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Spine Surgery
Relevant information about Spine Surgery.
Back pain can be caused by several things such as damage of the joints, ligaments, disc or the muscles or a combination of these, and a few treatments are recommended before spinal surgery is even considered as an option. Among these, one can try to rest the spine in order to treat low back pain, mainly because this type of pain is caused by muscle strain. However, the advised rest time is two to three days, due to the fact that more time can cause persistent pain. Anti-inflammatory medications (however, GI bleeding is part of side-effects, and those who suffer from stomach ulcers should not take them) and heat application (easing discomfort) are other treatments, as well as doing exercises (involving strengthening back muscles that can lead to flexibility and a minor amount of force is compressed on the spine), physical therapy (such as aquatherapy) and epidural steroid injections. Alternative treatments for back pain are visiting a chiropractor, which is believed to have a very effective result; massages, which do not have a long-lasting effect; and finally, acupuncture. The largest numbers of people suffering from back pain improve their condition without surgery, just with minimal treatment. Doctors suggest that treatments must last from 3 to 6 months before considering Spine Surgery.
Surgery is a step taken when the patient has tried all of the recommended treatments and none has relieved the pain. It must be an evaluated decision, primarily depending on the seriousness of the condition, whether there is pressure on the spinal cord, and past medical history.
There are different types of spine surgeries. These include:
- Discectomy: a disc herniation happens when a piece or fragment of the spinal disc is displaced, and it might press against the spinal cord or the nerves around it. In these cases, a discectomy is performed in order to remove the herniated disc from the spinal canal; general anesthesia is used, taking approximately an hour to finish the procedure. However, the time-extension of the surgery relies on the severity of the disc herniation. A small incision (3 centimeters) is done on the center of the back, dissecting the muscles around the spine and removing bone and ligament. Then, the spinal nerves are protected and the herniated disc is removed. Possible complications include that another fragment of disc herniates (between 10 and 15% of the cases), infection, and spinal fluid leaks. After the surgery is done, patients should be pain free. However, if this remains, a lumbar corset brace helps to control it. Bending excessively is out of the question, as well as lifting heavy weight and exercise, at least for a few weeks. Nevertheless, taking walks are authorized.
- Foraminotomy: its goal is to alleviate the symptoms caused by foraminal stenosis. The foramen, which is the cavity where the spinal nerves cross when they leave the spine, narrows leaving the possibility of leading to neurological symptoms; the nerves gets pinched which provokes numbness, pain and it weakens the muscle. This procedure relieves the pressure on the nerve. It consists of the removal of the bone and soft tissue that overlie the foramen. The risks involve damage to the spinal cord, but it is a low risk: 1%; bleeding, high pressure; damage of the nerves. However, these are very rare (1% of the cases). Patients, post-surgery, are symptoms-free. Some pain in the necks muscles might be suffered, but only for the firsts days after the procedure.
- Spine fusion: this procedure is done in order to link together different vertebrae within the spine, removing the source of the back pain. Bone growth is stimulated between the vertebrae, linking them together, and furtherly placing metal (spinal instrumentation) with the aim to hold the segments together. This will eliminate the motion between the fused vertebrae. Among the complications, the no-fusion of the segments and problems caused by the proximity of the vertebrae and discs can be found as well as bleeding and infection.
- Laminectomy: its goal is to relieve the pain on the back. It involves the removal of a part of the lamina, or body arch, located on the dorsal surface of a vertebra. Risks or complications are bleeding, worse back pain, spinal fluid leak, nerve damage and infection. General anesthesia is used and the surgery lasts between 1 and 3 hours. Patients are pain free after the operation, but its recovery is a slow process: the majority of the patients recover normal function after a year of the procedure; physical therapy may be needed in order to have a full recovery. However, this period of the recovery process depends on the type of laminectomy that has been done: on one side, if the minimal operation has been performed, recovery only will take days; on the other side, if the conventional open surgery has been performed, the process will take weeks or even months.
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