Whether you’ve got spondylosis, a herniated disc, spinal stenosis, scoliosis, or chronic back pain, a surgery may be the next move in your health journey. Read on as we break-down the most common types of back surgeries, explain the procedure, and share which back/ spine surgery might resolve your back condition and symptoms.
When Might Back/ Spine Surgery Be Recommended?
There are dozens of different back and spine surgeries that may be recommended by your orthopedic surgeon. Most of the time, back or spine surgery is only recommended after non-surgical, less invasive treatments like physical therapy, injections, or acupuncture have been tried and are no longer effective. If you’ve tried a laundry list of non-surgical treatments, your MRI and X-ray show a treatable structural problem, and your physician’s exam points to a condition or deformity that can be treated with surgery, then this may be the recommended route.
A surgery may be the recommended course of action if:
- All Nonoperative modalities have been exhausted. You’ve tried physical therapy, injections, acupuncture, massage, and all other non-surgical treatments your physician has recommended.
- Your symptoms match medical findings. If your pain and symptoms align with your physical exam, x-rays, or MRI, you may be a candidate.
- You have more than just “pain”. Sometimes your back pain may not be caused by a surgically correctable problem. In these cases, surgery may not be recommended as there isn’t a specific structural issue that your surgeon can fix.
- You have a treatable deformity. If your medical exams point out a physical deformity, like degenerative scoliosis, then surgery can help correct the issue. The better your surgeon can zero-in on what is causing your back pain, leg pain, numbness, or tingling, the better your chances are at a successful surgical intervention.
- You’re in good health. Elective surgeries are only performed on patients who are mentally and physically healthy enough to recover from them. If you have a secondary disease, are overweight, smoke, or have any conditions that put you at greater risk of complications or poor recovery, surgery may not be recommended until these issues are optimized.
- The pros outweigh the cons. If your orthopedist thinks that they can physically correct your spine issue and can likely reduce your pain, an elective surgery may be the right choice. Some back surgeries, like a discectomy and spinal fusion, are quite successful at treating certain corresponding conditions. When the underlying cause of pain is less obvious, the surgery success rate goes down.
4 Main Types of Back Surgery
Here are the 4 main types of back surgery. Under each of these surgery umbrellas, there are many variations to treat the individual patient.
- Spinal Fusion
- Vertebroplasty/ Kyphoplasty
A discectomy (sometimes called a microdiscectomy, percutaneous discectomy, lumbar discectomy, herniated disc surgery, decompression surgery) involves taking out material that is putting pressure on the spinal column or nerve root. The procedure involves removing the herniated portion of the intervertebral disc (the nucleus pulposus) which is putting pressure on the nerve or spinal cord. Removing part of the disc that is putting pressure on your spine will help address pain, numbness, weakness, balance issues, or mobility problems.
A microdiscectomy is a minimally invasive version of the surgery where part of the nucleus pulposus is removed traditionally or with a laser through a smaller incision (1-1.5 inches) with a microscope. A percutaneous discectomy involves removing part of the disc using a laser or suction through a small incision and probe.
A discectomy can be performed on various parts of the spine. For instance, a lumbar discectomy is performed to remove the herniated portion of the lumbar disc (lower back).
A discectomy is performed to:
- Address leg and/or buttock pain caused by nerve compression from a herniated/ ruptured disc
- Treat leg weakness, numbness
- Relieve pressure on the spinal nerves or cord
Similar to a discectomy, a laminectomy is a decompression surgery. In a laminectomy, part of the bone in your spinal column (lamina) is cut away to expose the spinal canal. The lamina is the backside of the spinal canal that forms a cover over the spinal cord. The goal of the surgery is decompress a portion of the spine and remove pressure on the spinal cord or nerves.
This lamina is cut or removed along with the ligamentum flavum (a ligament) that helps support the spinal column. Often times, the ligament is the cause of compression on nerves or spinal cord. This is termed central stenosis. The compressed nerves could be caused by a bulging disc, bone spurs, overgrown joints, or the ligament tissue itself etc. Your surgeon will determine the cause of the pressure/ compression and remove the cause (like a bone spur or a disc fragment) surgically.
This compression and pressure on your nerve can be the source of your back and leg pain. Compressed nerve roots can be very painful, and relieving this pressure through surgery can improve function and cut pain.
A laminectomy is performed to:
- Gain access to a herniated/ ruptured disc in the spine (like sciatica)
- Remove bone spurs also known as osteophytes (“spondylosis deformans”)
- Address back pain caused by nerve damage
- Treat numbness and leg pain
- Relieve pressure on the spinal nerves
- Remove a tumor from the spine
3. Spinal Fusion
A spinal fusion is a surgery most commonly used to address spinal instability associated with degenerative disc disease, scoliosis, or another problem with spinal alignment. Whether you’ve been diagnosed with idiopathic scoliosis (cause is unknown), congenital scoliosis (rare birth defect), neuromuscular scoliosis (side effect of another disease), or degenerative scoliosis (caused by wear and tear), a spinal fusion may be the recommended “last resort” treatment.
In a spinal fusion, two or more vertebrae (bones) are fused together with healthy bone (usually using bone graft harvested from your bone or from a bone bank) and locked in place (often with hardware like metal rods, plates, screws etc.). This fusion is a permanent solution used to correct alignment or a degenerative problem. Fusing the vertebrae will stabilize the spine into a more correct or straighter position. A spinal fusion can correct a spinal curve by 50-70%.
A spine curve of 45°-50° or greater will put you in the category of a “severe” curvature. This is when a spinal fusion may be recommended to help with your deformity and related side effects.
A spinal fusion is performed to:
- Reduce spinal curve deformity by straightening or aligning the spine
- Treat scoliosis, spondylolisthesis, spondylosis, spinal stenosis, spinal disc herniation, fractures, infection and tumors.
- Treat side effects like moderate-severe back pain, mobility issues, breathing issues etc.
- Degenerative disc disease
4. Vertebroplasty/ Kyphoplasty
Vertebroplasty and kyphoplasty are similar procedures used to treat vertebral compression fractures. When the vertebrae fractures, compress, and are left untreated, one can have excruciating pain, and a “hunch” deformity may form. These compression fractures can be caused from injury, or most commonly, osteoporosis (low bone mass that leads to fractures).
In a vertebroplasty and kyphoplasty procedure, bone cement is inserted into the fracture through a long, hollow needle. Bone cement is put into each affected vertebrae. In more severe spinal compression cases, a kyphoplasty is performed. In this procedure, a balloon is inserted and inflated to lift the compressed vertebrae back to a normal height. With the vertebrae lifted, bone cement is then inserted into this heightened space.
The bone cement strengthens the vertebrae, helps prevents further collapse, and improves pain.
A vertebroplasty and kyphoplasty are performed to:
- Treat vertebral compression fractures (VCF) of the spine.
- Prevent future osteoporotic fracture or collapse (which are common after an initial fracture)
- Improve osteoporosis (calcium broken down in bones)
- Biopsy tumors or cancer in bone.
Are you thinking about or have a scheduled back surgery? PeerWell’s PreHab program for spine surgery can help. Patients that “PreHab” before orthopedic surgery are optimized for the procedure, have fewer complications, and recover faster. Learn more about PreHab for spine/back surgery.