Surgical Treatment Of Back Pain | wambe.org

Surgery may sometimes be required for the patients with underlying disease of the spine including:

• Lumbar disc herniation: As the disc degenerates it moves from its place to outside. This is called disc herniation. It is most common in lower back also called lumbar disc herniation.
• Degenerative disc disease: After trauma or with aging the intervertebral disc becomes diseased and starts to break. The common end point of multiple pathologies is called degenerative disc disease.
• Lumbar spinal stenosis: It is narrowing of the spinal canal which is present in the center of the spinal cord. The features are similar to ruptured intervertebral disk. The pain may radiate to the toes and may progress to numbness or weakness unless the patient rests.
• Degenerative joint disease: Any joint disease can involve the joints of spinal cord e.g. rheumatoid arthritis.
• Spondylolisthesis: It is a condition in which the vertebral body moves forward or backward from its original position.
• Scoliosis: It is a condition in which the spine of a person is curved more than normal.
• Compression fracture: In old age the bones become weak which and because of the weight of the spine itself or while trying to life heavy weight vertebrae breaks down and fall on the vertebrae below it.

Surgery is usually an option when the medical treatment fails to relieve the symptoms of the patient. Minimally invasive surgery is often a solution for many symptoms and causes of back pain. These types of procedures offer many benefits over traditional spine surgery, such as more accurate diagnoses and shorter recovery times.

There are different types of surgical procedures that are used in treating various conditions causing back pain. All of them can be classified into

• Nerve decompression: is primarily performed in older patients who suffer from conditions causing nerve entrapment leading to nerve irritation or nerve damage.
• Fusion of body segments: it is a procedure used to fuse together two or more bony fragments with the help of metalwork.
• Deformity correction surgeries: it is normally performed to correct congenital deformities or those that were caused by a traumatic fracture.

The main procedures used in back pain surgery are

1. Discetomies:

It is the surgical removal of herniated disc or torn disc or disc material. It involves removing the protruding disc, either part or whole of it. The portion which is putting the pressure on the nerve root is excised. This is one of the most popular types of back surgeries and which also has a high rate of success. The recovery period after this procedure does not last longer than 6 weeks. A newer technique called microendoscopic discetomy is now gaining popularity which is as effective as discetomy [1] but has a smaller scar.

2. Spinal Fusions:

It is a procedure in which two vertebrae are fused together so they can heel into a single bone. Spinal fusions is indicated in cases of unstable vertebrae and those in which discetomy is performed. Anterior spinal fusion surgery is a safe procedure for treatment of lower back pain[2]. A newer Fusions technique using recombinant human bone morphogenetic protein-2 has shown biomechanically stronger and stiffer fusion than autograft fusions [3].

3. Laminectomies:

In cases of spinal stenosis or disc herniation, surgical removal of the intervertebral disc can be performed to relieve the pressure on the nerves. The severity of the condition as well as the general health status of the patient are key factors in establishing the recovery time, which may be range from 8 weeks to 6 months. Single interspace laminectomy is a risk factor for poor outcome [4]. Recurrent laminectomies can be safely performed for repeated disc herniation[5].

4. Removal of Tumors:

The approach to spinal tumors depends on the type, stage and involvement of the spinal structure by the tumor. In the first case, surgery has the goal of relieving the pressure from the nerves which is caused by a benign growth, whereas in the latter the procedure is aimed to prevent the spread of cancer to other areas of the body. Recovery depends on the type of tumor that is being removed, the health status of the patient and the size of the tumor. After removal of spinal schawannoma the life expectancy is similar to general population [6]. In spinal neurofibroma life expectancy after surgery is still less than normal population [7]. Tranthoracic vertebrectomy for metastatic tumors improves the quality of life [8].

5. Vertebroplasty:

Vertebroplasty is a procedure where bone cement is injected through a small hole in the skin into a fractured vertebra with the goal of relieving the pain of vertebral compression fractures. Vertebroplasty is used in vertebral compression fracture [9], pain relief [10] and metastatic tumors[11].

1. Zhang, C.Y. and S.P. Bai, [Microendoscopic disectomy in the treatment of lumbar disc herniation]. Hunan Yi Ke Da Xue Xue Bao, 2001. 26(5): p. 457-9.

2. Faciszewski, T., et al., The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976), 1995. 20(14): p. 1592-9.

3. Schimandle, J.H., S.D. Boden, and W.C. Hutton, Experimental spinal fusion with recombinant human bone morphogenetic protein-2. Spine (Phila Pa 1976), 1995. 20(12): p. 1326-37.

4. Katz, J.N., et al., The outcome of decompressive laminectomy for degenerative lumbar stenosis. J Bone Joint Surg Am, 1991. 73(6): p. 809-16.

5. Herron, L., Recurrent lumbar disc herniation: results of repeat laminectomy and discectomy. J Spinal Disord, 1994. 7(2): p. 161-6.

6. Seppala, M.T., et al., Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases. J Neurosurg, 1995. 83(4): p. 621-6.

7. Seppala, M.T., et al., Long-term outcome after removal of spinal neurofibroma. J Neurosurg, 1995. 82(4): p. 572-7.

8. Gokaslan, Z.L., et al., Transthoracic vertebrectomy for metastatic spinal tumors. J Neurosurg, 1998. 89(4): p. 599-609.

9. Garfin, S.R., H.A. Yuan, and M.A. Reiley, New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976), 2001. 26(14): p. 1511-5.

10. Barr, J.D., et al., Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976), 2000. 25(8): p. 923-8.

11. Cotten, A., et al., Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology, 1996. 200(2): p. 525-30.