A General Overview regarding spine surgery or back pain
In most cases, lower back pain can be treated or managed using conservative treatment methods that do not involve surgery. In fact, for chronic pain patients, a survey has suggested that the success rate of spine surgery is only 20 to 40 percent. That makes its failure rate very high. This lack of success of back surgery is termed as failed back surgery syndrome in medical terms.
Nevertheless, spine surgery is still a very viable and in some cases, necessary treatment option for patients with musculoskeletal injuries or nerve compression. Before considering spine surgery, consult in-depth with your pain management specialist to make sure that your pain can, indeed, be treated by surgical treatment.
Dr. Arun Saroha is the best back pain doctor in Gurgaon, who is experienced in dealing with all sorts of spine conditions.
In which cases should spine surgery be considered?
As per the guidelines of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), an integral part of the National Institute of Health (NIH), spine surgery is a viable treatment in the following cases:-
- Herniated or ruptured disks, i.e. damage to one or more discs that cushion the bones of the spine
- Spinal stenosis, i.e. when the spinal column narrows and starts putting pressure on the spinal cord and nerves
- Spondylolisthesis, i.e. disc slip, displacement of one or more bones in the spine
- Vertebral fractures caused either due to trauma or osteoporosis
- Degenerative disk disease, i.e. damage to the spine due to old age
- In cases where the back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome
NIAMS has advised surgery the right way in these cases to provide patients with immediate relief from pain.
What are the different kinds of spine surgery?
National Institute of Neurological Disorders and Stroke (NINDS) at NIH has listed a few different kinds of surgeries for back pain. They are:-
- Vertebroplasty and Kyphoplasty- the procedure is done to repair compression fractures in the vertebra that occur due to osteoporosis. It includes the injection of a glue-like substance that is responsible for hardening or strengthening the bone.
- Spinal laminectomy or spinal decompression- this procedure involves the removal of bony walls of the vertebra or other bony spurs to widen the spinal column to remove any pressure on the nerves. It is performed in cases of spinal stenosis where the spinal column narrowing is causing pain, numbness, or weakness.
- Discectomy- a discectomy is done in cases where a herniated disc is pressing on a nerve root or spinal cord by removing a spinal disc. It is performed in conjunction with laminectomy.
- Foraminotomy- foraminotomy is done to increase the opening in the vertebra where a nerve root exits the spinal cord so that the bulging disks or thickened joints would not press the nerve in old age.
- Nucleoplasty or plasma disk decompression- it is a laser surgery procedure that uses radiofrequency energy to treat patients with a mildly herniated disk associated with low back pain.
- Spinal fusion- In a spinal fusion procedure, the surgeon removes a spinal disc between two or more vertebrae and then fuses two adjacent vertebrae with the help of bone grafts or metal devices and securing them by screws.
- Artificial disk replacement- Artificial disk placement is an alternative treatment for spinal fusion with severely damaged spinal discs. In this procedure, the surgeon removes the disc and replaces it with a synthetic disk to restore the height and movement of the spine.
What are the risks associated with spine surgery?
Spine surgery is a very risky endeavor that is associated with many different tissues such as bone, nerves, vertebral sics, etc. Some of the most commonly associated risks with spine surgery are paralysis and infection.
Even if the surgery is successful, the recovery periods for it can be quite long. Depending on the condition and the type of surgery being performed, healing and rehabilitation can take more than a few months.
Spine surgery is also associated with postoperative pain. Complete pain relief may take weeks to occur. This is to be discussed with the pain management specialist so that he can highlight the pros and cons of the surgery, along with its effectiveness, potential side effects, the potential for addiction, and impact on the recovery process.
Above all, the surgery also has a high chance of being unsuccessful in resolving the pain that it is being performed for. This can be highly demotivating for the patient and can drive them to depression.
Which secondary problems can be associated with spine surgery?
In many cases, spine surgery can also be associated with various secondary problems even if the cause for the original problem has been resolved.
One such example is that of a patient with a pinched L5 nerve root caused due to disc herniation. Even after the problem has been resolved, the patient still needs months of physical therapy, any problem which can lead to secondary piriformis syndrome in the patient. Unpinching the nerve can resolve the original problem of sciatica but the patient will still feel a muscle spasm in the piriformis in the buttocks. Until both problems are completely resolved, the patient can not truly heal.
Nevertheless, spine surgery should be a part of the patient recovery process, along with conservative treatment options and spine rehabilitation treatment. Spine surgery alone can never be the true answer to chronic back pain. It is a universally acknowledged truth among spine surgeons and should be conveyed to the patient without any doubts or delays. The patient should understand that in many cases of back pain, spine surgery is an unnecessary risk and should be avoided at all costs. Dr. Arun Saroha is the best spine surgeon in India, capable and experienced in performing all sorts of surgical procedures.