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eLearning Series:
Relieve My Back Pain NOW!
( 23 pages )
SURGICAL
TREATMENTS FOR BACK PAIN
The good news
about surgical treatments for back pain is twofold: 1) Less
than 1 percent of those who suffer from back pain ever
need it. 2) Medical advances have made back surgery easier
to tolerate and recover from, with more optimistic prospects
for recovery than ever before. At present, many experts agree
that more back surgery than was medically necessary was performed
in the past, with too many of the recipients not benefiting
from it. Some even became worse as a result. Today the standard
for back surgery is that an individual has a clearly defined
medical condition with a specific solution that will provide
clear benefits.
Below we will
look at the three most common types of back surgery: disc
surgery, spine stabilization
and creating additional space in the spine.
DISC SURGERY
There are general
standards that must be met before one can be a candidate
for disc surgery, a procedure that is usually
done when a disc is herniated (protrudes from its normal spot)
and causing severe discomfort.
A) An MIR or CT
scan reveals that a disc is pressing against the root of
a nerve.
B) Persistent
pain is experienced despite the use of more conservative
measures, such as weight loss, exercise,
and
ergonomic measures.
C) Severe pain
is radiating down the leg or into the buttock, despite conservative
interventions
of physical
therapy or
medications.
D) Neurological
warning signs are observed, such as the loss of reflexes
or bodily control. These may
be indicators
of
a surgical emergency.
Once the need
for disc surgery has been established there are a number
of approaches available:
1 Discectomy: This is the most frequently performed back operation. In
general, an incision is made
over
the disc
and a part, or
all of it, is removed in order to relieve pressure
on the nerve.
2 Microdiscectomy: The procedure is much the same as for a discectomy. The difference
is that
a smaller
incision is made
because magnification is used to enlarge the
view of
the
target space.
3 Laser
Decompression: A needle is inserted into the disc and a portion of it is
destroyed
with
a laser.
This relieves
pressure
on the nerve. The advantage of the procedure
is that it is less invasive than traditional
surgeries
and
can be
performed
on an outpatient basis.
4 Percutaneous
Removal: A small tube called an endoscope is inserted into
the back
and
used
to remove portions
of the disc.
This allows the surgeon to pinpoint the problem
and leave the surrounding area intact. This,
too, can
be performed
on an
outpatient basis.
5 Chemonucleolysis: This
is an alternative to taking out part or all of a disc. A
preparation
from papaya
plants,
called
chymopapain, is injected and has the effect
of
decreasing the size of a disc, with the
intention of relieving
nerve pressure.
Spine Stabilization
In
this form of back surgery two vertebrae are joined together
in a process called
spinal fusion.
It is
accomplished by
putting bone grafts either between
or alongside the vertebrae. Hollow
metal cages filled with bone graft
can also be inserted between the vertebrae.
The bones
may
be attached
to the vertebrae
with metal plates or screws that serve
as a brace.
Once the grafts
are in place the bones begin growing together, which serves
to fuse the
vertebrae. This
serves to bring
normal stability and strength to
structures
that have been fractured
or damaged by disease.
Creating Additional
Space
The purpose of
this form of surgery is quite simple: by opening up
more room
for the vertebrae
pressure
is taken
off the
affected nerve(s). Most often
this is done for patients with spinal
stenosis. In this condition the
spinal canal has become too narrow, with
the result being
a lack
of suitable
space for
the spinal cord and nerves that
causes pain in the back and weakness of
the legs.
In order to provide
more space a laminectomy is performed. This
involves
removing
portions of the
laminae, the
bones on the back of the vertebrae.
An
Improved Process
With greater specialization
in back surgery and the
ongoing development of techniques,
success
rates
have improved
and there has been a reduction
in
post-surgery difficulties.
Recovery
times, especially given
the growth in outpatient procedures
and rehabilitation
strategies,
have
been significantly reduced.
Surgeries that once were
regarded as things
we needed months to fully
recover from
are now
seen more as temporary interruptions, with
some only requiring a few
hours.
An important point
to remember when considering back surgery
is that
it is only helpful
when a specific
change in the anatomy
of an individual’s back
is called for to correct a condition
that has been clearly identified.
It
is not done
on an exploratory
basis or because no cause
has yet been found.
In
addition, even when the problem has been
identified, surgery is
generally regarded
as a last resort
and recommended only
after more conservative approaches,
such
as medication and physical therapy, have
been attempted and
judged not to be sufficient.
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