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Surgery 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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