Surgery may be indicated for persistent back pain that involves an anatomical problem such as a herniated disk, spinal stenosis, or spondylolisthesis. Rarely, surgery may be performed on an emergency basis if there are severe symptoms, such as loss of bowel or bladder control, or if a tumor is present.
The two main surgical options to treat a herniated disk are laminectomy (with or without spinal fusion) and diskectomy. Spinal decompression may be done to treat spinal stenosis. Spondylolisthesis is treated either with a fusion or with a fusion and a decompression.
Laminectomy (Spinal Decompression)
A laminectomy, also called spinal decompression, is an open surgical procedure. It involves removing a small portion of the lamina. The lamina is the small part of the vertebral bone over the area where the nerve is being pinched. It is removed to relieve pressure on spinal nerves. Along with bone, fragments of a ruptured disk also may be removed.
The surgeon makes an incision in the back, spreads the overlying muscles, and removes the lamina. After the bone is removed, the surgeon can see what is compressing the nerve and may remove the offending disk. The incision is closed with stitches or staples.
Spinal fusion is a procedure that joins two bones (vertebrae) in the spinal column together to eliminate pain caused by movement.
Most of the time when a patient has a laminectomy and disk removal, a spinal fusion is not done. If a spinal fusion is to be performed, the adjacent vertebral bones are joined together with bone collected from the patient or a bone donor bank. Additional internal devices, such as metal rods and pins, may be used to provide added stability. The actual fusing of the vertebral segments occurs as the body stimulates new bone growth between the vertebrae over the course of the healing period. This process may take three to six months or longer.
Diskectomy is the removal of the protruding disk and part of the backbone. The doctor makes an incision in the back. A small part of the bone is removed to obtain access to the disk. The disk is then removed to take pressure off the nerve.
In certain cases, the doctor can perform a microdiskectomy to remove a herniated disk. A microdiskectomy is a less invasive procedure. The doctor makes a smaller incision and uses a magnifying instrument to see the disk and nerves. It is not always possible to do a microdiskectomy.
Surgery is not always the better choice. People have been able to improve with nonoperative treatment options. Talk to your doctor about risks and benefits of surgery and other treatment options.
A relatively new procedure, total disk replacement, is now available as an alternative to fusion. It is chosen when the cause of the injury is a degenerated disk. In the procedure, an artificial disk is used to replace the damaged disk. In theory, it offers the ability to repair the damaged portion of the spine while still maintaining the mobility of the spine. However, this new procedure remains controversial. It may be appropriate for only a limited group of patients. Patients with multiple degenerating disks or those who have had multiple failed back surgeries may not be candidates for artificial disk replacement. There is also a device to replace only the nucleus pulposus. This is the soft inner part of the disk. The role of these new technologies is not yet established and long-term outcome data are lacking.
Nucleoplasty is one of the newer, less-invasive surgical procedures. This procedure typically uses radio waves to treat patients with low back pain caused by a contained or mildly-herniated disk. In nucleoplasty, the surgeon inserts a wand-like transmitter into the disk. Guided by x-ray imaging, the surgeon sends radiofrequency pulses into the center of the disk. The radiofrequency energy heats and shrinks the gel-like tissue. This results in less volume and relieves pressure on the nerve. You are awake, but lightly sedated. The entire procedure lasts about 30 minutes.
Radiofrequency denervation treats the nerves to stop them from sending pain messages to the body. During the procedure, a needle is placed in the nerve that is connected to the damaged joint. An anesthetic is injected. Then, the needle is heated to damage the nerve so it stops sending pain signals. The procedure is done on an outpatient basis.
Intra-articular Steroid Injections
An intra-articular steroid injection is a steroid medication that is injected into the joint space of a vertebrae to reduce pain.
- Reviewer: Rimas Lukas, MD
- Review Date: 10/2012 -
- Update Date: 11/11/2013 -