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 youve tried a laundry list of non-surgical treatments, your MRI and X-ray show a treatable structural problem, and your physicians 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:
Surgery For Low Back Pain
Surgery to treat low back pain can be a far more extensive type of back surgery, with a longer healing period and a somewhat lower success rate, than back surgery for a pinched nerve . If the patient does not get low back pain relief after 6 to 12 months of conservative treatment, however, a fusion surgery may be a reasonable option. When the patient has the right indications, low back surgery to stop the motion at a painful motion segment and remove the pain generator should reduce the patient’s lower back pain.
Myth: Surgery Doesnt Work Since Some Patients Need More Surgeries Down The Road
Fact: When it comes to back pain, surgery can be a lifesaver for many patients. Success rates vary by type of procedure, but they tend to be impressive. For example, spine surgery for lower back or leg pain has a success rate of between 70 to 90 percent, depending on the specific condition being treated.
There are times when you may need a second surgery. That doesnt necessarily mean that the surgery didnt work the first time. It may mean that a different part of your back is actually causing your pain, or that an entirely new problem has arisen.
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Can A Laminectomy Treat A Herniated Disk
Yes, spine surgeons commonly perform a special type of laminectomy to treat a herniated disk.
Intervertebral disks are soft, flexible cushions between the back bones that are the shock-absorbers for the spine. A herniated disk happens when the soft inner portion of the disk is pushed outside the fibrous external covering. The extruded disc material can then push against a spinal nerve or the spinal cord leading to a serious problem. A herniated disk can be very painful.
Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
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Candidates For Mis Surgery
A doctor will be able to tell which MIS surgeries, if any, might be an option for treating a spinal condition. In some situations, MIS surgery may not be as safe or effective as traditional open surgery. If so, the doctor will be able to inform you about the relative risks and benefits. In addition, there are some conditions that are not truly treatable with MIS surgery.
What Happens During Lumbar Decompression Surgery
If lumbar decompression surgery is recommended, you’ll usually have at least one of the following procedures:
- laminectomy where a section of bone is removed from one 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 two 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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Who Performs Lumbar Surgery
Orthopedic surgeons commonly perform lumbar surgery. Orthopedic surgeons specialize in treating diseases, disorders and conditions of the muscles, bones and joints. Other types of doctors may also perform these surgeries, including interventional radiologists, neuroradiologists, and neurosurgeons who specialize in the spine.
Sensations That Might Indicate A Medical Emergency
1. Sharp pain rather than a dull ache: This could indicate a torn muscle or ligament, or a problem with an internal organ in the back or side.2. Radiating pain: This pain “moves” or shoots to the glutes or legs, which could indicate a nerve compression condition.
3. Sudden weakness in the legs: Limb weakness can be caused by compressed nerves in the spine due to conditions like sciatica or spinal stenosis. However, sudden leg weakness could also indicate a stroke.4. Incontinence: Back pain paired with inability to control the bowels or bladder might be a sign of serious nerve compression or a spine infection, such as discitis or meningitis.5. Numbness or pins and needles in the groin or glutes: This is known as saddle anesthesia and is also a sign of a serious nerve or spine condition.
If you have leg weakness, incontinence, and numbness together, you might have cauda equina syndrome, a serious illness characterized by spinal cord nerve damage. This is a medical emergency, and patients usually need surgery immediately to decompress the nerves and reduce permanent damage.
Related reading: Get help for back, neck, and leg pain caused by spinal stenosis
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Cervical Spine Surgery Complications
No surgery is without risks and there is the risk of complications through any surgery but when the surgery is undergone near the spine and spinal cord, these complications are very serious.
General complications of most surgery include infection, bleeding, blood clots, and anesthesia risks.
Some patients might need several additional surgeries, after spine surgery. A list of some common complications are provided here:
Do The Benefits Outweigh The Risks
Like most surgeries that require general anesthesia, sciatica surgery comes with the risk of blood clots and heart attack. Infection is also a risk with most surgeries. And since this particular operation involves tissues around a nerve, nerve injury is a possibility.
In addition to the general surgery risks, there may be risk factors specific to your background, lifestyle or state of health. Doctors call them comorbidities. They may increase your risk during the surgery or affect how successful the surgery is in relieving your sciatica pain. Studies have shown that factors such as smoking, high blood pressure, diabetes and duration of the sciatica pain before surgery may affect the outcome of the procedure.
If you are seriously considering sciatica surgery, it’s important to partner with a surgeon who would look beyond your physical symptoms and help assess many other factors that may influence your decision.
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Spine Surgery Risks And Potential Complications
Surgery of any type has the potential for complications, and spine surgery is no different. If you have a scheduled spine surgery, one of your first questions is likely about the risks of your procedure. While your surgeon will explain the possible risks of your specific back or neck treatment, this article describes potential general complications of spine surgery: anesthesia, bleeding, blood clots, dural tear, infection, lung problems, and persistent pain.This article describes potential general complications of spine surgery. Photo Source: 123RF.com.In your pre-surgery meetings with your medical team, its important you accurately answer questions related to your medical history, allergies, medication regimen, and lifestyle choices, as these can help your doctor understand your potential surgery risks. Many factors can affect your risk for a surgical complication, such as:
- Overall health
Fortunately, the likelihood that any of the general surgery complications listed below will occur during or after your surgery are rare.
If you want to learn about more specific spine surgery risks, read .
Wrong Back Strengthening Exercises
Any type of exercise is good for you, right?
When you have low back pain, it usually means that you have some type of muscle imbalances that cause it in the first place.
Just random back strengthening exercises, that are not tailored to fix your specific injury, can make the problem much WORSE.
For example, if you have sciatica, a hamstring stretch is a bad idea.
Whether youre standing and leaning forward, in a runners stretch, or leaning over both feet, this one stretch aggravates the entire length of your sciatic nerve, from the lower back to the heel.
The Safe Alternative
The best exercises for your lower back pain should be tailored specifically to your muscle imbalances.
The first step, obviously, is to identify your muscle imbalances. The next step is to do the specific back and core exercises to re-balance these muscle groups.
You can spend hours researching this online, or you can simply use The Lose the Back Pain system, which shows you how to discover tour muscle imbalances and the exact exercises you need to fix them.
If you are serious about permanently curing your low back pain , I highly recommend this inexpensive program. I believe they even gave a free trial for it, so you have nothing to lose.
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Facial Sores And Loss Of Vision
As you’re positioned face down during lumbar decompression surgery, you’ll be resting on your forehead and chin while the operation is carried out.
The anaesthetist will check regularly to make sure this isn’t causing any problems, but many people will wake up with a slightly puffed up face. In some cases, a red sore can develop over the forehead or chin, which could last several days.
Treatments For Spinal Stenosis
Thankfully, spinal stenosis can often be treated, first with anti-inflammatories, physical therapy, and epidural steroid injections, which can decrease inflammation and pain. Minimally invasive surgery can also be performed in an outpatient procedure with a small incision and no stiches.
When its time to see a doctor for treatment for back pain that wont go away or is worsening, seek out a leader in minimally invasive procedures. Advances in minimally invasive treatments means treating chronic back pain is easier than ever. Between outpatient treatments and minimally invasive surgical procedures using small incisions, you can expect a quicker recovery time instead of a long hospital stay.
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Common Causes Of Back Pain
The causes of back pain can vary from one extreme to the other, and each type of accident or injury can result in severe and chronic back pain if left untreated for too long.
If you believe you have injured your back in an accident or suffered an injury, do not wait to seek treatment.
Some pain will take time to develop and by the time you visit a doctor or chiropractor the damage will be irreversible.
No matter what type of accident or injury caused your back pain, a chiropractor should be able to help you repair the damage without the need for surgery.
Some of the most common causes for back pain include,
- Repetitive Stress
- Degenerative Disc Disease
Open Spine Surgery Or Minimally Invasive Spine Surgery
If your surgery is performed through a relatively large incision in your back, that’s called open surgery. Another option is minimally invasive surgery, which is done through several small incisions. The surgeon may use a microscope, endoscope, or tiny camera and very small surgical instruments.
However, minimally invasive surgery is not for everyone. If your surgeon needs to work on many vertebrae, you’ll probably need to have open surgery.
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Surgical Approaches To The Cervical Spine
The cervical spine could be approached from the front called “anterior approach” or from the back called “posterior approach”. In most cases, if both approaches are possible, surgeons prefer the anterior approach to the cervical spine. Anterior approach has less disruption and also is easier for surgeons to maintain the normal alliance of the spine. There are some cases that only require a posterior approach or even a few cases require a combination of anterior and posterior approach.
Questions To Answer Before Considering Sciatica Surgery
Sciatica is the type of pain that originates in your lower back and typically radiates down one or both of your legs. It results from the inflammation of the sciatic nerve in your lower back. The medical term for sciatica is lumbar radiculopathy: pinching of a nerve as it exits the spine.
Surgery is one of the treatment options for sciatica, but it’s not for everyone. Below are some important questions to consider before making your decision, addressed by orthopaedic surgeon Brian Neuman.
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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.
Interested In The Balancedback Fusion Surgery Alternative
If youre facing the prospect of spinal fusion surgery and are searching for an alternative, we encourage you to explore the BalancedBack website, including our patient stories, surgical results, and the Knowledge Center.
3Spine is a new kind of healthcare company that vertically integrates the development, clinical research, and delivery of novel healthcare technology. The BalancedBack Total Joint Replacement is the technology platform developed by 3Spine as an alternative to fusion for the lumbar spine.
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Understanding The Risks Of Spine Surgery
There are many potential complications that can occur with spine surgery, and listing them one-by-one can be a bit overwhelming. It is easier to break the risks into categories to help making understanding them easier.
There are three general categories of risk with any surgery, including spine surgery:
- Risks of Anesthesia
- Risks of Complications that can occur During the Surgery
- Risks of Complications that can occur After the Surgery
RISKS OF ANESTHESIA
Most spinal operations require general anesthesia. Although all types of anesthesia involve some risk, major side effects and complications from anesthesia are uncommon. Your specific risks depend on your health, the type of anesthesia used, and your response to anesthesia.
These risks can include:
- Changes in heart rate or rhythm
- Death risk is 1 out of 200,000
- Nausea and vomiting after the surgery
- Complications from the breathing tube
- Swelling of the throat
- Damage to the teeth or lips
RISKS OF COMPLICATIONS DURING THE SURGERY
- Nerve or spinal cord injury 1 out of 5,000
- Injury to nearby anatomical structures – rare
- Abnormal bleeding
- Dural tear and spinal fluid leak 1%
Nerve or Spinal Cord Injury
RISKS OF COMPLICATIONS AFTER THE SURGERY
- Continued pain, numbness or weakness
- Blood clots in the legs
- Dural tear and spinal fluid leak
- Medical complications
- Wound Infection 1%
- Implant & Fusion Complications
Persistent Pain, Numbness or Weakness
Implant & Fusion Complications
What Happens Before Surgery
In the doctors office, you will sign consent and other forms so that the surgeon knows your medical history . Discuss all medications you are taking with your health care provider. Presurgical tests may need to be done several days before surgery. Consult your primary care physician about stopping certain medications and ensure you are cleared for surgery.
Continue taking the medications your surgeon recommends. Stop taking all non-steroidal anti-inflammatory medicines and blood thinners 7 days before surgery. Stop using nicotine and drinking alcohol 1 week before and 2 weeks after surgery to avoid bleeding and healing problems.
You may be asked to wash your skin with Hibiclens or Dial soap before surgery. It kills bacteria and reduces surgical site infections.
Morning of surgery
- Dont eat or drink after midnight before surgery . You may take permitted medicines with a small sip of water.
- Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
- Wear flat-heeled shoes with closed backs.
- Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
- Leave all valuables and jewelry at home.
- Bring a list of medications with dosages and the times of day usually taken.
- Bring a list of allergies to medication or foods.
Arrive at the hospital 2 hours before your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks.
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