At Coastal Spine our goal is to improve chronic spine related pain. We provide a comprehensive approach, both Minimally invasive and surgical treatment options all under one roof. If a patient fails Minimally invasive treatment such as injections, we are able to provide minimally invasive surgical options to them.
Here’s some information about spine surgery.
What Is Spine Surgery?
Spine surgery is done to improve pain from degenerative or herniated discs as well as joint mediated pain. Decompressions/discectomies involve removing the lamina in the back of the vertebrae to make more room for the nerve roots. Fusions, broadly, involving fusing two vertebrae together.
Most back pain originates in the lower back, the lumbar spine. This is because this five-vertebrae section of the lower spine takes the highest loads, as it carries most of the weight of our bodies. Still, most of these cases can be resolved through Minimally invasive means, such as physical therapy or anti-inflammatory medications.
Sometimes if the pain has not diminished after months of Minimally invasive treatment spine/back surgery may be necessary to help you return to a normal life. Most of these procedures are minimally invasive, such as a microdiscectomy for a herniated disc. Fusions, which can be done minimally invasive as well, for degenerative disc disease, fractures or slips, but can be more involved and create longer recovery periods.
Benefits Of Spine Surgery
Relief of chronic pain is the main benefit. That is usually the singular goal of these procedures. If your pain has become persistent and disabling, it needs to be addressed. Otherwise, without surgical intervention, the patient’s quality-of-life may be affected. They may be unable to perform the activities that he once enjoyed, or even simple activities such as walking the dog.
In addition to pain relief, successful back surgery can allow a person to return to activities they have been forced to stop. Sleeping, which can become greatly affected by back and neck pain, can be restored.
Who Is A Good Candidate For Spine Surgery?
Spine surgery can accomplish two things. It can decompress a nerve root and/or it can stabilize a painful mobile segment of the spine. These procedures are not performed simply because the patient has chronic pain, though it is a major indication. The purpose is to correct a physical abnormality in patients who don’t show improvement through various Minimally invasive. Surgery is not an option for patients when an anatomical lesion that’s behind the pain cannot be identified.
These surgeries are never exploratory. They are not done unless the nerve being compressed, the degenerating disc and impacted vertebrae, or the other direct cause of the pain can be identified.
How Will I Know If I Need Spine Surgery?
Our spine is made up of 33 vertebrae. These surgeries are usually done on the cervical spine, involving vertebrae C1-C7, or the lumbar spine, involving vertebrae L1-L5. Least often, they are performed on the thoracic spine, the middle of the back involving vertebrae T1-T12. This is simply because the ribs prevent the thoracic spine from moving as much as the cervical or lumbar.
If you have chronic pain that has been consistent for months and all conservative treatments have been exhausted, it could be time for spine surgery. If you are beginning to lose function of an area served by a compressed nerve in the spine, surgery may be a necessity to avoid permanent damage to the nerve and loss of function in the limb. Such examples, are pressure on the spinal cord, weakness in the arm or leg, or loss of bowel and bladder control.
Nerve root compression can cause symptoms of numbness, pain, burning or motor weakness. These compressed nerves in the neck will radiate pain out into the shoulders, upper back, arms, and hands. In the lumbar spine, the pain will run down one or both legs.
- Disc problems — Between each vertebra is a soft, rubbery cushion, the spinal discs. These consist of a tough outer shell with soft gel inside. These discs can rupture (herniate) or bulge outward. Either instance can then cause the disc to press on a nearby spinal nerve root exiting the spinal column. Degenerative disc disease is often at the root of serious disc problems that may require surgery. Sometimes trauma (such as a fall or car accident) can also cause this.
- Overgrowth of bone — Osteoarthritis can result in the formation of bone spurs on your spine. These usually affect the hinge joints on the back part of the vertebrae and they can narrow the space available for the nerves to pass through.
Types Of Spinal Surgery Performed At Coastal Spine
There are different types of back surgery, titled by their goal or purpose.
- Discectomy — Usually now called microdiscectomies because they are done with minimally invasive methods, these procedures remove the herniated portion of a spinal disc to relieve irritation and inflammation of a nerve. Discectomies usually involve full or partial removal of the lamina, the back portion of the vertebra, to access the ruptured disc.
- Laminectomy — Here the goal is to enlarge the spinal canal, which holds the spinal cord or cluster of nerves in the lumbar spine. Laminectomies usually remove bone spurs that have developed due to osteoarthritis, and is done whenever there is pressure on the nerves known as spinal stenosis.
- Fusion — These surgeries fuse two vertebrae into a single piece, eliminating the degenerated or ruptured spinal disc between the two vertebrae. These procedures eliminate painful movement between the two vertebrae.
- Artificial discs — An alternative to fusion, these procedures remove the damaged spinal disc and replace it with an artificial disc. This is a newer surgical option which allows for preserved range of motion and less stress on the adjacent levels. However, not all patients are a candidate for this procedure. Usually, this is done in younger patients without significant arthritis.
How Are These Surgeries Done?
A 1 to 1.5-inch incision is made in the midline of the low back or in the neck, depending on the location of the bulging disc. The back muscles are lifted off the bony arch of the back of the spine, the lamina, and moved to the side. This allows for less muscle to be cut, as they run vertically. Operating glasses or an operating microscope provide visuals of the nerve root in question. In some cases, a small portion of the inside facet joint is removed to provide access to the nerve root and to relieve any pressure or pinching on the nerve. Next the nerve root is gently moved to the side. Small instruments are then inserted under the nerve root to remove fragments of the disc material that have pushed out of the disc. This relieves pressure on the nerve. The nerve is then brought back into place, the muscles are moved back to the center, and the incision is closed.
The job of the lamina is to provide protective covering to the spinal canal. A laminectomy is usually done to relieve spinal stenosis in the lumbar spine. Stenosis is caused by degenerative changes that led to the enlargement of the facet joints or ligaments in the back of the vertebrae. The enlarged structures have begun to compress the nerve roots as they exit the spine. A laminectomy removes all or part of the lamina, two portions of vertebral bone over the nerve roots in the back of the spine.
In an open laminectomy, a 2- to 5-inch incision is made over the vertebra in question. The back muscles are dissected off the lamina on both sides and at multiple levels. This opens the approach to the spine. Next the lamina is removed, which allows visualization of the nerve roots. The facet joints creating the compression are then trimmed to provide more room for the nerve roots.
Most often, at Coastal Spine, minimally invasive laminectomies were performed with a 1 inch incision made on both sides of the lower back. This leads to improved postoperative recovery time, less postsurgical pain and overall improved prognosis.
There are many different approaches to spinal fusion, which is usually used to address degenerative disc disease or spondylolisthesis, a condition where one vertebra has slipped forward out of alignment. The goal is to make two vertebrae into a single piece. An incision is made above the vertebrae in question and the muscles and other tissues are gently moved aside. To remove compression on the nerve, the lamina may then be removed, along with any boney growths called osteophytes, that are pressing on nerve roots. The disc material is removed. Bone graft material is either taken from the patient’s hip, comes from donor material or a Biologic/synthetic option. The surgeon then removes some bone from the surface of the vertebrae to make a more friendly location for the bone graft to adhere. The bone graft is then placed between your vertebrae. Screws are then placed into both vertebrae and they are connected with rods. This locks the two vertebrae in place, preventing movement. The bone graft is then placed between your vertebrae. Over time, new bone grows over the screws and rods and grows between the two vertebrae, creating a permanent fusion.
Recovery After Spine Surgery
Spinal fusion requires the longest recovery, as the bone graft needs to grow between the adjacent vertebrae. This takes from 3-6 months. However, early mobilization is the key to recovery. Most patient are mobile the night of surgery, and leave the hospital in about 3 days. The bone then fully immobilizes the spine between those vertebrae.
Patients with microdiscectomies or laminectomies can go home the same day of their surgery, amazingly enough. Most patients can return to work in a week or so, depending on their duties. Most activities can be resumed relatively quickly, with pain being the guide to what is OK.
When Can I Return To Normal Activities After Spine Surgery?
After fusion, patients usually need 4-6 weeks before they can return to an office or sedentary job. It will take at least 3 months before returning to more physical activity. After 6 months, many patients can return to activities, including weightlifting or construction work, can be resumed.
As mentioned above, microdiscectomies and laminectomies usually advise walking almost immediately to facilitate recovery. This starts with short distances, working up to a few miles. Other activities, such as driving, can be resumed relatively quickly, dictated by pain.
What Are The Risks With Spine Surgery?
Fusion poses the most risks, but these surgeries are usually successful at alleviating pain. There are risks that the vertebrae don’t properly fuse. This is more likely when fusing three or more levels. There can be hardware failure. There can be some nerve damage due to the proximity of working near the spinal cord. This could lead to motor and sensory deficits where parts of the body experience numbness or paralysis. This is quite rare. More commonly excessive bleeding and require a blood transfusion. Infection is a risk with any surgery. Also, it should be pointed out that these risks are drastically reduced with a minimally invasive techniques employed at Coastal Spine.