Whether or not to undergo surgery is a decision that you and your surgeon and/or physiatrist will make together, based on your symptoms and your overall health. Although spine surgery can be an extensive procedure, most patients, even the elderly, are medically capable of tolerating the procedure.
If you are severely disabled by your back or leg symptoms, and non-operative treatment has not decreased your symptoms, then surgery may be a reasonable option. The choice of a specific surgical technique depends on the exact cause of your pain and your surgeon’s preference. Regardless of the surgical approach that is chosen, if decompression (making room for the nerves) is not adequate, relief of symptoms may be incomplete or the problem may recur following a short period of clinical improvement.
- Laminectomy: A standard decompressive procedure to enlarge the space available for your nerves. This involves a midline incision over the involved levels, dissection down to the spinous processes, and removal or “unroofing” of parts of your bony vertebrae (spinous processes, laminae, and ligamentum flava) to make room for the nerves in the spinal canal. This procedure is often performed across multiple vertebral levels, since canal stenosis rarely occurs in an isolated fashion. Removal of other bony prominences such as facet joints (oftentimes enlarged because of osteoarthritis) may be necessary to adequately decompress the nerves.
- Hemilaminectomy: An alternative to the basic laminectomy, with slightly less risk of destabilizing the spine because only half of the structure is removed.
- Laminotomy: “Windows” or fenestrations are created by removing the superior aspect of the inferior lamina and the inferior aspect of the superior lamina at the involved levels. Proponents of this approach believe that sparing the interspinous ligaments and preserving spinous processes minimizes the risk of postoperative instability.
- Medial Facetectomy: If you have osteoarthritis in your spine, then your facet joints might be enlarged with osteophytes. Sometimes, in order to adequately decompress your nerves, it may be necessary to remove part of the medial facets. However, this additional procedure has the potential of creating instability in your spine, which may then require instrumentation and fusion.
- Laminoplasty: Involves the en bloc removal and loose reattachment of the posterior vertebral arches.
- Vertebroplasty: Used in cases of back pain caused by compression fractures. Percutaneous vertebroplasty involves injecting acrylic cement into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body. This procedure does not restore the shape or height of the compressed vertebra.
- Kyphoplasty: Used in cases of back pain caused by compression fracture. First, the compressed vertebral body is expanded by a high-pressure balloon, then acrylic cement is injected into the cavity to restore height to the collapsed vertebra.
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