What Are the Different Types of Spinal Surgery?
Does back pain stop you from enjoying an active south Florida lifestyle or make it hard to get around or work? Well you’re not alone. According to statistics, around 16 million adults in the US experience chronic back pain.
If you’ve been enduring this condition for quite some time now, it’s not surprising if you’re wondering whether you need a back surgery. Indeed, back surgeries are among the treatment options that the best spine surgeons in South Florida may recommend after a thorough evaluation of your condition.
However, there are many different sources of back and neck pain.
The good news is most causes are short lived and manageable if diagnosed and treated properly. Additionally, not every condition that causes back pain requires surgery.
In this article, we take a closer look at the different types of back or spinal surgery. Ultimately, we hope to give you an idea of the options currently available should you turn out to be a candidate for back surgery.
Types of Back or Spinal Surgery
1. Spinal fusion
Spinal fusion is a procedure wherein a spine surgeon joins (fuses) two or more vertebrae in the low back. This is usually done for conditions which involve instability or imbalance (fractures, spondylolisthesis, scoliosis, etc) or an unusually painful joint (disk degeneration, spondylosis).
There are many different techniques used to facilitate a fusion (ALIF, XLIF, TLIF PLF, pedicle instrumentation, etc) depending on each patient’s unique medical and biomechanical conditions. Spinal fusion procedures are some of the most cost-effective surgical treatments available (Polly Spine 2007) when performed appropriately.
A fusion does, however, permanently restrict motion at the treated level and the surgeon must carefully analyze all variables to ensure a fusion is the best option and is performed in a way to offer the best and most endurable outcome. See our website for some of the fusion procedures that Dr. Hepler, one of the most reliable spine surgeons in Delray Beach, FL, performs.
All joints wear and tear with time producing “arthritis” as we age. In the back, these arthritic changes can narrow the room for the spinal cord and nerves. This narrowing, called stenosis, can impair nerve function just like a clogged pipe decreases water flow.
Spinal stenosis is the most common cause of back and leg pain in patients over 60 years old and can severely limit activity as it worsens. Early on, spinal stenosis is treated successfully with non-operative treatments, anti-inflammatories, pain medications, epidural injections, and physical therapy.
As the stenosis becomes more severe, surgical treatment may be necessary to “unclog the pipe”.
The most effective, timely, and definitive means to treat spinal stenosis is through a laminectomy. The bone spurs and thickened ligaments are removed to relieve pressure on the nerves and resolve pain.
This can often be performed with minimally invasive spine surgery and the patient often goes home the same day. A spine fusion may be necessary if significant instability is also present and in fact laminectomy and fusion are often performed together.
Lumbar discectomy is another type of surgery done to remove an injured, herniated, or degenerative disk in the patient’s lower spine. In a discectomy, the problematic disk that causes the pain as it presses on the spinal cord or nerve root is basically “cut out.”
There are two types of lumbar discectomy: open spine surgery and the minimally invasive arthroscopic discectomy. However, open spine surgery is the more common procedure.
Furthermore, diskectomy is often performed together with laminectomy.
The foramen are small openings that nerves pass through as they exit the spine and enter the body. Sometimes disk herniations or bony spurs will pinch the nerves as they pass through these foramina causing stenosis and nerve pain. If nerve pain persists despite non-operative treatment surgical treatment may be necessary.
Foraminotomy is a procedure a spine surgeon may recommend to relieve the nerve compression and pain. This involves removing the disk fragment, thickened ligaments, or bony spurs that compress the nerve thereby opening the space and relieving the nerve compression and pain.
A foraminotomy can often be performed through a small 2-centimeter incision with minimally invasive spine surgery as an outpatient. Laminectomy and spine fusion are often performed in addition to a foraminotomy if there are other areas of stenosis or instability.
As the population ages osteoporosis and osteoporotic fractures have become an increasingly common source of back pain and disability.
Studies show over 1 million vertebral compression fractures occur each year. And are a source of worsening disability and mortality. Although many fractures may heal if diagnosed and treated early on many go on to produce worsening pain, kyphosis (hunchback), and increased mortality.
Kyphoplasty is a minimally invasive spine surgery that stabilizes the fracture with a strong glue like material (methyl methacrylate). This is often done under sedation with two small 4mm incisions and the patient goes home the same day.
Patients often experience immediate pain relief, functional improvement, and better survival. Our spine surgeon in Palm Beach County may recommend a kyphoplasty procedure to treat your back pain, hunchback (kyphosis), or instability. He can also treat the osteoporosis itself to decrease the risk for future fractures.
This is a type of laser surgery that uses radiofrequency energy to treat lower back pain due to a mildly herniated disk. This is done by inserting a needle into the herniated disk, then a plasma laser device is inserted into the needle to heat the tip. As a result, this creates a field that vaporizes the protruding tissue in the disk to reduce its size until it can no longer put pressure on the nerve.
7. Disk replacement
A spinal disk is a strong elastic pivot between each vertebra. It makes the spine strong and stable while allowing motion. With time, a disk can weaken and start to cause back pain. In such cases, the doctor may decide that a disk replacement surgery might relieve the pain. During the procedure, the damaged – ‘herniated’ – disk is removed and replaced with an artificial joint.
The disk replacement has been shown to decrease pain in properly selected patients while preserving joint motion; this might decrease the risk for later disk degeneration in adjacent spine joints.
8. Minimally Invasive Spine Surgery (MISS)
MISS is an alternative to a standard, open incision surgery. It is considered as effective as traditional “open surgery” with less dissection, blood loss, and operative time. MISS involves making small incisions and accessing the spine through specialized retractors or endoscopes.
This can be performed in the front, anterior, part of the spine (XLIF, DLIF) or the back, posterior, part of the spine (TLIF). The advantages of such an approach include less soft tissue trauma, lower blood loss, decreased risk for infection and shorter hospital stays and faster rehabilitation.
When Should You Consider Spine Surgery?
Thanks to modern advancements in healthcare, there are now a number of surgical and non-surgical options to relieve back pain. However, it’s also not surprising if you find it daunting to decide whether you should consider spine surgery or not.
To help you out, there are three basic signs you can watch out for to know if you could be a candidate for back or spine surgery. These are:
- Pain that doesn’t go away
- Pain that radiates to the arms and/or legs
- Severe symptoms related to trauma
Furthermore, the best and surest way to know if your condition warrants surgery is to consult a trusted spine surgeon near you.
As mentioned above, not all spine problems require surgical treatment. Only after a thorough evaluation of your condition can a surgeon recommend any surgery. As such, you don’t need to beat yourself up wondering if you should get back surgery.
The first step you should take is to consult a spine surgeon like Dr. Hepler.
How to Decide About Spine Surgery – Start With Finding the Right Spine Surgeon
The first and most important step to getting better is making a diagnosis with a trained spine specialist. Dr. Matthew Hepler is a fellowship-trained adult and pediatric spine surgeon in Delray Beach and Fort Lauderdale with leading expertise in the diagnosis and treatment of spine conditions.
Following a thorough evaluation, he can help make a diagnosis and formulate an effective treatment plan to get you back on your feet. Most of the time this can be done with non-operative treatments including a focused exercise regimen. Surgical treatment may give the best result for patients who fail to improve with non-operative care.
What Types of Spine Surgery Are Offered at Dr. Hepler’s clinic?
Some of the most common causes of back pain include spinal stenosis, spondylolysis, spondylolisthesis, lumbar stenosis, compression fractures, sagittal malalignment, and – rarely – infections, tumors, or inflammatory conditions.
There are many conditions that can cause back pain, so it is important to get an expert opinion. Our orthopedic surgeon will be able to diagnose the cause of your pain. After that, Dr. Hepler may suggest any of the following surgical treatments offered at one of our clinics:
- Minimally Invasive Spine Surgery (MISS)
- MicroEndoscopic Discectomy (MED)
- Posterior Lateral Fusion (PLF)
- Posterior (Transforaminal) Lateral Interbody Fusion (P/TLIF), and many more!
If you are suffering from back pain, don’t hesitate and make an appointment with Dr. Matthew Hepler. He is offering his services at two convenient locations:
For more information give us a call or schedule an appointment. We look forward to seeing you soon!
The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.