While the majority of treatment for lower back pain is non-surgical, there are some conditions for which surgery is appropriate. As well, in some rare cases, surgery can be used to treat chronic back pain for which other treatments have failed. Below we list some common conditions that may be treated surgically, and describe the treatments used.
A herniated disc occurs when the hard outer coating of the discs, the circular pieces of connective tissue that cushion the vertebrae, are damaged. These discs may leak, irritating nearby nerves. A herniated disc is also known as a ruptured disc. A herniated disk can cause severe sciatica, nerve pain that radiates down the leg.
Herniated discs may be treated surgically by discectomy, either laminectomy, microdiscectomy or laser discectomy. In a laminectomy, part of the lamina, a portion of the bone on the back of the vertebrae, is removed. The herniated disc is then removed through this cut. In microdiscectomy a much smaller incision is made and the doctor uses a magnifying lens to locate the disc. The smaller incision may reduce pain and the disruption of tissues, and it reduces the size of the surgical scar. With a laser discectomy, a laser is used to vaporize the tissue in the disc, reducing its size and relieving pressure on the nerves.
Spinal stenosis is a condition where the spinal canal narrows, compressing the nerves inside. It is often caused by bone spurs which are a result of osteoarthritis. Compression of the nerves can lead to pain, numbness in the legs and the loss of bladder or bowel control. A laminectomy may be used to open up the spinal column remove the lamina and any bone spurs. The procedure is major surgery that requires a short hospital stay and physical therapy afterwards.
Spondylolisthesis is a condition where a vertebra of the slips out of place. As the spine tries to stabilize itself, the joints between the slipped vertebra and adjacent vertebrae can become enlarged. This can pinch nerves, causing low back pain and severe sciatica leg pain. A spinal fusion may be used with a laminectomy.
In spinal fusion, two or more vertebrae are joined together using bone grafts, screws, and rods to prevent slippage of the slipped vertebrae. The bone used for the bone graft usually comes from the hip or pelvis of the patient, although a donor bone may be used. The fused area of the spine becomes immobilized.
Vertebral fractures can be caused by trauma or by osteoporosis. A vertebroplasty injects a cement-like mixture called polymethyacrylate into the fractured vertebra to stabilize the spine. Kyphoplasty inserts a balloon device to help restore the height and shape of the spine before injecting polymethyacrylate to repair the fractured vertebra.
Degenerative disc disease is an aging process where the discs between the vertebrae break down over time.
Intradiscal electrothermal therapy (IDT) involves inserting a heating wire into the disc to strengthen the collagen fibers that hold the disc together.
Spinal fusion may be used to remove the injured disc and immobilize the spine around it.
Finally, disc replacement is possible. Here the disc is simply removed and replaced with a synthetic disc.