes the tissue and bone (vertebrae) from the spinal cord that is affecting the nerve roots and causing the back pain. Often times a laminectomy will be used in conjunction with spinal fusion surgery to stabilize and strengthen the area where the decompressive laminectomy was done.
Spinal stenosis can appear in both the lumbar (lower) and cervical (neck) regions of the back. Spinal stenosis of the cervical area is much more serious and almost always requires surgery to prevent the condition from worsening. If spinal stenosis worsens it can lead to nerve damage and paralysis. Decompressive laminectomies are usually performed in the lumbar region where spinal stenosis normally occurs and the incision is made through the back, revealing the spinal cord. Laminectomies are an elective surgery, but health care professionals may recommend it if the condition is in the cervical area or symptoms of back pain are not relieved by non surgical methods. Patients may elect to have the decompressive laminectomy if their symptoms are so severe that it interrupts normal daily activities or if the condition worsens over time.
Instrumentation for Spinal Surgeries
Before the development of plates and rods for back surgery, the only way to fix spinal pain and injuries was with wiring. Wiring is rarely used alone today, except to fuse the upper cervical vertebrae segments together; it is often times used with facet screw or Magerl screw to provide stability. The most common instrumentation for back surgery is artificial discs, plates, rods or cages. Artificial discs are comprised of two pieces of chrome with a plastic core and are inserted in between vertebrae during artificial disc surgery. Artificial disc surgery has become a replacement for spinal fusion surgery because it allows for a larger range of movement while still providing relief from severe back pain. Artificial discs carry a higher risk of infection and allergic reaction due to the body’s defense against foreign material.
Metal plates and rods are used in conjunction with bone graphs during spinal fusion surgery to protect the graph and keep the vertebral section stable while the bone fuses the section together. Risks with the use of rods and plates include loosening or failure of the screws used to keep the plate/rod in place, a higher risk of infection, and misplacement of the screw into the spinal disc area or vertebral artery.
Cages or interbody cages are used to obtain fusion and are made out of various materials such as carbon fiber, titanium or polyethylketone, and are either impactable or threaded. Usually the surgeon will fill the cage with a bone graph (synthetic or the patient’s own) or a moprhogenic bone protein.
Postoperative cervical braces will be provided by the surgeon and may need to be worn for up to 12 weeks, depending on if the surgery was a single level fusion or a multi-level fusion. Spinal surgery instruments are intended to aid in the process of bone fusion, providing support and strength while limiting mobility as the spinal cord heals.
Kyphoplasty or Vertebroplasty
Kyphoplasty and vertebroplasty are the least invasive of all back surgeries. Both procedures provide the relief of back pain resulting from a vertebral fracture. Vertebral fractures can occur with out pain or can cause the patient a disabling pain. Vertebral fractures that do not improve with pain medication and a brace are treated with kyphoplasty or vertebroplasty.
Kyphoplasty is procedure where a balloon catheter, much like the balloon used in angioplasty, is placed in between the vertebra and inflated. The balloon catheter is inflated with liquid under pressure which restores the fractured bone to its original placement in the spinal cord. Abnormal wedging of the vertebra bone can also occur from a fracture and the balloon catheter can correct the displacement. After the balloon has restored the vertebrae to its rightful place, the balloon is deflated and the void is filled with bone cement. Once the cement hardens it will continue to maintain the correction done by the kyphoplasty.
Vertebroplasty is a less complicated procedure where bone cement is injected directly into the fracture, hardening in about 10 minutes. The bone cement surrounds all broken pieces and congeals, giving the spine new stability.
Both the vertebroplasty and kyphoplasty can be done under local anesthesia or under general anesthesia, making these back surgery options the least invasive, but the cement used in the bonding of the fracture does come with some risks. The cement can leak out of the vertebra before it finally hardens and if the cement leaks into the spinal canal it can cause compression of the spinal cord and nerves, resulting in new pain and if the nerves are affected, neurological problems. Currently there is no FDA approved spinal cement for use in these procedures and has not received clearance for injection. The procedures shouldn’t be taken lightly and should be considered only when the fractured vertebra cannot heal properly without surgical intervention.