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Surgery for Upper Back Pain

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In treating upper back pain, surgery is generally a "last resort" option. If you try several months of non-surgical treatment options, such as physical therapy and medications, and you're still in pain, your doctor may recommend surgery. Rest assured: only 5% of people end up needing surgery to treat back problems.

For some severe cases, the doctor may recommend surgery right away. Some examples of severe cases are:

  • You experience progressive neurological symptoms (numbness, tingling, weakness).
  • You have trouble with balance and /or walking.

The surgical procedure is determined by what is causing your pain, and the surgeon will make the best recommendation for the type of procedure. Usually, surgeries for upper back pain involved removing what's causing pain and then fusing the spine to control movement. When the surgeon removes tissue that's pressing on a nerve, it's called a decompression surgery. Fusion is a stabilization surgery, and often, a decompression and fusion are done at the same time.

Traditional decompression surgical options include:

  • Corpectomy (or Vertebrectomy): Occasionally, surgeons will need to take out the entire vertebral body because disc material becomes lodged between the vertebral body and the spinal cord and cannot be removed by a discectomy alone. In other cases, bone spurs (osteophytes) form between the vertebral body and spinal cord. In these situations, the entire vertebral body may need to be removed to gain access to the disc material that's pressing on your nerve-that's a corpectomy.
  • Discectomy: If you have a bulging disc or a herniated disc, it may be pressing on your nerves. In a discectomy, the surgeon will remove all or part of the disc. The surgeon can do a discectomy using a minimally invasive approach.

    Minimally invasive means that there are smaller incisions and the surgeon works with a microscope and very small surgical tools. You'll have a shorter recovery period if you have a minimally invasive discectomy.
  • Facetectomy: There are joints in your spine are called facet joints; they help stabilize your spine. However, facet joints can put pressure on a nerve. Ectomy means "removal of." So a facetectomy involves removing the facet joint to reduce that pressure.
  • Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
  • Laminectomy: At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina.
  • Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on a nerve structure, so the surgeon may make more room for the nerves using a laminotomy.

After part of a disc or vertebra has been taken out, your spine may be unstable, meaning that it moves in abnormal ways. That makes you more at risk for serious neurological injury, and you don't want that. The surgeon will need to stabilize your spine. Traditionally, this has been done with a fusion.

In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability as the bones fuse. The fusion will stop movement between the vertebrae, providing long-term stability.

If you know the exact diagnosis of your upper back pain, you can read more specific articles about surgical techniques here on SpineUniverse:

If your doctor recommends surgery, always ask the purpose of the operation, results you can expect, and possible complications.

Feel free to ask for a second opinion if back surgery is suggested; this is your right as a patient. Your doctor will be happy to refer you to a specialist to re-evaluate your condition.

Updated on: 05/09/12
Jason M. Highsmith, MD
This article was reviewed by Jason M. Highsmith, MD.
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