Spine treatment options?
Updated: Nov 26, 2020
If you’ve struggled with back pain for any length of time, you may be wondering if spine surgery is your only treatment option. Aging, improper body mechanics, trauma and structural abnormalities can injure your spine, leading to back pain and other symptoms such as leg pain and/or numbness or even leg weakness. Chronic back pain is a condition that generally requires a Spine Specialist to diagnose and treat.
While most problems that cause back pain can be treated successfully without surgical intervention, sometimes spine surgery is necessary. Listed below are five important points you want to know about spine surgery.
Understand the Spine Surgery Procedure that's Been Recommended for You
It's important that you understand what procedure (operation) you are having preformed and why this is being done. Educate yourself on your condition and the goals of the surgical procedure. Spine City is a great resource for this information.
Some common spine surgeries include the following:
Discectomy treats herniated discs. A discectomy involves removing the soft gel-like material typically herniated out of the disc and compressing a spinal nerve. This returns the disc to a more normal shape and relieves the pressure on the nearby spinal nerve.
Laminectomy (removal of the entire lamina) or a laminotomy (removal of part of the lamina) are surgical procedures used to treat many spinal disorders including spondylolisthesis, spinal tumors, and spinal stenosis; a common cause of back pain particularly in older people. The lamina is a bony plate that is part of each vertebral body. It is located at the back of the spine and protects the spinal canal or entrance to the spinal cord and other nerve structures.
Foraminotomy treats pinched nerves. This procedure relieves spinal nerve compression by surgically increasing the size of the opening where spinal nerves exit the spine. This opening is call the foramen or neuroforamen.
Spinal Fusion often includes instrumentation and bone graft to stabilize the spine. Instrumentation refers to medical devices such as cages, plates, screws, and rods. There are different types of bone graft materials including the patient's own bone (autograft), donor bone (allograft), and bone morphogenetic protein (BMP). A spinal fusion may be included with another surgical procedure such as a discectomy or laminectomy.
Prepare for Your Spine Surgery
Seldom is spine surgery an emergency. Therefore, it is advantageous to be in the best physical condition possible. Here are a few helpful tips:
Eat right. Good nutrition is paramount to keep your immune system healthy. By eating a balanced diet with vitamin supplements in the weeks before your surgery, you will help to increase the chance for healthy wound healing and reduce the risk for infection.
Get in shape. Weak muscles and low cardiovascular endurance make recovery from the surgery more difficult. Talk to your doctor about how to start an exercise program that is right for your condition before and after spine surgery. If you already exercise regularly - make sure your exercise regimen is approved by your doctor and then keep it up!
Lose weight. Back pain can make losing weight or weight maintenance a challenge. If you are overweight it is a good idea to slim down before your surgery. Why? Because more body weight strains the spine and may slow the healing process and increase post-operative pain. If you need to lose more than 25 pounds before surgery, your doctor will talk to you about safe methods to shed those unwanted pounds.
Don't Smoke If you are a smoker, being told to quit may be the last thing you want to hear! However, it is the most important step you can take to help ensure a safe and successful surgery. Did you know that by quitting at least one month before surgery you can decrease your chance of experiencing a serious complication such as problems with anesthesia and post-operative pneumonia? Patients who quit increase the likelihood of a successful spinal surgery. If you think quitting may be difficult for you, talk to your doctor about smoking cessation programs in your area.
Find an Experienced Spine Surgeon
Most spine specialists are either neurosurgeons, or orthopaedic surgeons who specialize in spinal disorders. The following tips are provided to help you locate the best surgeon for your type of spine surgery:
Make sure the spine surgeon is board certified (or board eligible) having MBBS, MS, MCh qualifications. Some of the these specialist go on to do further advanced training in spine by doing various Fellowships.
Choose a spine surgeon who devotes at least 50% of his or her practice to the treatment of spinal conditions.
Make sure the doctor you choose is someone you feel confident in and who makes you feel comfortable.
Talk to the doctor about his or her experience with the latest techniques and technologies in spine surgery.
Open surgery vs. minimally invasive spinal surgery
Traditionally, spine surgery is usually performed as open surgery. This entails opening the operative site with a long incision so the surgeon can view and access the spinal anatomy. However, technology has advanced to the point where more spine conditions can be treated with minimally invasive techniques.
Because minimally invasive spine surgery (MISS), does not involve long incisions, open manipulation of the muscles and tissue surrounding the spine is avoided, therefore, leading to shorter operative time. In general, reducing intraoperative (during surgery) manipulation of soft tissues results in less postoperative pain and a faster recovery.
Imaging during spine surgery
Computer-assisted image guidance allows surgeons to view the operative site in far finer clarity than traditional visualization techniques. In addition, implants such as rods or screws can be inserted and positioned with a greater degree of accuracy than is generally achieved with conventional techniques.
In computer-assisted image guidance, images taken preoperatively (before surgery) are merged with images obtained while the patient is in surgery, yielding real-time views of the anatomical position and orientation of the operative site while the patient is undergoing surgery. Preoperative computed tomography (CT) and intraoperative fluoroscopy (real-time x-ray) are generally used, as these enable surgeons to operate with a high level of precision and safety.
Not all patients are appropriate candidates for MISS procedures. There needs to be relative certainty that the same or better results can be achieved through MISS techniques as with an open procedure.
Spinal instrumentation
Examples of spinal instrumentation include plates, bone screws, rods, and interbody devices; although, there are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.
An interbody cage is a permanent prosthesis left in place to maintain the foraminal height (eg, space between two vertebral bodies) and decompression following surgery.
Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it requires less exposure to place within the spine and therefore is a MISS procedure.
Pedicle screws help to hold the vertebral body in place until the fusion is complete.
Should surgical treatment be your only recourse, it may help to understand that minimally invasive spine surgery offers many benefits. Patients who want to return to work and active play, as well as the elderly or those with major spinal problems, often achieve a higher level of function once symptoms are alleviated.
Get Ready for Recovery
Talk to your doctor about what to expect after your surgery. This will help you to prepare for your recovery period. Listed below are a few things common to recovery following spine surgery:
You will have a surgical dressing over your incision, which will be removed several days after your surgery.
You may have stitches that will either dissolve as you heal or will need to be removed (usually two to three weeks after surgery). Your doctor will let you know how to keep the incision(s) clean.
Everyone's experience with post-surgical pain is different. To keep you comfortable following surgery, a variety of pain relief options are available. This includes medication by mouth (oral), intravenous drugs (IV), or Patient Controlled Analgesia (PCA). PCA is an IV and programmable pump system equipped with a push button control that allows the patient to self-dose pain relieving medication.
Adequate post-operative pain management will help you to be prepared to take a few steps shortly after surgery. No longer do patients lie in bed for long periods of time following spine surgery. Brief periods spent walking - usually with staff assistance - promotes circulation, healing, mobility, and a faster recovery.
Your doctor will let you know when it is okay for you to leave the hospital. The hospital staff will provide you with a set of written instructions to follow at home. The home care instructions may include information about wearing a back brace, when to begin physical therapy, or how to take prescribed medication. It is important to understand these instructions and know who to call in case additional information about care is needed quickly.
The lifestyle changes you made to prepare yourself for surgery (diet, exercise, smoking cessation) will continue to be important after you leave the hospital. Make a commitment to maintain these healthy habits to ensure that your recovery is quick and future spine problems can be avoided.