Over 85% of people will, at some stage in their life, experience back pain. Of this number, less than 5% are good candidates for surgery. The other 80% of people are able to alleviate back pain through conservative methods, such as physiotherapy and rehabilitation. Some of the common types of lower back surgeries are discussed below.
Lumbar Nerve Root Block This procedure is primarily used as a diagnostic tool to identify the specific source of nerve root pain, and secondarily for therapeutic relief of lower back pain or leg pain caused by a compressed or inflamed nerve root. The aim is to reduce the inflammation of the nerve root and to block the pain impulses from travelling up the nerve to the brain causing a partial or complete (but usually temporary) relief of pain. The surgeon will use an injection containing a mixture of local anaesthetic for pain relief and steroids for reduction of inflammation, which is administered at the painful level of the spine.
Lumbar Facet Block This procedure is also considered diagnostic and therapeutic in nature. It is performed to identify which facet joint is causing pain and to reduce the inflammation at that level, thus reducing pain. This will bring about partial or complete (but usually temporary) relief of pain. Similarly to a nerve root block, the surgeon also uses an injection for this procedure.
Lumbar Radiofrequency Rhizotomy This is a more conservative procedure which is used where pain is caused by clearly identified facet joint damage. It is often performed after a successful facet joint block. The procedure involves temporarily paralysing the small nerves that supply the facet joint, thus making them unable to sense pain. This is done through a radiofrequency generator.
Lumbar Microdiscectomy This operation is performed on lumbar disc herniations, to remove the portion of nucleus pulposus (soft inner portion of the disc) that has herniated through the annulus fibrosus (tough outer ring of the disc). This operation only removes the escaped portion of nucleus pulposus, leaving a risk of recurrence following surgery. It is, however, less invasive than removing the whole disc and needing to fuse the spine. The surgeon will have to make an incision for the removal.
Lumbar Decompression This surgical procedure is done to remove any abnormal compressive forces on the lumbar spinal nerves caused by bone, ligament or disc. Nerve dysfunctions usually presents when these nerves are entrapment leading to motor and sensory fallout in the lower limbs, which could eventually lead to permanent fallout if compressed over a long period of time.
Lumbar Fusion This procedure is done to create stability between vertebrae where there may be an instability caused by wear and tear changes, injury or secondary to a previous lumbar surgery that has resulted in spinal instability. The aim of the fusion is to keep the distance between the spinous processes for the spinal canal to remain patent, reducing nerve compression. Bone is usually grafted from the hip, but occasionally metal implants are needed to improve the chances of a successful bony union.
Lumbar Total Disc Arthroplasty This is where a damaged disc is completely removed and replaced with an artificial disc. This is performed to alleviate nerve root compression, thus impacting back pain and/or referred lower limb pain.
Kyphoplasty and Vertebroplasty These minimally invasive procedures are sometimes used for osteoporotic and metastatic vertebral compression fractures of the spine and sacrum. The procedure stabilises the collapsed or fractured vertebral body and restores its height by reinforcing soft bone with cement. With a Kyphoplasty, the shape and height of the vertebral body is restored as a cannula is inserted through the skin posteriorly into the vertebral body. The balloon is inflated and filled with cement restoring alignment. With a Vertebroplasty, the fracture is restored, but the height of the vertebral body is not.
Physiotherapy is useful prior to surgery to prepare one for what to expect, inform them of the specific precautions that need to be followed post-surgery and to assist in keeping as active and strong as possible. Physiotherapy is vital post-surgery. There are various physiotherapy interventions that help to alleviate pain and rehabilitation exercises are vital to restore control, strength and optimal function.
Remember, less than 5% of spinal conditions require surgery, and most can be managed conservatively, with physiotherapy able to assist you either way!
