Lumbar spine surgery is an invasive treatment that involves the physical removal, repair, or readjustment of spinal structures to treat injuries, diseases, or deformities affecting the spine between one or more of the L1-S1 spinal motion segments.
Types of Lumbar Spine Surgery
There are several types of back surgeries that can help stabilize the spine and manage back pain and leg weakness. The surgical management of spinal disorders is multi-disciplinary and involves an evidence-based approach after carefully analyzing the potential benefits and risks and overall benefit to the patient.
Lumbar Decompression:Lumbar Spine Surgery that Helps Relieve Nerve Compression
Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves. Pinched nerves cause pain, numbness, and abnormal sensations in the areas that they supply, such as the back, buttock, thigh, leg, and/or foot.
During a lumbar decompression surgery, a small portion of the bone over the nerve root or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment.
Decompression surgeries can be of 2 types:
- Lumbar discectomy
- Lumbar laminectomy
Spinal Fusion:Lumbar Spine Surgery that Helps Stabilize the Low Back
Fusion of a motion segment typically involves creating a living bone bridge between two contiguous vertebrae, either behind the disc, through the disc space, or both. This bridge stabilizes the spine and stops any motion at the fused motion segment. A bone graft is commonly used to bridge the vertebral bones, which is then replaced by the patient’s new native bone.
Lumbar spinal fusion surgery is designed to improve spinal stability and reduce pain in conditions that cause spinal malalignment or spinal degeneration, such as scoliosis, degenerative spondylolisthesis, and isthmic spondylolisthesis.
A combination of anterior and posterior lumbar fusion surgery may be performed if the front and back of the spine need to be fused.
This type of Lumbar Spine Surgery is typically indicated when a high degree of spinal instability is present (such as in complex spinal fractures), or in a revision surgery if the initial fusion did not set up.
Multilevel Spinal Fusion: Fusing more than 2 Levels of the Spine
Some fusion surgeries may involve fusing 2 or more motion segments of the spine to become one single unit. This type of surgery is called a multilevel spinal fusion. This surgery is designed to improve spinal stability and reduce pain in conditions that cause spinal malalignment or spinal degeneration.
Multilevel spinal fusion is almost always performed on contiguous spinal levels. The commonly fused spinal levels in the lower back are the motion segments in the lower half of the lumbar spine.
Interspinous Spacer: Preserving Posterior Spinal Motion
Posterior motion preservation spine surgery is a surgical technique that includes the implantation of small, specialized devices that help open up bony spaces in the spine that compress or pinch spinal nerves. The commonly used device is an interspinous spacer, which is designed to open up the foramen—the bony opening through which the nerve endings pass out of the spinal cord and into the legs. Nerve compression from spinal degeneration and lumbar degenerative disc disease may benefit from an interspinous spacer.
The interspinous device implantation surgery can be performed under mild sedation and local anesthesia as an outpatient/day surgery procedure and the patient can go home the same day. In select patients, the implantation of this device may serve as an alternative to a more complex spinal fusion surgery.
Facet Arthroplasty: Arthritic Facet Joint Replacement in the Spine
Total facet arthroplasty (TFA) is an implant intended to replace painful and stiff arthritic facet joints. This surgery may be combined with a spinal decompression surgery and aims to restore function and improve spinal stabilization.
The joint implant is inserted through an open surgical approach. The implant is fixed into the vertebral pedicles using bone cement. TFA surgery is new, and the long-term results of this surgery are not established in the literature.
Spinal Cord Stimulation (SCS): Reducing Back Pain Through Electric Stimulation
Spinal cord stimulation, also called neurostimulation, is a treatment where mild electrical pulses are directed to the nerves in the spinal cord. These impulses stimulate the nerves and interfere with pain signals, stopping them from reaching the brain.
It includes the implantation of a small device (similar to a cardiac pacemaker) near the spine, which generates these pulses. One of the potential benefits of this procedure is that it can be tried for a short time before a person commits to having the implant or having any lasting negative effects.
Separation Surgery: Separating Spinal Tumors from the Spinal Cord
Metastatic spinal tumors (tumors that spread to the spine from cancer elsewhere in the body) pressing on the spinal cord may be treated with a special surgical technique called separation surgery. The goal of this surgery is to remove enough of the tumor to separate it from the spinal cord to achieve spinal cord decompression. After the tumor is separated and removed, radiation therapy can be performed on the remaining part of the tumor with lesser risk to the spinal cord.
When indicated, a combination of separation surgery and radiation therapy enables more of the vertebra to remain intact compared to more traditional spinal decompression surgeries.