Depending on the diagnosis, lumbar surgery may be either the first treatment option, which happens in rare cases, or the alternative of choice in lumbar pain refractory to most medical treatments.
If you have constant pain or if the pain occurs frequently and interferes with sleep, work or other daily activities, then surgery may be needed in the spine.
Usually the results of lumbar surgery are more predictable in people with sciatic nerve damage, in those who suffer only from isolated low back pain, the effectiveness of the interventions is lower.
1. Conditions that require surgical treatment
This is a condition in which the outer shell of the intervertebral disc, made up of concentric rings of connective tissue, is damaged, allowing the inner part of the disc – which has a gelatinous consistency – to protrude outward, compressing the surrounding nerves.
This causes sciatic pain, which radiates along the lower limb. Disc herniation is often also called intervertebral disc rupture.
It is characterized by narrowing of the bone canal through which the spinal cord and spinal nerves pass. Spinal stenosis is usually caused by excessive bone development due to osteoarthritis of the spine.
Compression of the nerves in the case of spinal stenosis leads to low back pain, paresthesia in the lower limbs and loss of bladder and / or intestinal control. These patients may have difficulty walking any distance and severe lower limb pain.
A condition in which a vertebra slips from its place in the spine. As a result of attempts to stabilize the spine, the joints between the vertebrae that have changed position and the adjacent vertebrae enlarge, leading to compression of the spinal nerves at their exit through the intervertebral holes.
Spondylolisthesis causes both low back and lower limb pain along the sciatic nerve.
Fractures caused by vertebral trauma or caused by osteoporotic collapse of the vertebral bodies. Vertebral fractures lead to low back pain and lower limb pain – by compressing the roots of the spinal nerves.
2. Surgical procedures
Here are some of the most commonly used surgical procedures:
In case of disc herniation:
Laminectomy / discectomy: in this operation, the dorsal portion of the affected vertebra and a ligament portion are removed in order to extract the herniated disc, in order to decompress the spinal cord and the roots of the spinal nerves.
Microdiscectomy: As with discectomy, this procedure removes the herniated disc through an incision made in the back, with the amendment that the incision is much smaller and the doctor uses a special microscope to locate the herniated disc.
The fact that the incision is small decreases the size of the postoperative scar and the intensity of the post-intervention pain. It seems that the recovery period after the intervention is the same as in the case of classical discectomy.
Laser surgery: Technical advances in recent decades have made it possible to use lasers in herniated disc operations.
During these procedures, the surgeon inserts a needle into the disc and then releases a few laser pulses at that level to vaporize the tissue inside the disc. This reduces its volume and moves the pressure exerted by the disc on the surrounding nerves.
The decrease in pain intensity in the case of this intervention is not immediately noticed by the patient; Although it can return to daily activities after 3-5 days of surgery, the pain decreases in intensity only after a few weeks or months after surgery. There is currently some controversy in the medical world over the effectiveness of this type of intervention.
In the case of spinal stenosis:
Laminectomy: When the narrowing of the spinal canal compresses the roots of the spinal nerves with the appearance of pain or paresthesias, doctors resort to decompression of the spinal canal, resorting to a surgical procedure called laminectomy.
A wide incision is made, the purpose of which is to partially remove the ligaments and osteophytes that appeared as a result of osteoarthritis. The operation is laborious and requires hospitalization and physiotherapy sessions to regain the strength and mobility of the spine.
In the case of osteoporotic vertebral fractures:
Vertebroplasty: When low back pain is caused by a fracture caused by osteoporosis or trauma, doctors can make a small skin incision above the affected area, which injects a polymer called polymethacrylate into the fractured vertebra, which reduces pain and stabilizes the spine. The method is performed on an outpatient basis under local anesthesia.
Kyphoplasty: Similar to vertebroplasty, kyphoplasty is used to reduce pain and stabilize the spine following osteoporotic fractures. Kyphoplasty is a two-step procedure. The doctor initially inserts a balloon-like device to restore the height and shape of the spine.
Subsequently, polymethacrylate is injected to repair the fractured vertebra. The procedure is under anesthesia and in some cases can be performed on an outpatient basis.