is it needed ? If yes then When ?
If you’ve struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Sometimes, surgery is the only treatment. However , majority of back problems can be remedied with non-surgical treatments—often referred to as non-surgical or conservative therapies.
Aging, improper body mechanics, trauma and structural abnormalities can injure your spine, leading to back pain and other symptoms such as leg pain and/or numbness or even leg weakness.
What about conservative treatment?
As with all non-emergency spinal surgeries, a trial of non-operative treatment, such as physical therapy, pain medication—preferably an anti-inflammatory, or bracing should be observed before surgery is considered. The trial period of conservative treatment varies, but six weeks to three months is the general timeframe.
Spine surgery may be recommended if non-surgical treatment such as medications and physical therapy fails to relieve symptoms. Surgery is only considered in cases where the exact source of pain can be determined—such as a herniated disc, scoliosis, or spinal stenosis.
Open surgery vs. minimally invasive surgery
Traditionally, spine surgery is usually performed as open surgery. This entails opening the operative site with a long incision so the surgeon can view and access the spinal anatomy. However, technology has advanced to the point where more spine conditions can be treated with minimally invasive techniques. As minimally invasive spine surgery (MISS), does not involve long incisions, open manipulation of the muscles and tissue surrounding the spine is avoided, therefore, leading to shorter operative time. In general, reducing intraoperative (during surgery) manipulation of soft tissues results in less postoperative pain and a faster recovery.
Not all patients are appropriate candidates for MISS procedures. There needs to be relative certainty that the same or better results can be achieved through MISS techniques as with an open procedure.
Common Procedures :
Discectomy or Microdiscectomy: Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve. Microdiscectomy is a MISS procedure.
Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.
Laminotomy: Removal of a portion of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.Both laminectomy and laminotomy are decompression procedures. “Decompression” usually means tissue compressing a spinal nerve is removed.
Foraminotomy: Removal of bone or tissue at/in the passageway (called the neuroforamen) where nerve roots branch off the spinal cord and exit the spinal column.
Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one.
Spinal fusion: A surgical technique used to join two vertebrae. Spinal fusion may include the use of bone graft with or without instrumentation (eg, rods, screws). There are different types of bone graft, such as your own bone (autograft) and donor bone (allograft). A fusion can be accomplished by different approaches: