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Back surgery: pros, cons and common trajectory changes overview

When it comes the time you sign up your patient for back surgery, you must have already tried a number of treatments to ease their back pain or lower body weakness. Right?

Often, the result is more than just a drop in pain. Your patient may find that it is easier to move around, feel more physically fit, slight mood improvements, no need to take as much pain medicine and be more productive at work.
As in most of the surgeries, the odds that something could go wrong, go up for people with certain health conditions and they vary by type of surgery. Part of your surgeon’s job is to identify potential problems.

Let’s see – each type of surgery has its own risks:

Spinal fusion – this is probably the most common surgery for chronic nonspecific back pain with degenerative changes. Spinal bones will be joined together. It limits motion between them and how far the nerves will stretch but it won’t’ limit your patients’ activity.

Laminectomy – this is the most common surgery for lumbar spinal stenosis. You will need to remove parts of the bone, bone spurs, or ligaments. This will relieve pressure on spinal nerves but it can also make the spineless stable. If that is the case, your patient will need a spinal fusion as well. It is often to see booth procedures to be done together.

Foraminotomy – this surgery is used to relieve pain associated with a compressed nerve in the spine. The bone is cut at the side of the vertebrae to widen the space where the nerves exit the spine. The extra room will relieve pressure on the nerves and ease the pain. The surgeon may do a spinal fusion at the same time. It will increase the amount of time needed for recovery.

Diskectomy – sometimes a disk, the cushion that separates the vertebrae, can slip out of place, press on a spinal nerve, and cause back pain.  You might remove all or part of the disk and make a big cut in their back, or maybe there is a way to do it through a small one called microdiscectomy. Microdiscectomy is performed with an operating microscope through a smaller incision than open discectomy and has become the standard surgical procedure for lumbar disc herniation.

Disk replacement – you must remove the damaged spinal disk and inserts an artificial one between the vertebrae. Recovery time may be shorter than for spinal fusion. There is a slight chance the new disk could slip or fall out of place and require repair.

Interlaminar implant – a minimally invasive alternative to more invasive laminectomy or laminectomy plus fusion surgery. You must implant a U-shaped device between two vertebrae in the lower back. It can be done at the same time as laminectomy. Unlike spinal fusion, the implant provides stability and let your patient move the back almost like normal. They may not be able to bend backward as easily in that area.

Surgery is not the final step to stop back pain. After surgery, your patients will spend a few weeks of physical therapy. Physical therapy is designed to help the body reach optimal recovery, but it can be very difficult. It is fundamental that the therapist’s instructions be followed as closely as possible.

Physical therapy does not stop once your patient and their therapist part ways, though. They will send them home with exercises to do and it’s important to stay on track with these at-home activities.

Orthopedic Surgery Blog
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