Compared to how many people experience back pain every year, spine surgery is rarely the initial treatment. For a majority of patients, surgery is considered only after a course of treatments that combine self and doctor-steered-care. There are emergency situation where surgery necessary or considered early on, but most conditions are resolved non-surgically. Most commonly, doctors advise somewhere between 3 to 6 months (sometimes longer) of recovery treatments before even considering spine surgery.
Once the decision is made to opt for surgery there are generally two types of lower back surgery – decompression and spinal fusion.
Decompression back surgery involves removing a small portion of the bone or disc material from around the nerve root or spinal cord to relieve nerve pinching and provide more room for the nerve recovery.
Herniated Disk decompression:
Herniated disk surgery is the condition that receives the most surgeries. Surgery is to reduce the pain, but also to get the bulging disk from causing nerve damage or making damage worse. Surgical methods include:
- Chemonucleolysis: A non-surgical, but still invasive option where an enzyme is injected directly into the disk to dissolve the portion of the disk that is protruding
- Diskectomy: Surgery under general anesthesia where a surgeon removes the protruding portions of the disk from the spinal canal or from between the vertebrae.
- Microdiskectomy: Similar to a Diskectomy, but it is less invasive, since the surgeon makes a smaller incision and the surgery is performed looking through a microscope, as opposed to the standard open surgery of a Diskectomy.
A foramenotomy is another surgery used to reduce pressure on a nerve caused by a bit of bone or osteophyte. The suregery removes that portion of bone or other tissue that may be compressing as the nerve exits the spinal column.
Spinal fusion surgery links together vertebrae that are normally separate so that motion cannot occur between the individual vertebrae. These vertebrae are individual bones that stack to form the backbone.
A laminectomy is done to relieve pressure on the spinal cord. It is most commonly used to treat spinal stenosis and spondylolisthesis.
Spinal Disc Replacement
Spinal disc replacement is a treatment option for some types of low back pain. It is quite common in Europe, but not yet approved in the U.S.
Cauda Equina Syndrome
Cauda equina syndrome is an emergency situation where the complicated nerve root system in the lower spine is being compressed. This compression can cause tingling, numbness and loss of bladder or bowel control and without urgent treatment could cause permanent nerve damage.