Back pain is known to arise from nerve root compression or pressure on the dura sac surrounding the spinal cord. Back pain can stem from muscle spasm or mechanical pain. Episodes of low back pain can affect anyone at any point in his or her life and they can cause extreme pain. Despite the disruption acute back pain causes, it usually gets better with time and conservative non-surgical care, especially if it is just a case of muscle spasm from a pulled muscle or charley horse. Mechanical acute pain which worsens with activity is different to muscle spasms. It potentially may be a problem of instability or nerve pinching from anatomical complications, which requires surgery. Patients with low back pain should consult their primary physician for prescribed medicines, physical therapy and chiropractor to help alleviate the back pain, before consulting an orthopedic spine surgeon.
The patient’s symptoms have to fit with identifiable cause in the clinical and radiographic pictures such as MRI scan, CT scan myelogram or discography, for spine surgery to be recommended. When all conservative treatments fail over time, surgical options for back pain may be indicated as a last resort treatment.
Surgical procedures for back pain
A laminectomy is a surgical procedure to remove parts of the vertebral bone known as the lamina, bone spurs or ligaments in the back to relieve pressure on the spinal nerves. It is minimally invasive requiring only small incisions to push aside the back muscles instead of cutting into them. Portions of the vertebra adjacent to the lamina are left undamaged. A laminectomy may cause the spine to become somewhat unstable and require a spinal fusion to be performed.
A foraminotomy is performed by the surgeon to cut away bone at the sides of the vertebrae to make space for the nerve roots exiting the spine. The distended space can relieve pressure on the nerves, helping to relieve any agonizing pain. A foraminotomy too can sometimes result in reducing the stability of the spine, and a spinal fusion may be performed at the same time to correct the problem with the spine.
The spinal disc that acts as a cushion to separate the vertebrae may be inflamed from a bulging or slipped disc, causing it to press on a spinal nerve and cause back pain. In a discectomy procedure, the surgeon removes all or part of the herniated lumbar disc material pressing on the nerve root or the spinal cord. A discectomy can be performed either through a large incision or even with a smaller incision using micro tools from outside, known as microdiscectomy. Microdiscectomy uses a special microscope to get a larger view of the disc and nerves and therefore requires only a smaller cut, which causes less tissue damage. A discectomy can often form part of a larger surgery involving laminectomy, foraminotomy, or spinal fusion.
- Disc Replacement
In artificial disc replacement surgery, the surgeon removes a damaged spinal disc to insert an artificial disc between the vertebrae, which enables continued motion of the spine. This procedure is seen is seen as an alternative to spinal fusion because the recovery time for a disc replacement may be shorter in many people. Though there may be a small risk associated for artificial disc replacement surgery of the foreign artificial disc failing or dislodging.
- Spinal fusion
Spinal fusion is one of the most common surgical options for back pain, where mechanical back pain cannot be treated with aggressive conservative treatment, exercise and strengthening physiotherapy for the spinal muscles and ligaments. In this procedure the surgeon joins spinal bones, known as vertebrae, together to restrict movement between the bones of the spine at a painful vertebral motion segment. This should reduce the pain from the affected joint. Lumbar spinal fusion surgery involves adding bone graft to a section of the spine to allow a biological response in the body causing the bone graft to grow between the vertebral sections to create a bone fusion. This fixed bone created through the fusion procedure replaces the mobile joint to prevent any motion between the painful joints and also limit the stretching of the spinal nerves. Spinal fusions can be anterior or posterior in location, and sometimes cages or screws are used to further support the fusion. Spinal fusion surgery may not just be limited to one motion disc but across several motion segments.
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