Back Pain Surgery
Operative treatments continued...
For herniated discs:
operation, part of the lamina, a portion of the bone on the back of the
vertebrae, is removed, as well as a portion of a ligament. The herniated disc
is then removed through the incision, which may extend two or more inches.
As with traditional
discectomy, this procedure involves removing a herniated disc or damaged
portion of a disc through an incision in the back. The difference is that the
incision is much smaller and the doctor uses a magnifying microscope or lenses
to locate the disc through the incision. The smaller incision may reduce pain
and the disruption of tissues, and it reduces the size of the surgical scar. It
appears to take about the same time to recuperate from a microdiscectomy as
from a traditional discectomy.
in recent decades have led to the use of lasers for operating on patients with
herniated discs accompanied by lower back and leg pain. During this procedure,
the surgeon inserts a needle in the disc that delivers a few bursts of laser
energy to vaporize the tissue in the disc. This reduces its size and relieves
pressure on the nerves. Although many patients return to daily activities
within 3 to 5 days after laser surgery, pain relief may not be apparent until
several weeks or even months after the surgery. The usefulness of laser
discectomy is still being debated.
For spinal stenosis:
When narrowing of the
spine compresses the nerve roots, causing pain and/or affecting sensation,
doctors sometimes open up the spinal column with a procedure called a
laminectomy. In a laminectomy, the doctor makes a large incision down the
affected area of the spine and removes the lamina and any bone spurs, which are
overgrowths of bone, that may have formed in the spinal canal as the result of
osteoarthritis. The procedure is major surgery that requires a short hospital
stay and physical therapy afterwards to help regain strength and mobility.
When a slipped
vertebra leads to the enlargement of adjacent facet joints, surgical treatment
generally involves both laminectomy (as described above) and spinal fusion. In
spinal fusion, two or more vertebrae are joined together using bone grafts,
screws, and rods to stop slippage of the affected vertebrae. Bone used for
grafting comes from another area of the body, usually the hip or pelvis. In
some cases, donor bone is used.
Although the surgery is generally successful, either type of
graft has its drawbacks. Using your own bone means surgery at a second site on
your body. With donor bone, there is a slight risk of disease transmission or
rejection. In recent years, a new development has eliminated those risks for
some people undergoing spinal fusion: proteins called bone morphogenic proteins
are being used to stimulate bone generation, eliminating the need for grafts.
The proteins are placed in the affected area of the spine, often in collagen
putty or sponges.