For many patients who are experiencing pain or discomfort from a spinal condition, spine surgery can be an excellent option to relieve pain and return to every day activities.
Before having surgery, patients must be properly qualified by an experienced orthopedic spine surgeon and fully informed of their treatment options. Any surgery can be scary, and knowing the facts is an important step on the road to recovery.
Here, I’ll describe the most common types of spine surgery.
The most common spine surgeries fall into two categories: decompressing the neurological structures and stabilizing the spine. The categories are often combined during spinal procedures. More specifically, there are four common types of procedures that represent about 90 percent of all spine surgeries:
- Discectomy: This procedure usually consists of removing herniated disc material that presses the nerves or spinal cord. Discectomy is a decompressive type of surgery.
- Laminectomy/ laminotomy: An opening over the nerve or spinal cord is performed to relieve compression of those structures. The terms laminectomy and laminotomy correlate to the location of said opening in the posterior elements of the spine and their size. This is also a type of decompression.
- Spinal decompression and fusion: It is the most common spine surgery performed in the U.S., and it's performed to take pressure off of “pinched” nerves and/or the spinal cord and to stabilize the spine. During the procedure, pressure is relieved, and the spine is stabilized using hardware that is anchored to bony elements of the spine. This procedure combines decompression and spine stabilization.
- Anterior cervical discectomy and fusion: In a way, this is a spinal decompression and fusion procedure. The difference is that it is performed from the front of the spine, as opposed to the most common decompression and fusion procedures, which are generally performed from the back. Also, as indicated by the name, it is performed on the neck. It has earned a separate position on this list because it is very commonly performed. Indications include nerves or the spinal cord pinching in the cervical spine. This part of the spine is vulnurable to compression of neurological structures coming from the disc, so we remove the disc, restore the disc space by putting a spacer between the vertebrae and use instrumentation to accelerate healing of the vertebrae with each other, so-called fusion. This is another procedure that combines decompression and spine stabilization.
Conditions Related to the Most Common Types of Spine Surgery
Generally speaking, the most common conditions related to spine surgery are:
- Disc herniation.
- Spondylosis of the cervical and lumbar spine, which is basically accumulatuion of degenerative changes in the spine.
- Cervical myelopathy, when pressure on the cervical spinal cord causes compromise of patient's basic functions, i.e. walking. This condition is very often related to spondylosis.
- Spondylolisthesis, or slippage of one vertebrae over another.
Goals of Spine Surgery
Depending on the condition the surgeon is treating, immediate goals of the surgery can be classified in one of the following categories:
- Decompression of neurological structures.
- Stabilization of the spine.
- Combination of both, decompression of neurological structures and stabilization of spinal segments.
In the long term for spine surgery, our goal is to reduce pain and increase patients’ function.
The most common misconceptions are that spine surgeries are dangerous or that they carry a serious risk of permanent neurological injury. Hundreds of thousands of spine surgeries are safely conducted every year in the U.S., and risk of the aforementioned injuries is extremely low.
Another misconception is that patient function will be severely limited after the surgery. As I mentioned, the goal of surgery is to improve patient function, not limit it.
Finally, some patients believe that it doesn’t matter who performs the surgery. It’s important to work with a well-trained and experienced orthopedic spine surgeon to perform your procedure.
Importance of Being Qualified for Spine Surgery
The vast majority of patients who have been appropriately qualified for spine surgery achieve very good to excellent results, and they return to normal or near normal function with significant improvement in their pain.
In general, the small number of patients who do not achieve positive results were often not appropriately qualified and were likely not good candidates for surgery in the first place.
Recovery Process Is Always Improving
We are constantly pushing for innovations in spine surgery including less invasive surgical procedures and better pain control for patients undergoing spine surgeries. The recovery from a spine operation is significantly quicker now than it has been in the past, and it will continue to improve.
Depending on the surgery, we typically expect patients to return to their normal activities in about three weeks. Some patients who have less invasive procedures report being able to return to normal life, with a lack of pain, within several days.
Here are some specific recommendations for recovering from lumbar fusion surgery.