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Back surgery is an invasive pain management procedure in which a specially trained doctor (the surgeon) uses instruments to make incisions to repair damaged spinal tissues. The good news is that back surgery is generally not the treatment of choice for back pain. Research has shown that approximately 90% of cases of low back pain resolve themselves around 1-3 months. 1
There are a variety of conditions addressed by back surgery; however, back surgery really only does 3 things : -
relieves pressure on spinal nerves or the spinal cord.
provides stability to an area of the spine that is painful, fractured or has too much movement.
corrects spinal deformity in children, such as scoliosis.
In general, back surgery is a decision to be made by the patient, with guidance from their doctor. Usually, there is time for research and evaluation before "going under the knife". This research will likely take the form of the patient's consideration of their level of pain as compared with expected outcomes for the surgery. However, there are rare instances when having emergency back surgery is mandatory to save life.
This would include those patients with : -
weakness in the legs that gets progressively worse and/or
bladder and/or bowel incontinence caused by the back problem.
As mentioned above, doctors will usually try conservative methods before recommending back surgery.
Conservative methods include : -
physical therapy
ice
exercise
medication, including injections
Doctor and patient perceptions of a successful back surgery can be at odds with one another. Many times, patients are expecting all their pain to go away and a full recovery of activity. In fact, a 2005 study reported in Spine Journal showed that surgeons tend to predict more positive outcomes than patients subsequently report. 3 Doctors generally regard a surgery as successful if there is partial reduction of pain. Discussing your expectations with your doctor before you agree to any surgery is a good idea.
Do you need back surgery?
Most people will have back pain sometime during life. And 90 percent of these people will get better, without treatment or with conservative therapy for four to six weeks. Only 5 percent remain disabled longer than three months.
In most situations, an operation won't be considered unless conservative measures have failed, and even then surgery is not often indicated. Back surgery is usually reserved for times when spinal nerves are compressed, causing numbness along the back of your leg.
Many types of problems can reduce the amount of space in the spine, so nerves become pinched. The disks separating the bones in your spine can also bulge or rupture (herniate), which can irritate nearby nerves. However, many people with bulging disks have no pain.
To relieve pressure on the spinal cord or nerves, surgeons can remove portions of bone to widen the narrowed area in the vertebrae. Removing the gel-like interior of ruptured disks also helps relieve pressure on pinched nerves. Sometimes the entire disk must be removed, with the adjoining vertebral bodies fused together surgically.
The following conditions may require surgery if they're progressive, painful or causing nerve compression : -
Scoliosis, a curvature of the spine
Kyphosis, a humpback deformity
Spondylolisthesis, the forward slippage of a segment of the spine
Spinal stenosis, narrowing of the spinal canal typically from arthritis
Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear
Types of back surgery
Different types of back surgery include : -
Diskectomy This involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. It's done as an open surgery and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
Laminectomy This procedure involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
Fusion Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
Vertebroplasty During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar but more expensive procedure - called kyphoplasty - a balloon-like device is inserted to attempt to expand compressed vertebrae before bone cement is injected.
Artificial disks Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it's not yet clear what role they might play in treating spinal disk disease.
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Back surgery is an invasive pain management procedure in which a specially trained doctor (the surgeon) uses instruments to make incisions to repair damaged spinal tissues. The good news is that back surgery is generally not the treatment of choice for back pain. Research has shown that approximately 90% of cases of low back pain resolve themselves around 1-3 months. 1 
