Spine surgery is rarely an initial treatment for back pain, however, there are a few emergencies that may require surgical treatment. In the vast majority of patients, spine surgery is only considered after a long course of nonsurgical therapy. Back pain is usually a chronic problem, and often takes quite some time to resolve. Therefore, rushing into spine surgery may not be the best option. Most commonly, doctors will advise at least 3 to 6 months of conservative treatment before considering spine surgery.
A discectomy is a procedure to remove a portion of the spinal disc that rests between each vertebrae. A herniated disc is the most common reason for spine surgery. When a discectomy is performed, the fragment of herniated disc is removed to relieve the pressure on the spinal nerves.
A foramenotomy is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just a herniated disc. A foramenotomy removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column. Often a foramenotomy is performed along with a discectomy to ensure that there will be sufficient room for the compressed nerve.
A laminectomy is done to relieve pressure on the spinal cord itself. A laminectomy is most commonly used to treat spinal stenosis, a condition where pressure builds up around the spinal cord and spinal nerves. Depending on the amount of bone removed, a laminectomy may also require a spinal fusion to be performed. When enough bone and ligaments are removed, the fusion becomes necessary to stabilize the spinal column.
A spine fusion is surgery that is done to eliminate motion between adjacent vertebrae. The spine fusion may be done to treat a problem such as spondylolisthesis (unstable spine), or it because of the extent of other surgery (such as a laminectomy). A fusion requires bone to form between the adjacent vertebrae, and is often augmented with metal screws and rods to support the spine while the bone is healing.
Spinal disc replacement is a more recent surgical option that is still quite uncommon. Spine disc replacement is done to treat specific types of back pain, while avoiding the problems associated with spine fusion surgery.
Dynamic stabilization is another option for those trying to avoid spine fusion, but in need of some stability of the spine. Dynamic stabilization uses screws and rods, similar to a fusion, but these rods allow for limited mobility between each segment. Therefore, dynamic stabilization is intended to allow some limited motion between adjacent spinal segments.