Our back is under constant stress and strain. It is the part of the body that bears most of the body weight when we are stood up and is subject to various kinds of stretches and movements all the time. It is therefore natural for us to develop some degree of back pain which often warrants treatment.
There are different causes for back pain and treatments are usually individualised based on these causes. Many a time, painkillers and other comes to treatment options are sought initially to try and get rid of the pain. However, in some cases back surgery is required. In this article, we shall take a brief look at this aspect of management, concentrating on the risks and benefits and the different indications for performing surgery on the back.
Why is back surgery performed?
The main reason for performing back surgery is intractable pain that does not respond to painkillers. Of course, the underlying reason for the back pain should be one that can be treated with surgery. Not all back pains can be treated with surgery and some of them require just conservative management.
Back pain can occur due to a number of different causes. These include prolapsed vertebral discs, fracture of the vertebra, compression of the nerves due to stenosis (narrowing) of the spinal canal, degeneration of the vertebral discs, problems with alignment of the vertebra i.e. kyphosis or scoliosis and irritation of the nerve due to a bony protrusions such as bone spurs or from the protruding vertebral discs. As is evident, these different causes mean that the procedures performed will be different for each of them.
What are the types of back surgery?
There are various kinds of back surgery that are performed for various indications.
This surgical procedure involves the removal of small parts of the vertebral bone. It is performed in order to relieve pressure that any abnormal growths on the bone such as bone spurs may be placing on the underlying spinal nerves. The procedure is performed under general anaesthesia and is often accompanied by spinal fusion as a laminectomy alone can make the spine unstable.
This video demonstrates laminectomy in a bit more detail.
2. Spinal fusion
Spinal fusion is a very common procedure where the spinal bones are fused together. The aim of the surgery is to make sure that the movement of the spine is limited in order to prevent any damage to the nerves. Unfortunately, in some cases, the spinal bones do not fuse sufficiently and this is called incomplete fusion. If this occurs, patients may require repeat surgery.
This video demonstrates spinal fusion.
You may have heard of the clinical condition called disc prolapse. This is a condition where the intervertebral discs i.e. the soft collagen discs that lie between the vertebral bones protrude out of their space and place pressure on the nerves of the spinal-cord. A discectomy is a procedure where this protruding disc is removed partly or wholly.
This type of back surgery is where a small amount of cementing material is injected into the bone in areas where there has been fracture and collapse of the vertebra. It is offered to patients who have suffered a vertebral fracture due to underlying conditions such as osteoporosis (a condition where the bone is extremely thin).
Undergoing back surgery
Most back surgery procedures are performed under general anaesthesia. Patients are advised not to eat and drink anything on the day of the procedure. Once consent is obtained and general anaesthesia administered, the area where the surgery is to be performed is cleaned with antiseptic solution and is covered in sterile drapes.
Back surgery can be performed as an open surgery or as keyhole surgery. The choice depends upon the type of surgery that is to be performed. The procedure can take a few hours to complete and once it has concluded, the patient is observed for a period of time in hospital. Patients are requested to complete bed rest for a day or two following which they can start to gently mobilise. Supports in the form of a corset or brace may be offered to keep the spine stable during the healing process. Physiotherapy is offered 4 to 6 weeks after the procedure to promote healing and restore complete movement.
Benefits of back surgery
The main benefit of back surgery is a relief of symptoms. Patients find that pain relief that back surgery brings can have additional affects such as an improvement in their overall fitness, enhanced mood, ability to perform their day-to-day tasks with ease and an ability to perform their regular job effectively. However, not each and every patient experiences all these benefits and some of them may find a degree of residue pain despite surgery. In such cases, conservative treatment options may need to be observed or further surgery may be required to help relieve the symptoms.
Risks of back surgery
Risks are to be expected with back surgery. However, it is worthwhile noting that these are rare. The most common risk is the lack of resolution of back pain. The other risks include bleeding and bruising at the site of surgery and a reaction to the anaesthetic agent. In some cases, infection may occur at the site of surgery and may warrant the use of antibiotics. As patients who undergo back surgery tend to be immobile for some period of time, they are at risk of developing blood clots in the legs. This can be prevented by wearing compression stockings and administration of prophylactic heparin in hospitals.
In the rare cases, patients can develop a heart attack or stroke. Damage to the nerves can occur during the surgery which can result in worsening pain, paralysis and even impairment of sexual function and loss of bladder control.
This video discusses this in a bit more detail.
Back surgery is a complicated surgical procedure that is offered to patients to relieve their pain. The choice of surgery depends upon the cause of back pain. Benefits are many and the risks are a few.
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