It can be helpful to understand which part of the spine is causing your back pain and whether the pain is from a compressive or a mechanical problem.
It is important to determine what is, and what is not causing your back or neck pain.
Treatments for spinal problems range from conservative therapies, to more invasive therapies, including spinal injections and surgery.
Surgery is an important but serious option for the treatment of spinal problems. If your doctor is suggesting or recommending spinal surgery, it is important for you to know as much as possible about the procedure including the risks and benefits, and what you can expect after surgery including the process of rehabilitation.
There are many different types of spinal problems that can cause you pain and discomfort, and possibly make it difficult for you to move normally and perform your daily activities. Likewise, there are a number of different types of surgical procedures used to treat spinal problems.
The Anterior Cervical discectomy and fusion, known as ACDF, is a surgical procedure used to treat damaged discs in the neck or cervical spine. Wear and tear or trauma can cause the shock absorbing discs between the vertebral bones in the neck to degenerate, bulge or rupture. This can cause pain, weakness or numbness in the neck, arms or hands.
In this procedure, the surgeon enters the neck from the front (the anterior region) and removes the unhealthy disc and replaces it with a bone graft or synthetic spacer and a cervical plate with screws is used for stabilization. The goal is to help the bones to grow together into one solid bone.
Your spinal cord needs adequate space inside the spinal canal. The spinal canal is a protective ring of bone that surrounds your spinal cord. Conditions such as fractures, dislocations, tumors, or degenerative changes in the discs and joints of your spine can put pressure on your spinal cord. This is because the protective ring of bone around your spinal cord does not expand to accommodate the need for more space. Extra pressure within the confined space of the spinal canal can place your entire spinal cord in danger. Surgery to open the back of your spinal canal is one way to relieve the pressure on your spinal cord. This procedure is called a laminectomy.
The traditional way of treating a herniated disc is to perform a laminotomy and discectomy. The term laminotomy means "make an opening in the lamina." This procedure is used to give your doctor room to see and work inside your spinal canal. The term discectomy means "remove the disc."
The laminotomy is performed through an incision down the center of your back over the area of the herniated disc. Your muscles are moved to the side so your doctor can see the back of your vertebrae. X-rays may be required during surgery to make sure the correct vertebra is located. Once the correct vertebra has been confirmed, your doctor will cut a small opening through the lamina bone on the back of your spinal column. The nerve roots are moved out of the way so the problem disc can be located.
Improvements have been made in the tools available to your doctor for performing a discectomy. These improvements include:
Torn cartilages of the knee are now routinely removed with an arthroscope, and gallbladders are routinely removed with a laproscope. These small scopes give doctors a method of doing surgery with smaller incisions and with less risk to the nearby tissues. The same approach is evolving with spine surgery. Endoscopy of the spine is still in experimental stages and is not yet widely used. It might eventually give doctors a way to remove a disc with even less risk of injury than microdiscectomy.
Pedicle Screws and Rods and Intervertebral Cages are types of surgeries that your doctor may recommend, depending on your individual needs. A main goal of spinal surgery is to stop the pain caused by joints that have worn out over time or degenerated due to disease. Spinal fusion joins together the vertebrae on either side of a joint in your spine, allowing the two bones to grow together into one and stopping the motion that is causing pain. Use of pedicle screws and rods is one method doctors have of fusing the vertebrae in your spine.
A combination of metal plates, screws and rods (hardware) creates a solid "brace" that holds your vertebrae in place and stabilize the spine. These devices are intended to stop movement from occurring between your vertebrae. Pedicle screws and rods are designed to give stability to the fusion site and may potentially enable you to get out of bed much sooner after spinal fusion surgery.
Special screws called "pedicle screws" are placed through the pedicle bone on the back of the spinal column. The screw inserts through the pedicle and into the vertebral body, one on each side. The screws grab into the bone of the vertebral body, giving them a good solid hold on the vertebra.
Once the screws are placed they are attached to metal rods that connect all the screws together. When everything is bolted together and tightened, this creates a stiff metal frame that holds your vertebrae still so that healing can occur. Bone graft is then placed around the back of the vertebrae.
The intervertebral fusion cage is a large spacer made of metal, plastic, or bone, that is implanted between 2 vertebrae. The cages are made from various materials including metal or plastic. Your doctor will place bone graft inside the cage. The holes in the cage keep the graft in contact with the bony surface of your vertebrae. This provides a point of contact between the two endplates for fusion to occur across.
The intervertebral cage helps in several ways. The solid cage separates and holds two vertebrae apart. This makes the opening around the nerve roots wider, relieving pressure on your nerves. As the vertebrae separate, your ligaments tighten up, reducing instability and mechanical pain. The cage also replaces the problem disc while holding your two vertebrae in position until fusion occurs.
The intervertebral cage was first cleared for use by the United States Food and Drug Administration (FDA) in 1996.
Intervertebral cages can be implanted from the front, side, or back of your spine. They can also be implanted using an approach that is slightly from your side and slightly from your back, which is called a transforaminal approach, and they may also be implanted using a minimally invasive surgery (MIS) technique.
Surgery to implant an intervertebral cage from the front of your body is called an anterior interbody fusion. In this procedure, your doctor will move your organs and blood vessels to the side to access your spine, but he or she does not have to move your nerves out of the way to implant the intervertebral cage.
When surgery to implant an intervertebral cage is performed through the side of your body, it is called a lateral interbody fusion. The lateral approach uses a smaller incision compared to anterior and posterior approaches while still allowing your doctor to directly see your spine as the surgery is being performed. Lateral interbody fusion can also be performed using a minimally invasive surgery (MIS) technique. Using an MIS technique, your doctor will make 2 small incisions in your side instead of one large incision, which potentially enables the surgery to be performed in less time, and with less trauma and pain than traditional surgical approaches.
The procedure to implant an intervertebral cage from back of your body is called posterior interbody fusion. To access your spine using this approach, your doctor will need to remove the lamina of the upper vertebrae and move your nerve roots out of the way. Posterior interbody fusion can also be performed using an MIS technique, making 2 small incisions in your back instead of one large incision to reduce the time, trauma, and pain associated with more invasive surgical techniques.
Intervertebral cages implanted slightly from your side and slightly from your back use a transforaminal interbody fusion approach. Using this approach, your doctor can implant the intervertebral cage with little or no disruption of your nerve roots or back muscles.
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if spine treatment is right for you.
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if shoulder arthroscopy is right for you.
As with any medical treatment, individual results may vary. The performance of shoulder replacements depends on age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation you should not have this surgery. Only a spine surgeon can tell you if shoulder replacement is right for you.