Back pain can be a debilitating condition that is affecting a number of people worldwide. It has become one of the most common problems faced by not only elderly but young people also. Back pain and related problems can be treated with non-surgical treatments including anti-inflammatory medications, heat and physical therapy. But when these methods fail to improve the pain and other symptoms, back surgery is recommended.
The surgery can help relieve back pain in some cases when the pain is persistent and disabling, and conservative approached didn’t work. Back surgery also helps relieve numbness in one or both arms or legs, improves mobility and enables the patient to be more active.
There are two approaches for spine surgery – traditional/open and minimally invasive surgery. With traditional or open spine surgery, the surgeon makes larger incisions to expose the anatomy for operation. In minimally invasive spine surgery, smaller incisions are made and it requires less exposure of the anatomy, which ultimately leads to less surgical trauma and easier recovery for the patient. The doctors often use image data from CAT scans, navigations, and 3D images in minimally invasive spine surgery to visualize the spine and therefore provides same result as traditional/open surgery.
Both minimally invasive and traditional surgery has the same goals for the long-term, that is to have the overall improvement in symptoms or stop the degeneration. The major advantages of minimal access technique is that it results in less blood loss, shorter hospital stay, lower risk infection rates and a rapid recovery.
Average Cost of spine surgery in India for both these approaches is remarkably low in comparison to cost for same treatment in other countries, especially in the USA and Europe.
There are different type of back surgeries, depending on the condition that needs treatment and part of spine involved. Following are some of the most common back surgeries and what happens in the procedure:
Discectomy. Discectomy involves removal of part of the herniated disc that is causing pain and other symptoms. There are further two types of discectomy:
- Percutaneous: a portion of the disc is removed using laser or suction device through a narrow probe which is put through a small incision in the back.
- Microsurgical: a small incision, less than inch long, is made during this surgery. The surgeon uses a microscope to remove the damaged part of the disc and a small portion of the bone that covers the spinal canal.
Laminectomy: This surgery is performed to enlarge the spinal column to treat a condition called spinal stenosis (narrowing of the spine) that puts pressure on the nerve roots. In laminectomy, the doctor removes the backside of the spinal canal, the lamina, which forms a roof over the spinal cord. Also, any bony protrusions, or spurs, that may have formed due to osteoarthritis of the spine are also removed.
Spinal Fusion: It involves a welding process in which two or more vertebrae are joined or fused together. It is used for chronic non-specific back pain and to prevent the motion between the vertebrae. This helps relieve pain caused or aggravated by the movements, such as bending, lifting and twisting, or to stabilize the spine damaged by infections or tumours. It may also be used to halt the progression of a spinal deformity, such as scoliosis, or to treat injuries of the vertebrae or stabilize vertebrae that has become loose due to a defect in the joint.
Disk replacement: This involves removal of the damaged spinal disc and replacing it with an artificial disc between the vertebrae. This is at times an alternative to spine fusion but with ability to move spine and a shorter recovery time.
Foraminotomy: It is a surgery to relieve back pain that is associated with a compressed spinal nerve. The doctor removes the bone at the sides of the vertebrae to enlarge the space where nerves exit the spine. This extra space may provide relieve the pressure on the nerves and ease the pain. As with laminectomy, this procedure also makes the spine less stable.
Vertebroplasty and kyphoplasty: These two are similar procedures that are used to relieve the pain and, possibly, other problems related to compression fractures of the vertebrae. These involve strengthening the fractured bone with a cement-like material injected into the vertebrae through a needle.
Kyphoplasty involves an additional step in which the surgeon places a small balloon-like device into the compressed vertebra and then inflates it to restore height and reduce deformity.
After a spine fusion surgery, the recovery may take 3 to 12 months to resume normal everyday activities. The success rate for pain relief is almost 70% to 90%, depending on the condition being treated and the spine surgery type.