In most cases, spine surgery is only considered once a comprehensive treatment plan involving physical therapy and pain management (oral medication or spinal injections) has failed. It is the patient’s decision whether or not to undergo back surgery.
Orthopedic surgeons specialize in correcting musculoskeletal impairments. They perform 4 main types of back surgeries to treat back problems.
Discectomy
Sitting between each of your vertebrae are small rubbery sections of cartilage called discs. They perform a variety of functions, including acting as shock absorbers and preventing your vertebrae from grinding against each other. A herniated disk can compress a nerve and cause pain, numbness, or weakness in your back and legs.
For a discectomy, your surgeon removes the herniated part of your spinal disk. This may relieve your symptoms, but it doesn’t cure the condition that caused the herniated disk.
You might need a surgery to fix the problem that led to the herniated disk, such as a laminectomy or spinal fusion. These surgeries can reduce pain and help your spine stay stable.
An anesthesiologist will give you anesthesia for the surgery. Your surgeon will make a 1- to 2-inch skin incision over the affected area of your spine. They might use a lighted microscope to view the affected area. Then they will tunnel through your muscles with progressively larger tubes (dilators) to reach the damaged disk.
Laminectomy
Occasionally the spinal cord and nerves can become compressed due to narrowing of the pathways they travel through (vertebral canal or foramina). This is called spinal stenosis and causes back pain, muscle weakness, and loss of bowel or bladder control.
A lumbar laminectomy removes the bony lamina of a vertebra to relieve spinal cord and nerve pressure. It is usually performed after more conservative and nonoperative treatments have failed to produce symptom relief. It can also be combined with a spinal fusion procedure to stabilize sections of the spine.
The surgery is done through a skin incision and then the strong back muscles are moved to expose the bone. The surgeon will use a drill and bone-biting tools to remove the bony lamina. Often the ligamentum flavum that connects the laminae to the vertebra below is removed as well. This is a very delicate operation and requires great skill to do correctly. The surgeon will then replace the bone with a synthetic material or a bone graft and place hooks, screws, pedicle screws, or cages to increase stability.
Foraminotomy
If a herniated disc, bone spur or other condition is pressing on your spinal nerves, this surgery enlarges the opening where your spinal cord leaves each vertebra, called a neural foramen. It also removes the blockage causing nerve compression such as part of the lamina or a thickened ligament called the ligamentum flavum.
Your surgeon makes a skin incision and moves your strong back muscles aside to expose the affected vertebrae. You will be asleep (general anesthesia). Small surgical tools are passed through the opening in the spine, into the foramen and to the spinal nerves. Your surgeon removes the blocked tissue such as a herniated disk or bone spur and if necessary trims enlarged facet joints.
Any operation involving the spine has risks including damage to the spinal cord or nerves, spinal instability, infection and complications from anesthesia or medication. Your recovery depends on your dedication to physical therapy and following good ergonomic practices.
Spinal Fusion
If degenerative changes in one or more of your spinal discs cause pain, it may be necessary to fuse the vertebrae together. This can reduce your back pain.
During spinal fusion surgery, you will be given general anesthesia. Your surgeon will make an incision on your back, neck or abdomen. Tools called retractors will be used to hold muscles and other tissues apart so the surgeon can see the spine.잠실정형외과
The surgeon will remove the problem intervertebral disc or replace it with bone graft material, either from another part of your body (autograft) or from a bone bank (allograft). A living bone bridge develops across the painful motion segment. The bridge stiffens the segment and stops movement.척추관절병원