As you may have already discovered, doing research on the different types of back surgery isn’t as straightforward as it seems. In this article, we try to put back surgery into perspective from a patient’s point of view, which will hopefully give you a better foundation when discussing surgical options with your doctor.
Types Of Back Surgery Procedures
In the most general of terms, there are two things that cause pain in your back:
- Pressure on one or more nerves.
- Severe degeneration of one or more elements of your spine (including the disc and facet joints—the two components of the vertebrae that make up your spine).
For patients experiencing nerve pressure, the first course of action is some type of decompression surgery. Decompression is a general term used to describe the removal of the material impinging on the nerve. For example, if a herniated disc or bone spur is pressing on a nerve, a surgeon will attempt to remove a small portion of the disc or spur—just enough to relieve the pain.
For patients suffering from degeneration, like a naturally worn-out disc or arthritic facet joint, decompression won’t work—the spinal element will still be in poor condition no matter how much material is removed. And if those elements were to be removed, the spine would become unstable. To address this, a patient may undergo a stabilization procedure, which may or may not be used in conjunction with decompression surgery. If, for instance, a surgeon removes a substantial piece of material during decompression, it may make the spine unstable, and additional surgery may be necessary.
So first, it’s important to find out what exactly is causing your pain—is it a pinched nerve or a degenerating disc or facet joint? Or are both elements present? From there, you can then discuss with your doctor the types of low back surgery that may be used to address it.
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Types Of Back Surgery For Decompression
A good number of back surgeries fall into this category. Remember, decompression surgery removes material that is placing pressure on a nerve (or nerves), resulting in pain, weakness, or numbness. Often, decompression alone solves the problem, and patients are able to resume their daily activities pain-free.1
The lamina is the bony “roof” covering the spinal canal, which runs down the length of your spine. The lamina itself isn’t often the problem, but a surgeon may need to remove a portion of the lamina to gain access to the problem area—the spinal canal or the nerve root. It’s like lifting the hood of your car to change the spark plugs, making the car run smoothly again.
During a laminotomy, a surgeon removes a small amount of the lamina; a keyhole laminotomy requires an even smaller removal and incision. In some cases these smaller procedures are all that’s needed to gain entry into the canal and successfully address the nerve issue.
A degenerating facet joint may become enlarged or develop bone spurs (an outgrowth of bone), causing compression of a nearby nerve. Or, a small portion of a facet joint may need to be removed in order to gain access to a troublesome disc. In either case, a facetectomy is performed. (Note that the facet joints are vital to overall stability of the spine, so depending on how much of the joint is removed it may be necessary to do additional surgery for stabilization purposes.)
The foramen is the exit passageway for nerves leaving the spinal canal. If that passageway becomes smaller for any reason it will pinch the nerves, causing pain. In a foraminotomy, a surgeon tries to open the space up again by removing small portions of material on the inside of the passageway—the pedicle on top, facet joints on the sides, and the disc.
If a disc is herniated, pushing past its outer rim, it may interfere with the surrounding nerves. Removing a portion of the disc—known as a discectomy—is usually enough to ease the pain, but may require an accompanying laminectomy or facetectomy to reach the affected area. (Before considering the types of back surgery for a herniated disc, talk with your doctor about how to heal a bulging disc naturally.)
Types Of Back Surgery For Stabilization
Patients undergoing back surgery may require a stabilization procedure for one of two reasons:
- Significant material was removed during decompression surgery and the spine becomes unstable.
- A subtle instability has been identified prior to surgery due to something like multiple recurrent disc herniations, or worn-out joints adjacent to a previous spinal fusion.
Spinal fusion is the traditional method used to stabilize the spine. During fusion, a surgeon removes the disc and the facet joints, packs the space with bone graft, and inserts spacers, screws, and rods into the bones to temporarily hold everything in place. Eventually the bone graft fuses, the body heals, and what were once two or more separate vertebrae are now joined as one solid mass of bone. The joint has been eliminated from your spine, and, as a result, your range of motion will be impacted.2 (For more information about spinal fusion complications, read more about the types of spinal fusion surgery.)
For a very small number of patients who have an isolated issue with a single disc and healthy surrounding facet joints (a condition that’s not common among patients with back pain), a disc replacement would help stabilize the spine should a disc need to be removed for any reason.
BalancedBack Total Joint Replacement
BalancedBack Total Joint Replacement surgery is a new alternative to fusion. It allows surgeons to address decompression issues and provides needed stability by replacing not only a damaged disc but the function of the facet joints as well. BalancedBack works for a large percentage of the cases where patients need fusion.
Most fusions are done after a decompression, where a significant amount of bone or disc has been removed. But where fusion sacrifices motion for stability, BalancedBack retains motion and stability because it replaces rather than removes the facet joints. Ultimately, BalancedBack surgery can accomplish three things:
- Address a broad range of decompression issues.
- Stabilize the spine with a completely new joint.
- Retain full range of motion in the lumbar spine.
Interested in learning more about BalancedBack Total Joint Replacement?
No two patients are the same, so what benefits someone else may not be right for you. If you’re investigating different types of back surgery procedures and would like to know more about BalancedBack, visit our website.
1Jones, A. D. R., Wafai, A. M., & Easterbrook, A. L. (2014). Improvement in low back pain following spinal decompression: observational study of 119 patients. European Spine Journal, 23(1), 135-141.
2Choi, S.J., Moon, J.W., Ryu, D., Oh, C.H., & Yoon, S.H. (2018). Range of motion according to the fusion level after lumbar spine fusion: A retrospective study. The Nerve, 4(2), 55-59.