In this article, we will try to put various types of back surgery into perspective from a patient’s point of view. I hope this will give patients a better foundation while discussing the technical terms related to surgical options with your spine surgeon. Broadly spine surgeries related to back can be divided into 3 categories:
- Decompression surgery
- Stabilisation and spinal fusion surgery
- Motion preservation or disc replacement surgery
Decompression surgery
Majority of back surgeries fall into this category. As the name suggests decompression surgery aims at removing compression related to structures in the spine. Decompression surgery removes material that is placing pressure on a nerve (or nerves), resulting in pain, weakness, or numbness. Most of the times, decompression alone solves the problem, and patients are able to resume their daily activities pain-free. Based on the culprit compressive element removed decompression surgery includes: Laminectomy, facetectomy, foraminotomy and discectomy.
Laminectomy/Laminotomy
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 removing a wall of a room to gain good access and visualisation of the structure in the room. The procedure also provides more room for the structures. During a laminotomy, a surgeon removes a small amount of the lamina; a keyhole laminotomy requires an even smaller removal and incision. It is akin to creating a window in to the room, rather than removing the whole wall. In some cases, these smaller procedures are all that’s needed to gain entry into the canal and successfully address the nerve issue.
Facetectomy
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 such a scenario a facetectomy is performed, where part or whole of the facet joints need to be removed. 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.
Foraminotomy
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.
Discectomy
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.
Stabilisation and spinal fusion surgery
During back surgery a stabilization procedure may be required for one of two reasons:1, Significant material was removed during decompression surgery and the spine becomes unstable. 2. Or 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 or an inherent break in one of your bones. 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.
Motion preservation
Disc Replacement: 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.
It is in your best interest to get evaluated by a Spine specialist nearby for best assessment. It is important to be assessed by a spine specialist so that your symptoms can be matched with the appropriate spine surgery suited to your condition.
