Surgery may be considered if you have back pain from a herniated disk, spinal
stenosis, or sciatica that does not respond to medication or physical therapy.
Even though surgery is an option for these conditions, treating them without
surgery is better whenever possible. In fact, 90% of people with a herniated
disk can be treated without surgery.
Laminectomy and laminotomy
Operations that remove all (laminectomy) or part (laminotomy) of the arch
of the vertebrae may be used if you have spinal stenosis or some other vertebral
abnormality pressing on a nerve. This surgery may also be considered as part
of a larger procedure to remove a tumor on the spine. Like diskectomy, many
people will feel immediate relief after the procedure. However, recurrent back
pain is very common.
This surgical procedure removes the disk that is causing your pain. By doing
this, pressure on your spine is relieved. There are now ways to perform this
surgery with as little invasion as possible. For example, very small incisions
may be used.
|In a diskectomy, part or all of the disk is removed,
which reduces pressure on the spinal nerve.
While there may be an immediate relief from pain following this operation,
it is not clear whether this provides any more long-term improvement than treatment
with medications, physical therapy, exercise, and the other measures discussed
in this guide.
Following the procedure, you may develop scar tissue, which could cause back
pain itself. You will need to do a lot of resting for 3 - 4 days after this
surgery. But, it may take 4 - 6 weeks to fully recover.
When motion between two or more vertebrae causes severe pain, your surgeon
may recommend spinal fusion. This procedure eliminates motion between the bones
of the back by eliminating the joints between the bones and forming a solid
bony bridge. This is usually done by using a combination of metal implants,
like screws and rods, and grafting bone onto the spine from another part of
your body. The bone often comes from your pelvis.
Recovery from this procedure usually takes longer than from diskectomy or
laminectomy. Your surgeon may recommend you wear a brace after surgery as the
bone heals. This type of surgery is usually for people with chronic back pain
that has not responded to other treatments. Spinal fusion may also help people
who have instability of the spine, a condition that occurs when the connections
between the vertebrae have deteriorated, allowing vertebrae to slide back and
forth against each other.
The artificial disk is a newer method of spine surgery. This implanted device
is an alternative to fusion for some people.
Sometimes, a degenerated disk that is causing back pain can be removed through
surgery. However, when a disk is removed, the vertebrae in that area of the
spinal column must be re-connected. Typically, surgeons will use spinal fusion
to reconnect the vertebrae, which eliminates motion between the vertebrae.
The artificial disk, however, preserves motion between the vertebrae.
While experts believe there are many advantages to preserving motion, no long-term
studies prove that replacing a disk with an artificial one is better than spinal
fusion. Some surgeons are waiting for the results of more research before recommending
this new technology.
Review Date: 4/6/2007
Reviewed By: Benjamin D. Roye, M.D., M.P.H., Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY. Review provided by VeriMed Healthcare Network.
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