Surgical Mx of Back Pain

Surgery is not always the best option for treatment of sciatica or back pain, as it can cause complications in some cases. Surgery is advised only for a selective group of people with back pain. The pain must present for at least four weeks, and must be so severe that it affects normal function. These are some of the types of surgeries that are performed for back pain and sciatica:

Laminectomy, the removal of the entire lamina or Laminotomy, removal of part of the lamina is a treatment method for back pain resulting from spinal stenosis, or spinal tumours. Part of the lamina is cut away to uncover the ligamentum flavum, which is then incised to enter the spinal canal. The cause of the compression (eg a herniated disk) can then be corrected.

Discectomy Is the treatment of a herniated disk (where the gel-like substance in the intervertebral disk breaks through the exterior). This is usually done with laminectomy. In a discectomy the gel substance which has broken through and is compressing the spinal nerve is removed. This returns the disk to its normal shape, and relieves the pressure on the spinal nerve.

Rhizotomy is a procedure whereby the sensory nerve roots are first separated from the motor ones and then cut. Identification of the nerve fibres to be cut is then made by means of electrical stimulation. The one(s) producing the pain or other problems are identified in this way, and then selectively cut.

Foraminotomy is the treatment for pinched nerves. The opening where the spinal nerve exits the spine (foramen or neuroforamen) is surgically enlarged. This relieves compression of spinal nerve.

Spinal fusion is when vertebrae are fused together because abnormal positioning of the vertebrae is putting pressure on the nerve. A bone graft may be used, or devices such as cages, plates, screws and rods, to fuse the vertebrae.

Most spinal surgeries are not an emergency, so it is possible to prepare for surgery. It is important to eat a balanced diet with adequate vitamin supply, to help wound healing and reduce risk of infection. Exercise (which is approved by doctor) can increase cardiovascular endurance and speed up recovery. More body weight strains the spine, slows healing process, and increases post operative pain. So losing some weight (if required) before surgery may be beneficial. Also, smokers are encouraged to quit, as it can increase the chance of complications.