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How Successful Is Lower Back Surgery

Main Types Of Back Surgery

Does Discectomy Lead to Spinal Fusion?

Here are the 4 main types of back surgery. Under each of these surgery umbrellas, there are many variations to treat the individual patient.

  • Laminectomy
  • Vertebroplasty/ Kyphoplasty

1. Discectomy

A discectomy 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 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 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 .

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

2. Laminectomy

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.

3. Spinal Fusion

Different Types Of Spine And Lower Back Surgery

Mar 28, 2018 | Patient

Whether youve 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.

Doctors At Nyu Langones Spine Center Can Usually Help Patients With Back Pain Avoid Surgery But Even When A Procedure Is Necessary A Full Recovery Is The Norm

Joined by her surgeon and fellow running enthusiast, Dr. Erich G. Anderer, Connie Allen enjoys a full recovery one year after back surgery.

As a neurosurgeon who specializes in spinal cases, Erich G. Anderer, MD, has spent well over a decade mastering techniques and procedures to treat severe back painand avoiding them whenever possible. My philosophy is less is more, says Dr. Anderer, chief of neurosurgery at NYU Langone HospitalBrooklyn and a member of NYU Langones Spine Center. There are situations when we have no choice but to fix a problem in the operating room, but I work with patients to develop a treatment plan that usually doesnt require surgery.

Unlike most of Dr. Anderers patients, Connie Allen, a devoted athlete who has run four marathons, was one of those who didnt have a choice. In 2017, the 30-year-old fitness enthusiast from Verona, New Jersey, was squatting 200 pounds at the gym when she felt something pop in her lower back. Intense pain radiated down her legs. Refusing to let the injury slow her down, Allen tried a variety of alternative therapies: acupuncture, massage, chiropractic. Nothing helped. Then, an MRI revealed the reason: a ruptured disc in her lumbar spine was compressing nearby nerves. An orthopedist recommended surgery and giving up the weights.

My goal is not just to get patients pain-free, but back to doing all the things they did before the injury, with no limits, says neurosurgeon Dr. Erich Anderer.

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Do Doctors Recommend Back Surgery

The answer is yes. Doctors recommend back surgery like spinal fusion surgery, laser spine surgery, and spinal cord stimulation. These treatment options are most available for serious spinal injuries, like a herniated disc, a sports injury, or a spinal deformity.

If you have a less serious condition like lower back pain, spinal stenosis, spinal instability, or nerve pain, then the doctor may suggest pursuing different pain treatment options instead.

How Does It Work

Is Lumbar Fusion Surgery a Reliable Procedure?

The most common form of treatment is injections that are given to the patient, introducing a numbing agent or anti-inflammatory steroid directly to the area of concern. These injections often lead to months of pain relief, as well as allowing doctors to locate pain more specifically. Depending on the specific area where pain is occurring, injections can vary, with Epidural injections targeting leg and arm pain, facet joint injections aiding the joints, and nerve root injections directly impacting the nerve.

In addition to injections, patients may undergo radiofrequency neurotomy, which uses x-ray technology to deliver heat and radiofrequency to the area of pain, stopping nerves from transmitting pain. Intradiscal electrothermal therapy also uses heat, remodeling the walls of discs that have been damaged and cause pain.

Almost 90% of injuries to the back or the neck can be addressed using a minimally invasive technique, with similar success rates to their more invasive counterparts.

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Q& a: Surgery For Low Back Pain

Low back pain is common, with about 80% of adults experiencing it at some point in their lifetimes. Fortunately, most people find relief from the pain with time, activity modifications, physical therapy or other nonsurgical treatments. For others, surgery is the best treatment option to improve the quality of their lives.

It’s common to feel nervous about the prospect of surgery. That’s why it’s important to talk with the surgeon to learn more about the procedure and get answers to your questions.

T.K Schiefer, M.D., a Mayo Clinic Health System neurosurgeon, answers seven questions about surgery to correct low back pain.

1. How do you know when surgery is needed for low back pain?

“Usually we would try to exhaust all of our treatments that are nonsurgical first,” says Dr. Schiefer. This could include activity modification, taking nonprescription pain medications and time.

“With time, however, if things are not going well, and especially if there’s some pain going down one of the legs, there may be a need for surgery in the future,” says Dr. Schiefer. “But even at that point, we still wouldn’t just jump to surgery. We probably try some physical therapy first maybe a steroid injection into the spine to see if that will settle down some of the inflammation that’s causing the pain in that nerve root and then see where we’re at from there.”

In this video, Dr. Schiefer explains when to know if you need lower back surgery:

2. What type of surgery can correct low back pain?

How Long Does It Take To Heal From Laminectomy Surgery

Everyone recovers at a different pace. Rest and take it slow in the beginning. You should avoid bending or twisting motions right after surgery. Gradually do more each day, as your body allows.

Be sure to follow the instructions your provider gives you. Physical therapy may help you move more easily, with less pain.

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How Minimally Invasive Spine Surgery Works

Because the spinal nerves, vertebrae and discs are located deep inside the body, any approach to gain access to the spinal area requires moving the muscle tissue out of the way. In general, this is facilitated by utilizing a small incision and guiding instruments and/or microscopic video cameras through these incisions. Contrary to popular belief, lasers are very rarely used in MIS surgeries.

A number of methods can be used to minimize trauma during MIS surgery. Some of the more common techniques are outlined here.

Benefits Of Awake Spine Surgery

Endoscopic Lumbar Discectomy

Procedures take one to three hours, compared with four to six hours for open spine surgeries

Patients walk on the day of surgery and usually go home within 24 hours, instead of three to four days for standard spine surgery under general anesthesia

Faster recovery rates mean patients can rapidly return to daily recreational and work activities

Postoperative IV narcotics are not needed

Since no general anesthesia is necessary, patients do not need to be on a ventilator, resulting in a lower risk of side effects and faster recovery time

This means were not giving post-operative IV narcotics anymore, said Mummaneni. And its allowed us to cut the hospital stay by two-thirds.

A traditional spinal fusion surgery with general anesthesia takes about four hours and requires a hospital stay of three to four days as well as IV painkillers. The awake spine surgery takes half the time and typically has patients out of the hospital within 24 hours.

Patients might continue oral pain medication for a week or two after the long-acting anesthetic wears off, but overall the pain management is much less intensive.

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When Should I Call The Doctor

Reach out to your healthcare provider about any symptoms that concern you after surgery. Pay particular attention to possible signs of infection or more serious complications.

Always call your provider if you have:

  • Redness, swelling or foul odor near the incision site.
  • Bowel or bladder control problems.

A note from Cleveland Clinic

A compressed nerve in the spine is a common problem as people get older. It may cause severe symptoms, such as lower back pain, that affects your mood or keeps you from enjoying life. Often, medication and physical therapy can relieve minor symptoms. When other therapies dont help, surgery may be an option. Laminectomy surgery is one of many types of spine surgery that may relieve chronic back pain. Ask your provider which treatment options are best for your situation.

Last reviewed by a Cleveland Clinic medical professional on 01/11/2021.

References

What Is L5 S1 Fusion Surgery

Spinal fusion is a major surgery where one or more spinal bones are fused together using screws, bolts, and or plates. The hardware may be placed in the front or the back of the spine. The disc between the spinal bones is often times removed and replaced with bone or a spacer. L5 S1 Fusion refers to the level of the surgery.

There are 5 spinal bones in the low back which are numbered from top to bottom L1, L2, L3, L4, and L5. Sandwiched between each of the spinal bones is a disc. The disc is named for the two spinal bones it is sandwiched between. For example, the lowest disc in the low back is the L5/S1 disc. The L5/S1 disc is sandwiched between the L5 and S1 spinal bones. Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. Different surgical techniques and approaches exist. PLIF, posterior lumbar interbody fusion is a case in point that has been reviewed in detail in a prior blog.

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What Happens After Surgery

You will wake up in the recovery area called the post-anesthesia care unit . You may have a sore throat from the tube used during surgery to assist your breathing. You may feel tired, thirsty, cold, or have a dry mouth. Once awake you will be moved to a regular room.

Pain Pain and anti-nausea medication will be given as needed. Everyone feels pain differently. Only you know how to describe your pain. Your healthcare team may ask you to rate your pain on a scale of 1 to 10. 1 = mild pain and 10 = worst possible pain.

Nursing care Your blood pressure, pulse, temperature and breathing will be checked at intervals. The nurse will also examine your incision, change the dressing and check your circulation. You will be given antibiotics through your IV after surgery. Good nutrition and keeping your incision clean and dry helps prevent infection.

You will not be able to eat or drink right away. An IV will give you fluids for hydration. You may have ice chips to wet your mouth. The nurse will increase your diet once you are passing gas and there is movement in your stomach.

You may have a catheter to drain your bladder. It is usually removed after surgery.

Respiratory therapy will monitor your breathing. You will be shown how to use a breathing aid to help keep your lungs healthy after anesthesia. Breathing deeply and coughing helps clear air passages and reduces the risk of pneumonia.

When Is Back Surgery The Right Choice

Lumbar Discectomy, Microdiscectomy, and Percutaneous Discectomy

More men are having spinal fusion, but make sure this is the appropriate solution before considering it.

The decision to consider back surgery should always come after trying nonsurgical or “conservative” options. However, when the pain is persistent and clearly related to a mechanical problem in the spine, you might talk to your doctor about surgery.

There are a variety of procedures for spine-related back problems, but the 800-pound gorilla in the room during any discussion of back surgery is spinal fusion. In this procedure, the surgeon joins two adjacent vertebrae to form a single unit.

Fusing an unstable joint is supposed to prevent motion that can cause pain, but it’s a major operation that often fails to offer a lasting solution. As a result, fusion has become the poster child for expensive, risky, and unnecessary back surgery. Despite that, the number of fusions has risen sharply over the years.

But men with aging spines should be wary of fusion and its false promises, says Dr. Steven Atlas, an associate professor of medicine at Harvard Medical School. “Based on the evidence, the indications for fusion are few and far between, but that doesn’t stop surgeons from doing them or patients from getting them.”

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Why Does Failed Back Syndrome Happen

One of the most common situations in which wesee failed back syndrome is after a spinal fusion surgery. The spine is notimmediately, fully fused after spinal fusion rather, surgeons have created anenvironment that encourages fusion, through the use of a tissue graft betweentwo vertebrae.

For the vertebrae to fully fuse, the spine mustbe stabilized and immobilized to a degree. If the environment for growing newbone tissue is not quite right, the spinal fusion may prove ineffective. Thisis one of the main causes of failed back syndrome.

Another common scenario happens after a discectomyor laminectomy to relieve symptoms of a herniateddisc when the patient has degenerative disc disease . The surgery may have been performedflawlessly, but DDD can affect multiple locations in the spinal column.

Sometimes patients have one disc herniationrepaired only to find that another herniation has occurred after recovery fromthe surgery, or a more minor existing herniation was being masked by strongersymptoms, which the surgery addressed.

The risk for failed back syndrome rises witheach surgery. According to a 2018 review in Asian Spine Journal, about half of initial surgeries aresuccessful. That percentage, however, drops to 30 percent, then 15 percent,then 5 percent after the second, third and fourth surgeries.

  • Nerve injury
  • Hematoma formation

In later stages, changes to the spinal column can affect the way a patient moves, which can cause further spinal problems after time.

What Happens Before Surgery

Health exam You will need to have a physical exam from your primary care physician before surgery to be sure your heart and lungs are healthy. A blood test, electrocardiogram , and chest X-ray may be performed. Discuss all medications you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery. Medications that thin the blood should be stopped 7-10 days prior to surgery. Drugs that thin the blood include:

  • Antiplatelets
  • Wintergreen snuff

Do not drink alcohol 1 week before and 2 weeks after surgery to avoid bleeding problems.

The hospital will call you several days before your surgery and ask questions about your health . They will also ask for a complete list of medications including prescriptions, over-the-counter, and herbal supplements.

SmokingThe most important way to achieve a successful spinal fusion surgery is to quit smoking. Stop all tobacco use: cigarettes, e-cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco . Nicotine prevents bone growth and decreases successful fusion. Fusions fail in 40% of smokers, compared with 8% of non-smokers . Smoking also decreases blood circulation, resulting in slower wound healing and an increased risk of infection.

Talk with your doctor about nicotine replacements, pills without nicotine , and tobacco counseling programs.

What to bring to the hospital

Night before surgery

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A Patient’s Guide To Complications Of Spine Surgery

Introduction

With any surgery, there is the risk of complications. When surgery is donenear the spine and spinal cord, these complications can be veryserious. Complications could involve subsequent pain and impairment and theneed for additional surgery. You should discuss the complications associatedwith surgery with your doctor before surgery. The list of complications providedhere is not intended to be a complete list of complications and is not a substitutefor discussing the risks of surgery with your doctor. Only your doctor can evaluateyour condition and inform you of the risks of any medical treatment he or shemay recommend.

Anesthesia Complications

Thrombophlebitis

When blood clots form inside the veins of the legs, it is referred to as DeepVenous Thrombosis . This is a common problem following many types of surgicalprocedures. It is true that these blood clots can also form in certain individualswho have not undergone any recent surgery. These blood clots form in the largeveins of the calf and may continue to grow and extend up into the veins of thethigh, and in some cases into the veins of the pelvis.

Reducing the risk of developing DVT is a high priority following any type ofsurgery. Things that can be done to reduce the risk of developing DVT fall intotwo categories:

  • Mechanical – getting the blood moving better
  • Medical – using drugs to slow the clotting process

Mechanical

Medical

Lung Problems

Infection

Hardware Fracture

Implant Migration

Spinal Cord Injury

What Happens During Lumbar Decompression Surgery

Endoscopic Lumbar Discectomy

If lumbar decompression surgery is recommended, you’ll usually have at least 1 of the following procedures:

  • laminectomy where a section of bone is removed from 1 of your vertebrae to relieve pressure on the affected nerve
  • discectomy where a section of a damaged disc is removed to relieve pressure on a nerve
  • spinal fusion where 2 or more vertebrae are joined together with a section of bone to stabilise and strengthen the spine

In many cases, a combination of these techniques may be used.

Lumbar decompression is usually carried out under general anaesthetic, which means you’ll be unconscious during the procedure and won’t feel any pain as it’s carried out. The whole operation usually takes at least an hour, but may take much longer, depending on the complexity of the procedure.

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