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Is Lower Back Surgery or Lumbar Spine Surgery Appropriate?

300px Spinewithcord Is Lower Back Surgery or Lumbar Spine Surgery Appropriate?

Lower Back Surgery: What Happens in lumbar spine surgery- Image via Wikipedia

Lower back surgery is actually a misnomer. What we call “lower back surgery” is specifically lumbar spine surgery or lower spinal surgery.

There are only a few indications for lower spinal surgery. These are…

  • When conservative treatment is not effective in reducing pain
  • When there are signs of focal neurologic deficits, such as leg weakness, sexual dysfunction (impotence), loss of bladder or bowel control (occurs when central lumbar disc herniation causes spinal abscess or cauda equina syndrome)
  • When there are signs of progressive nerve problems caused by herniated discs
  • Spine injury

The various types of lower back surgery each treat a specific cause of lower back pain. A patient may require only one type of surgery, but others may also need spinal fusion to further stabilize the problematic site.

Here are the most common types of lower spine surgery…

  • Discectomy/Microdiscectomy: The procedure involves removing the herniated portion of a disc that has impinged upon a nerve. Discectomy serves to relieve irritation and inflammation on the compressed nerve. The procedure may involve full or partial removal of the posterior portion of the affected vertebra (called the “lamina”) to be able to reach the ruptured disc.
  • Laminectomy: The procedure involves removal of herniated discs or bone spurs that press upon a spinal nerve. Laminectomy also involves enlarging the spinal canal in order to relieve pressure on the nerve caused by spinal stenosis and spondylolisthesis. This procedure may be performed with spinal fusion in order to achieve stabilization in the affected site.
  • Foramenotomy: As its name denotes, it involves the removal of bone and other tissues that impinge upon the nerve as it exits the spinal column via the intervertebral foramen. This is performed when the nerve is being compressed by more than just a herniated disc.
  • Spinal Fusion: This involves permanently connecting two or more bones in the spine by using screws, plates, or by creating bony bridges between vertebrae with bone grafts. This procedure aims to give the spine greater stability and thus reduce painful motion between vertebrae in causes of injured and degenerated discs and spinal fracture.
  • Vertebroplasty: This procedure involves injecting bone cement into compressed vertebrae to help stabilize fractures and thus reduce pain in compressed and fractured vertebrae.
  • Kyphoplasty: A variation of vertebroplasty, this procedure first involves the insertion and inflation of a balloon in between compressing vertebrae in order to expand the bone to its normal size. Cement is then injected to fill the empty space. Kyphoplasty is commonly performed in patients suffering from back pain as a result of osteoporotic and compression fractures, and can help prevent spinal deformities (such as scoliosis, kyphosis and lordosis) and height loss.
  • Spinal cord stimulator implant: A minimally-invasive technique which involves implanting a spinal cord stimulator that relieves pain and other symptoms of sciatica and other chronic radiculopathies (diseases of the nerve roots).
  • Lumbar Artificial Disc Replacement: A new type of surgery being explored as an alternative to spinal fusion. The procedure involves the implantation of artificial discs that would prevent painful compression between two vertebrae because of an injured or degenerated disc.

Clinical trials at the present time have yet to show conclusively the effectiveness of spinal surgery in the treatment of lower back pain. What most studies have shown is that the benefits of spinal surgery are limited when treating degenerative discs with symptoms of spinal pain. Also, there is an increased risk of complications in the use of spinal implants, including risks of blood loss, nerve injury, infection, and even repeat lower back surgery, in comparison to spinal fusion.

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What Is A Bulging Disc and What Are The Symptoms?

Bulging DiscBulging Disc 300x243 What Is A Bulging Disc and What Are The Symptoms?

Most patients make the mistake in thinking that a “bulging disc” is the same as a “protruding disc”. In reality, a bulging disc may be considered as the earliest state in the development of a disc herniation.

A bulging disc is considered as a contained disc disorder. This means that the soft center of the intervertebral disc (nucleus pulposus) has pushed against the outer fibrous ring (annulus fibrosus) so that, without tearing or rupturing the outer layer, it would appear as a swollen mass. Unlike a protruding disc, however, a bulging disc is not large enough to jut into the spinal canal and compress a nerve root or nerve.

Bulging Disc Symptoms

So what causes bulging disc symptoms? Despite the absence of nerve compression, a bulging disc induces the release of inflammatory chemical mediators – most notably Tumor Necrosis Factor-Alpha (TNF) and Interleukin-17 (IL-17) – which irritate the nerve roots or nerves.

Most cases of bulging discs do not present with any symptoms at all. In fact, bulging discs are more often incidental findings on CT and MRI scans done on patients who are being evaluated for other diseases.

The pain of bulging discs is usually limited to the site in the spine where it is located. A cervical bulging disc usually presents with neck pain. On the other hand, lumbar bulging discs are characterized by pain in the lower back or buttocks. With persistent nerve irritation, pain may follow the nerve pathway radiation that is observed with protruding or herniated discs.

Relief Options for Bulging Disc Symptoms

Since bulging disc symptoms are acute, the pain may resolve on its own with a few hours of rest of with the application of ice and hot compresses. Non-steroidal anti-inflammatory drugs (NSAIDs) help not only to relieve pain but also to counteract the nerve irritation caused by the inflammatory mediators.

Patients diagnosed with bulging discs are advised to observe good posture habits and not do any heavy lifting so that the condition will not be aggravated any further. Back strengthening and stretching exercises also help to build stability in the spine and flexibility in the muscles and other supportive tissues.

Bulging discs have been found to respond very well to inversion therapy, a type of traction using an inversion table. A more effective bulging disc treatment is spinal decompression therapy, which could pull back the swollen nucleus pulposus to the center of the intervertebral disc.

Bulging disc surgery is rarely performed since this condition can be adequately managed through conservative means.

While a bulging disc should not be a cause of great concern for a patient, he or she must observe good posture and perform regular low-impact exercises that would prevent the condition from progressing to a more painful protruding or herniated disc.

Bulging DiscBulging Disc
What Is A Bulging Disc and What Are The Symptoms?

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