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Back and neck pain
Spinal degenerative disease and related disorders
What do you recommend, doctor?
The main aim of surgery is to relieve compression of trapped nerves. Occasionally there may be associated problems with stability of the spine and the surgeon may then have to undertake additional measures to deal with such difficulties. Generally, however, there is a desire to minimise the extent of surgery with advantages both to the patient, in terms of early discharge from hospital, and to health authorities in the form of reduced costs.
Laminectomy
This operation involves the removal of the arches of bone at the back of the spine, usually over a number of spinal segments. By doing this, the surgeon gains wide access to the spinal canal and its contained nerves. The operation can be performed in the neck or the lumbar region and is used when there is a narrowing of the spinal canal over more than one level, the condition known as spinal stenosis. This procedure creates a fairly long wound, with extensive separation of the spinal muscles, causing a fair amount of discomfort for several days after the surgery.
Discectomy
This term refers to the removal of an intervertebral disc, but the operation never involves the extraction of an entire disc. Only part of the disc is taken away, but this will include that part which is bulging and compressing the nerve. Usually this consists of some of the annulus and a good deal of the softer material from the inside of the disc, the nucleus. Remaining degenerate nuclear material is also extracted from inside the disc to lessen the chances of recurrent problems. Sometimes other structures, such as thickened ligaments and bony ridges, contribute to the problem and it is important for the surgeon to identify and remove these. Although usually referred to as ‘disc surgery’, this operation should really be thought of as the decompression of a trapped nerve.
Discectomy can be performed in the neck as well as the lumbar spine. In the lumbar region the operation is usually performed from the back but cervical discectomy is most commonly performed from the front and is known as anterior cervical discectomy.
Microdiscectomy
This term is used to describe a refinement of conventional discectomy where an operating microscope is used and disruption of body tissues is reduced even further.
Percutaneous surgery
Herniated intervertebral discs may bulge to varying degrees. Sometimes the annulus of the disc is completely torn and nuclear material escapes into the spinal canal. An open operation is then needed - that is one involving a general anaesthetic and an incision of the body tissues. In a minority of cases the disc bulge is contained, which means that the annulus is not completely disrupted. In these circumstances it may be sufficient to pass fine instruments into the disc via a steel tube which itself is passed through the skin. This can be done under local anaesthetic. This procedure is far less traumatic to the body tissues and, although it causes some discomfort, recovery is generally rapid.
Chemonucleolysis
This may be used as an alternative to percutaneous surgery to treat a contained disc bulge in the lumbar spine. A needle is passed through the skin into the disc. A substance is then injected which chemically ‘digests’ the nucleus, reducing the tension in the disc and thereby releasing the trapped nerve. The technique is even simpler than percutaneous discectomy but can sometimes produce a good deal of back pain lasting for up to two weeks after the injection.
Fusion
This operation involves fairly extensive surgery, more than for simple discectomy or even laminectomy. The aim is to make two (or more) adjacent vertebrae fuse together. Bone needs to be taken from one part of the body and placed between the vertebrae involved. Natural healing processes - the same processes that allow broken bones to heal - bring about fusion of the vertebrae.
With surgery of such magnitude fusions have only limited use in the treatment of degenerative disease of the lumbar spine. They may be called for when there is clear evidence of instability of the spine, but are used only occasionally to treat back pain in the absence of instability.
Fusions can be performed more readily in the neck, and results are more reliable than in the lumbar spine. The operation also involves manoeuvres which bring about the release of trapped nerves. Cervical fusions are therefore performed more often, comparatively speaking, than lumbar fusions.
This operation involves the removal of the arches of bone at the back of the spine, usually over a number of spinal segments. By doing this, the surgeon gains wide access to the spinal canal and its contained nerves. The operation can be performed in the neck or the lumbar region and is used when there is a narrowing of the spinal canal over more than one level, the condition known as spinal stenosis. This procedure creates a fairly long wound, with extensive separation of the spinal muscles, causing a fair amount of discomfort for several days after the surgery.
Discectomy
This term refers to the removal of an intervertebral disc, but the operation never involves the extraction of an entire disc. Only part of the disc is taken away, but this will include that part which is bulging and compressing the nerve. Usually this consists of some of the annulus and a good deal of the softer material from the inside of the disc, the nucleus. Remaining degenerate nuclear material is also extracted from inside the disc to lessen the chances of recurrent problems. Sometimes other structures, such as thickened ligaments and bony ridges, contribute to the problem and it is important for the surgeon to identify and remove these. Although usually referred to as ‘disc surgery’, this operation should really be thought of as the decompression of a trapped nerve.
Discectomy can be performed in the neck as well as the lumbar spine. In the lumbar region the operation is usually performed from the back but cervical discectomy is most commonly performed from the front and is known as anterior cervical discectomy.
Microdiscectomy
This term is used to describe a refinement of conventional discectomy where an operating microscope is used and disruption of body tissues is reduced even further.
Percutaneous surgery
Herniated intervertebral discs may bulge to varying degrees. Sometimes the annulus of the disc is completely torn and nuclear material escapes into the spinal canal. An open operation is then needed - that is one involving a general anaesthetic and an incision of the body tissues. In a minority of cases the disc bulge is contained, which means that the annulus is not completely disrupted. In these circumstances it may be sufficient to pass fine instruments into the disc via a steel tube which itself is passed through the skin. This can be done under local anaesthetic. This procedure is far less traumatic to the body tissues and, although it causes some discomfort, recovery is generally rapid.
Chemonucleolysis
This may be used as an alternative to percutaneous surgery to treat a contained disc bulge in the lumbar spine. A needle is passed through the skin into the disc. A substance is then injected which chemically ‘digests’ the nucleus, reducing the tension in the disc and thereby releasing the trapped nerve. The technique is even simpler than percutaneous discectomy but can sometimes produce a good deal of back pain lasting for up to two weeks after the injection.
Fusion
This operation involves fairly extensive surgery, more than for simple discectomy or even laminectomy. The aim is to make two (or more) adjacent vertebrae fuse together. Bone needs to be taken from one part of the body and placed between the vertebrae involved. Natural healing processes - the same processes that allow broken bones to heal - bring about fusion of the vertebrae.
With surgery of such magnitude fusions have only limited use in the treatment of degenerative disease of the lumbar spine. They may be called for when there is clear evidence of instability of the spine, but are used only occasionally to treat back pain in the absence of instability.
Fusions can be performed more readily in the neck, and results are more reliable than in the lumbar spine. The operation also involves manoeuvres which bring about the release of trapped nerves. Cervical fusions are therefore performed more often, comparatively speaking, than lumbar fusions.
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Page 12 of 19
Contents
- Introduction
- What causes spinal pain?
- Why do I experience different types of pain?
- What other symptoms can develop?
- How common are spinal problems?
- Could it be something serious?
- What will happen if the pain is not treated?
- What do the various words used by doctors mean?
- What tests can be performed?
- How is spinal pain treated?
- When is an operation necessary?
- What do you recommend, doctor?
- Who should perform my operation?
- What are the drawbacks of surgery?
- What is the recovery period?
- What is surgery fails?
- What advances are likely in the future?
- Conclusions
- Other organisations that may be able to help
