Back Surgery

Back surgery is a viable and sometimes necessary treatment option for significant musculoskeletal problems (like herniated discs) when other solutions have failed. A pain management expert may assist you in determining whether surgery is an appropriate alternative after making sure that all other choices have been exhausted.

When should I consider back surgery?

The following problems, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health (NIH), might be good candidates for surgical treatment:

• Herniated or ruptured disks, in which one or more of the disk bones that cushion the spine bones are damaged
• Spinal stenosis, or a narrowing of the spine that puts pressure on the spinal cord and nerves, is an example of this condition.
• Spondylolisthesis, in which one or more bones in the spine shift out of position
• Vertebral fractures caused by a fall or by osteoporosis are the most common types of spinal injuries.
• Disk deterioration, or spinal disk damage as a person becomes older, is referred to as degenerative disk disease.

Back pain can occasionally be caused by a tumor, an infection, or cauda equina syndrome. To ease the discomfort and prevent further issues in these situations, NIAMS recommends surgical intervention as soon as possible.

What are some types of back surgery?

Some of the most common surgical choices for low back pain are the following:

• Vertebroplasty and kyphoplasty. Vertebrae fractures caused by osteoporosis are healed using these techniques. Injection of glue-like bone cement that hardens and strengthens the bone is involved in both operations.
• Spinal laminectomy/spinal decompression. When spinal stenosis causes a narrowing of the spinal canal, causing pain, numbness, or weakness, it's time to have this procedure. The surgeon removes the bony walls of the vertebrae and any bone spurs in an effort to expand the spine and relieve pressure on the nerves.
• Discectomy. When a disk herniates and presses on a nerve root or the spinal cord, this procedure is used to remove it. Laminectomy and discectomy are frequently done at the same time.
• Foraminotomy. In this operation, the surgeon enlarges the bony hole through which a nerve root exits the spinal canal to protect nerves from pressing on.
• Nucleoplasty is also called plasma disk decompression. A relatively herniated disk is treated with radiofrequency laser surgery, which uses radiofrequency energy to treat persons with low back discomfort due to a slightly herniated disk. The surgeon punctures the disk with a needle. The tip of the needle is heated with a plasma laser, which vaporizes the tissue in the disk and reduces its size, relieving pressure on the nerves.
• Spinal fusion. The surgeon removes a spinal disk between two or more vertebrae before fusing the adjacent vertebrae using bone grafts or metal devices fastened with screws. Spinal fusion involves the fusion (or fusing) of two or more bones together. There is a risk of reduced flexibility in the spine, which necessitates a long rehabilitation period for the bone implants to grow and join the vertebrae together.
• Artificial disk replacement. This is a surgical technique that's used to treat people with severely harmed disks instead of spinal fusion. A spinal fusion involves removing the disk and replacing it with a synthetic disk that restores height and mobility between the vertebrae.

What are the risks of back surgery?

Back surgery has a greater risk than other types of operations since it is done closer to the nervous system. Paralysis and infections are the most serious of these threats. Even if you have a successful operation, recovery may take months. Healing time will vary depending on the sort of surgery and your health before the procedure. And you could permanently limit your mobility.

What are the considerations for anesthesia during surgery?

Patients are typically under general anesthesia during back surgery. In addition to the usual hazards of anesthesia, there are additional risks associated with the patient lying face down on the surgical table. This posture affects the body's hemodynamics, or how blood flows through the body. The position also prevents the surgical team from accessing the patient's airway. This necessitates careful placement of equipment, monitors, patients, and anesthesiologists for everything to fit together correctly. It's critical to have a physician anesthesiologist in the operating room to ensure that everything is in order and that they can act swiftly if anything goes wrong.

How do I manage pain during my recovery?

Post-operative pain following a neck surgery is not unusual. It would help if you explored various techniques for alleviating pain after the operation. It is important to understand that no two patients have the same procedure. That means the above options and combinations of options may not work for everyone—discussing these choices with a pain management professional who can compare the benefits and drawbacks of each option or combination of options, as well as their effectiveness, side effects, the potential for addiction, and impact on rehabilitation.

Some factors to consider:

• Many of your treatment options will include opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and local anesthetics. Sometimes more than one medication is used. This multimodal therapy might help with pain management while reducing opioid use.
• Opioids should be used with caution to avoid addiction and manage side effects, some of which can be deadly.
• Consider all options for pain relief that do not include medication, such as herbal therapies or acupuncture.

Physician anesthesiologists who specialize in pain management can collaborate with you before and after surgery to create a specific treatment plan for your needs, background, and preferences. They will keep track of what is working and what isn't after surgery, so they may adjust your pain management therapy as needed.