Decompressive Spinal Surgery for back pain part 2

What is Laminectomy?

Laminectomy involves removal of the entire roof (lamina) along with adjacent joint segment and ligaments over the spinal cord. This procedure is often done when the spinal stenosis is long and there is extensive narrowing.

What is laminotomy?

Laminotomy involves removal of a small piece of the lamina and ligaments on one side. Today, this procedure is often performed using a camera and a very tiny incision.

What is Foraminotomy?

Foraminotomy is removal of the bone where the nerve exits the spinal cord. It is often combined with the above two procedures and is helpful to relieve pressure from a pinched nerve.

What is laminoplasty?

Laminoplasty is a procedure done in the neck area to increase room in the spinal canal.

What is spinal fusion?

Spinal fusion may be done with any of the above procedures. When bone is removed from the back, instability can result. To prevent instability, the surgeon may fuse the back using bone grafts or metal rods. Fusion also prevents restenosis of the spinal canal from recurring.

Is spinal decompression surgery an emergency?

Unless one has cauda equina syndrome (a disorder where there is severe compression of the nerves which results in loss of bowel and bladder control), all back surgery is strictly elective.

Because there are side effects and possible complications, it is important to discuss with the surgeon what the best procedure is for your back. One should remember that no matter what type of decompressive surgery, only the symptoms are relieved. Disorders like arthritis will continue to progress.

Final Word

The overall results of spinal surgery are terrible. It is hard to meet anyone today who has had successful spine surgery. So do not rush for surgery, no matter how nice the surgeon looks or talks. Spine surgery is big business for the doctors. It is an expensive undertaking, is associated with many complications and there is no guarantee it will work. You do no get any refunds.

Herniated Discs 101 part 2

Does everyone develop shrinkage of the herniated discs?

Yes, it is important to understand is that regardless of treatment type, spontaneous shrinkage does occur to some degree in all individuals.

How should herniated discs be treated?

The first treatment for herniated discs is always non surgical. This hold true as long as there is no loss of bowel or bladder control. If a surgeon recommends surgery before trying out any other therapies, you need to get a new physician.

How long does improvement take?

Generally the pain can be moderate/severe during an acute episode of disc herniation and last anywhere from 2-10 days. The majority of individuals will improve without any aggressive treatment. In most cases, this simply means rest and pain control. Gradual decrease in pain will occur over the next two months

What are treatment options for herniated discs?.

The currently available non surgical methods to treat herniated discs include:

- use of over the counter pain medications (Advil)
- use of prescription pain medications
- use of heat packs
- use of ice packs
- application of TENS
- Wearing braces or corsets
- Hydrotherapy once the pain has subsided
- Use of ultrasound
- traction devices to help ease pain and increase range of motion
- Stretching of muscles
- Aerobic exercises

Which treatment should a patient with herniated disc undergo first?

Most individuals should undergo a trial of one or more of above treatments for at least 3-9 months before any decision about surgery is made.

When should one undergo surgery for herniated disc?

If you can help it- avoid surgery. However, sometimes there is no choice. In any case, the decision to undergo surgery is complex and needs to be thoroughly discussed with the surgeon. You need to get a surgeon who is more interested in your back than the money. Plus, the surgeon must be competent. Thirdly check out the surgeon’s experience and record. Ask to talk to his/her former patients. And most important, get to know the procedure and its possible complications. Surgery for back pain has a very poor track record of success.

What types of surgery is available for herniated disc?

The two currently available surgical options for herniated discs include:

- minimally invasive surgery (small incisions)
- decompression surgery to remove pressure off the nerve

If you have a herniated disc, the best thing to do is have a consultation with a physician who specializes in back disorders.

Remember read about the procedure and surgery is always the last option. There are no refunds when things go wrong.