Surgery for Spondylosis
For patients diagnosed with spondylosis, the best news is that it seldom requires spine surgery. Non-surgical treatments, such as medications or physical therapy, work quite well in reducing patients' pain levels, and those treatments are almost always tried first for several months. However, surgery is necessary in a few scenarios:
- You have bowel or bladder dysfunction. This is rare, but it may occur with spinal cord compression.
- You have spinal stenosis, and your doctor feels that surgery is the best way to treat it.
- You are experiencing other neurologic dysfunctions, such as severe arm or leg weakness, numbness, or tingling.
- Your spine is unstable. As spondylosis affects the parts of your spine, especially your facet joints (the joints that help control the spine's movements), your spine can develop spinal instability. An unstable spine puts you more at risk for developing neurological problems.
Traditional Surgical Options for Spondylosis
Surgery for spondylosis involves two main components: removal of 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 for spondylosis include:
- 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.
All of the above decompression techniques are done from the back of the spine (posterior). Sometimes, though, a surgeon has to do a decompression from the front of the spine (anterior). For example, a bone spur (osteophyte) pushing into your spinal canal sometimes cannot be removed from behind because the spinal cord is in the way. In that case, the decompression procedure is usually performed from the front (anterior). One example of an anterior decompression technique is:
- Corpectomy (or Vertebrectomy): Occasionally, surgeons will need to take out part of the vertebral body because bone spurs (osteophytes) form between the vertebral body and spinal cord and compress the nerves.
After part of a vertebra or disc has been taken out, your spine may be unstable, meaning that it moves in abnormal ways. As mentioned earlier, that puts you more at risk for serious neurological injury, and you don't want that. The surgeon will need to stabilize your spine.
Traditionally, stabilization has been done with a fusion, and it can be done from the back (posterior), the front (anterior), or the side (direct lateral). A recent technique accesses the L5-S1 level of the spine through the sacrum.
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 (often 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—such as screws, rods, interbody devices, plates and other devices—to increase spinal stability as the bones fuse. The fusion, when healed, will stop movement between the vertebrae, providing long-term stability.
Besides fusion, there are other stabilization options:
- Interspinous Process Decompression: Your doctor may perform an interspinous process decompression using an X-Stop. An X-Stop is a special spinal implant that fits in between your spinous processes and should keep them from pinching nerves and causing pain. It should also help you maintain more spinal flexibility and range of motion.
- Dynamic Stabilization: The surgeon will attach spinal implants to the pedicles (a region of your vertebra) to provide a tension band for support. Dynesys is an example of a dynamic stabilization implant, and it may help you maintain more spinal flexibility and range of motion.
As you can tell, there are many types of surgery used for spondylosis. Your spine surgeon will recommend the best procedure to treat your particular case.
Risks Associated with Spondylosis Surgery
As with any operation, there are risks involved with spine surgery for spondylosis. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:
- injury to your spinal cord or nerves
- non-healing of the bony fusion (pseudoarthrosis)
- failure to improve
- instrumentation breakage/failure
- infection and/or bone graft site pain
- pain and swelling in your leg veins (phlebitis)
- urinary problems
Complications could lead to more surgery, so again—make sure that you completely understand your surgery and the risks before proceeding. The decision for surgery is yours and yours alone.
Recovery from Spondylosis Surgery
It will take your body awhile to recover from surgery for spondylosis; you won't feel better right away. If you've had a fusion, it will take some time (several months or longer) for the fusion to heal properly, and in the meantime, you could have pain in the area where you had surgery. Your incisions should heal in 7-14 days.
What you can and can't do after surgery depends on your particular case, and your surgeon will give detailed instructions about your recovery period. Above all, stick to your recovery plan and don't try to rush it. You don't want to overstress your spine as it heals. If you have any problems—such as fever, increased pain, or infection—report those to your doctor right away.