Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery.
This surgery involves joining two vertebrae to eliminate painful movement.
In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective for back pain.
A lumbar laminectomy is a surgical procedure that is performed to alleviate pain caused by impingement of the spinal cord or the nerve roots, which is most often caused by spinal stenosis. The laminectomy surgery is designed to remove a small portion of the bone over the spinal canal to give the nerve roots more space and a better healing environment. A laminectomy is effective to decrease pain and improve function for patients with lumbar spinal stenosis.
First, the back is approached through a small incision in the midline of the back and the left and right back muscles (erector spinae) are dissected off the lamina on both sides and at multiple levels. After the spine is approached, the lamina is removed (laminectomy) which allows visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may then be undercut (trimmed) to give the nerve roots more room.
Post-operatively, most patients are in the hospital for one to two days.
The individual patient's return to normal activity is largely dependent on his/her pre-operative condition and age. Directly following the procedure, patients are encouraged to walk. However, it is recommended that patients avoid excessive bending, lifting or twisting for six weeks in order to avoid pulling on the wound before it heals.
The success rate of a laminectomy surgery is favorable. Following surgery, approximately 80% to 90% of patients will have significant improvement in their function (ability to perform normal daily activities) and markedly reduced level of pain and discomfort.
The laminectomy surgical results are much better for relief of leg pain caused by spinal stenosis, and not nearly as reliable for relief of lower back pain.
The potential risks and complications with a laminectomy procedure include:
Nerve root damage (1 in 1,000) or bowel/bladder incontinence (1 in 10,000).
Paralysis would be extremely unusual since the spinal cord stops at about the L1 level, and surgery is usually done well below this level.
1 to 3% of the time a cerebrospinal fluid leak may be encountered if the dural sac is breached. This does not change the outcome of the surgery, and generally a patient just needs to lie down for about 24 hours to allow the leak to seal.
Infections happen in about 1% of any elective cases, and although this is a major nuisance and often requires further surgery to clean it up along with IV antibiotics, it generally can be managed and cured effectively.
Bleeding is an uncommon complication as there are no major blood vessels in the area.
In approximately 5 to 10% of cases, postoperative instability of the operated level can be encountered. This complication can be minimized by avoiding disruption of the pars interarticularis during surgery, as this is an important structure for stability. Also, the natural history of a degenerative facet joint may lead it to continue to degenerate on its own and result in a degenerative spondylolisthesis. Either of these conditions can be treated by fusing the affected joint at a later date.
General anesthetic complications such as myocardial infarction (heart attack), blood clots, stroke, pneumonia or pulmonary embolism can happen with any surgery. Although in the general population these complications are rare, laminectomy surgery for spinal stenosis is generally done for elderly patients and therefore the risk of general anesthetic complications is somewhat higher.
A microdiscectomy is a surgical procedure that is performed to relieve pain caused by a herniated disc. In this procedure, only the portion of the disc that is pinching the nerve is removed. A microdiscectomy surgery is actually more effective for treating leg pain, or radiculopathy, than for lower back pain. Most patients experience relief of leg pain immediately after surgery; however, in some cases it may take months for the nerve root to fully heal and any numbness or weakness to improve.
A microdiscectomy is performed through a small (3/4 inch to 1 1/2 inch) incision in the midline of the low back. First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine.
A small portion of the lamina is removed both to facilitate access to the nerve root and to relieve pressure over the nerve. A thick membrane over the nerve roots (ligamentum flavum) is removed, which allows visualization of the nerve root. The nerve root is then gently moved to the side and the disc material is removed from under the nerve root.
A microdiscectomy does not disrupt much of the joints, muscles, or ligaments in the spine, and therefore does not seriously alter the stability of the spine.
When to have microdiskectomy spine surgery Most herniated discs resolve with conservative treatment in six to eight weeks. As long as the pain is tolerable and the patient can function adequately, conservative treatment should be continued. During the first six to eight weeks, surgery is only indicated if the patient develops progressive weakness and neurological deficits, the leg pain is intolerable, or symptoms of cauda equina syndrome are present. Microdiskectomy spine surgery is typically recommended for patients who have experienced leg pain for at least six weeks and have not found sufficient pain relief with conservative treatment . However, after six months the results of the microdiskectomy are not quite as favorable, so postponing microdiskectomy surgery for a prolonged period of time is not recommended.
Usually, the microdiscectomy procedure is performed on an outpatient basis (with no overnight stay in the hospital) or with one night in the hospital. Post-operatively, patients may return to a normal level of daily activity quickly. However, the patient is advised to avoid bending, lifting objects over fifteen pounds, or twisting for the first six weeks following surgery. Depending on their line of work, most patients return to their jobs in two weeks.
Microdiscectomy spine surgery success rate The success rate for relief of leg pain from a microdiskectomy is approximately 90% to 95%. While these patients get relief of their leg pain, some may experience numbness or tingling, weakness in the leg, or back pain. These symptoms typically resolve within a few months of surgery.
There is a 5% to 10% risk of reherniation of the disc. A recurrent disc herniation may occur directly after surgery or many years later, although they are most common in the first two to three months after surgery.
Recurrent herniated discs occur because within some disc spaces there are multiple fragments of disc that can come out at a later date. If the disc does herniate again, generally a revision microdiscectomy will be just as successful as the first operation. However, after a recurrence, the patient is at higher risk of further recurrences (15 to 20% chance). For patients with multiple herniated disc recurrences, a spine fusion surgery may be recommended to prevent further recurrences. Removing the entire disc space and fusing the level is the only way to absolutely assure that no further disc herniations can occur.
Following a microdiskectomy spine surgery, physical therapy may be recommended to strengthen of the back and to help prevent recurrence of back pain.
Microdiskectomy surgery risks and complications As with any form of spine surgery, there are several risks and complications that are associated with a microdiskectomy procedure, including:
Dural tear (cerebrospinal fluid leak). This occurs in 1% to 2% of these surgeries and does not change the results of surgery, but post-operatively the patient may be asked to lay flat for 24 hours to allow the leak to seal.
Nerve root damage
Bowel/bladder incontinence
Bleeding
Infection
However, the above complications for microdiscectomy spine surgery are quite rare.
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