Type of Surgery
Last updated: 02/17/2009
Surgery for lower back pain is considered a treatment of last resort, with the exception of cauda equina syndrome. Patients should always try one or more conservative approaches before consulting a surgeon about...
a laminectomy. In addition, most health insurers will require proof that the surgery is necessary, since the average total cost of a lumbar laminectomy is $85,000.
Some conservative approaches that have been found to relieve lower back pain include:
- Analgesic or muscle relaxant medications. Analgesics are drugs given to relieve pain. The most commonly prescribed pain medications are aspirin or NSAIDs. Muscle relaxants include methocarbamol, cyclobenzaprine, or diazepam.
- Epidural injections. Epidural injections are given directly into the space surrounding the spinal cord. Corticosteroids are the medications most commonly given by this route, but preliminary reports indicate that epidural injections of indomethacin are also effective in relieving recurrent pain in the lower back.
- Rest. Bed rest for 48 hours usually relieves acute lower back pain resulting from muscle strain.
- Appropriate exercise. Brief walks are recommended as a good form of exercise to improve blood circulation, particularly after surgery. In addition, there are several simple exercises that can be done at home to strengthen the muscles of the lower back. A short pamphlet entitled Back Pain Exercises may be downloaded free of charge from the American Academy of Orthopedic Surgeons (AAOS) web site.
- Losing weight. People who are severely obese may wish to consider weight reduction surgery to reduce the stress on their spine as well as their heart and respiratory system.
- Occupational modifications or change. Lower back pain related to the patient's occupation can sometimes be eased by taking periodic breaks from sitting in one position; by using a desk and chair proportioned to one's height; by learning to use the muscles of the thighs when lifting heavy objects rather than the lower back muscles; and by maintaining proper posture when standing or sitting. In some cases the patient may be helped by changing occupations.
- Physical therapy. A licensed physical therapist can be helpful in identifying the patient's functional back problems and planning a course of treatment to improve flexibility, strength, and range of motion.
- Osteopathic manipulative treatment (OMT). Osteopathic physicians (DOs) receive the same training in medicine and surgery as MDs; however, they are also trained to evaluate postural and spinal abnormalities and to perform several different manual techniques for relief of back pain. An article published in the New England Journal of Medicine in 1999 reported that OMT was as effective as physical therapy and standard medication in relieving lower back pain, with fewer side effects and lower health care costs. OMT is recommended in the United Kingdom as a very low-risk treatment that is more effective than bed rest or mild analgesics.
- Transcutaneous electrical nerve stimulation (TENS). TENS is a treatment technique developed in the late 1960s that delivers a mild electrical current to stimulate nerves through electrodes attached to the skin overlying a painful part of the body. It is thought that TENS works by stimulating the production of endorphins, which are the body's natural painkilling compounds.
The most common surgical alternative to laminectomy is a minimally invasive laminotomy and/or microdiscectomy. In this procedure, which takes about an hour, the surgeon makes a 0.5-in (1.3-cm) incision in the lower back and uses a series of small dilators to separate the layers of muscle and fatty tissue over the spine rather than cutting through them with a scalpel. A tube-shaped retractor is inserted to expose the part of the lamina over the nerve root. The surgeon then uses a power drill to make a small hole in the lamina to expose the nerve itself. After the nerve has been moved aside with the retractor, a small grasping device is used to remove the herniated portion or fragments of the damaged spinal disk.
The advantages of these minimally invasive procedures are fewer complications and a shortened recovery time for the patient. The average postoperative stay is three hours. In addition, 90% of patients are pleased with the results.
Complementary and alternative (CAM) approaches
Two alternative methods of treating back disorders that have been shown to help many patients are acupuncture and chiropractic. Chiropractic is based on the belief that the body has abilities to heal itself provided that nerve impulses can move freely between the brain and the rest of the body. Chiropractors manipulate the segments of the spine in order to bring them into proper alignment and restore the nervous system to proper functioning. Many are qualified to perform acupuncture as well as chiropractic adjustments of the vertebrae and other joints. Several British and Swedish studies have reported that acupuncture and chiropractic are at least as effective as other conservative measures in relieving pain in the lower back.
Movement therapies, including yoga, tai chi, and gentle stretching exercises, may be useful in maintaining or improving flexibility and range of motion in the spine. A qualified yoga instructor can work with the patient's doctor before or after surgery to put together an individualized set of beneficial stretching and breathing exercises. The Alexander technique is a type of movement therapy that is often helpful to patients who need to improve their posture.
Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. There are many variations of laminectomy, in the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. The traditional form of laminectomy (conventional laminectomy) excises much more than just the lamina, the entire posterior backbone is removed, along with overlying ligaments and muscles. The usual recovery period is very different depending on which type of laminectomy has been performed: days in the minimal procedure, and weeks to months with conventional open surgery.
For a neurosurgery, as for any other surgery, it's important to always bring x-rays and any other medical records the patients has.
-Dr Catherine McAuley
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