Back Pain and Spine Surgery

Written by James S. Harrop, MD, FACS

While most problems that cause back pain and sciatica can be treated successfully without surgical intervention, sometimes spine surgery is necessary. Listed below are five important points you want to know about spine surgery.
Understand the Spine Surgery Procedure that's Been Recommended for You
It's important that you understand what procedure (operation) you are having preformed and why this is being done. Educate yourself on your condition and the goals of the surgical procedure. SpineUniverse is a great resource for this information. Some common spine surgeries include the following:

Discectomy treats herniated discs. A discectomy involves removing the soft gel-like material typically herniated out of the disc and compressing a spinal nerve. This returns the disc to a more normal shape and relieves the pressure on the nearby spinal nerve.

Laminectomy (removal of the entire lamina) or a laminotomy (removal of part of the lamina) are surgical procedures used to treat many spinal disorders including spondylolisthesis, spinal tumors, and spinal stenosis; a common cause of back pain particularly in older people. The lamina is a bony plate that is part of each vertebral body. It is located at the back of the spine and protects the spinal canal or entrance to the spinal cord and other nerve structures.

Foraminotomy treats pinched nerves. This procedure relieves spinal nerve compression by surgically increasing the size of the opening where spinal nerves exit the spine. This opening is call the foramen or neuroforamen.


 

Spinal Fusion often includes instrumentation and bone graft to stabilize the spine. Instrumentation refers to medical devices such as cages, plates, screws, and rods. There are different types of bone graft materials including the patient's own bone (autograft), donor bone (allograft), and bone morphogenetic protein (BMP). A spinal fusion may be included with another surgical procedure such as a discectomy or laminectomy.

Prepare for Your Spine Surgery
Seldom is spine surgery an emergency. Therefore, it is advantageous to be in the best physical condition possible. Here are a few helpful tips:

Don't Smoke
If you are a smoker, being told to quit may be the last thing you want to hear! However, it is the most important step you can take to help ensure a safe and successful surgery. Did you know that by quitting at least one month before surgery you can decrease your chance of experiencing a serious complication such as problems with anesthesia and post-operative pneumonia? Patients who quit increase the likelihood of a successful spinal surgery. If you think quitting may be difficult for you, talk to your doctor about smoking cessation programs in your area.

Find an Experienced Spine Surgeon
Most spine surgeons are either neurosurgeons, or orthopaedic surgeons who are specialize in spinal disorders. The following tips are provided to help you locate the best surgeon for your type of spine surgery:

  1. Make sure the spine surgeon is board certified (or board eligible).
  2. Choose a spine surgeon who devotes at least 50% of his or her practice to the treatment of spinal conditions.
  3. Make sure the doctor you choose is someone you feel confident in and who makes you feel comfortable.
  4. Talk to the doctor about his or her experience with the latest techniques and technologies in spine surgery.
  5. Make sure the doctor accepts your medical insurance.
  6. Choose a doctor who is referred to you by a reliable source such as your primary care doctor, a friend or relative, a doctor referral service from your local hospital, or the Find a Doctor area of SpineUniverse.

Get Ready for Recovery
Talk to your doctor about what to expect after your surgery. This will help you to prepare for your recovery period. Listed below are a few things common to recovery following spine surgery:

  1. You will have a surgical dressing over your incision, which will be removed several days after your surgery.
  2. You may have stitches that will either dissolve as you heal or will need to be removed (usually two to three weeks after surgery). Your doctor will let you know how to keep the incision(s) clean.
  3. Everyone's experience with post-surgical pain is different. To keep you comfortable following surgery, a variety of pain relief options are available. This includes medication by mouth (oral), intravenous drugs (IV), or Patient Controlled Analgesia (PCA). PCA is an IV and programmable pump system equipped with a push button control that allows the patient to self-dose pain relieving medication.
  4. Adequate post-operative pain management will help you to be prepared to take a few steps shortly after surgery. No longer do patients lie in bed for long periods of time following spine surgery. Brief periods spent walking - usually with staff assistance - promotes circulation, healing, mobility, and a faster recovery.
  5. Your doctor will let you know when it is okay for you to leave the hospital. The hospital staff will provide you with a set of written instructions to follow at home. The home care instructions may include information about wearing a back brace, when to begin physical therapy, or how to take prescribed medication. It is important to understand these instructions and know who to call in case additional information about care is needed quickly.
  6. The lifestyle changes you made to prepare yourself for surgery (diet, exercise, smoking cessation) will continue to be important after you leave the hospital. Make a commitment to maintain these healthy habits to ensure that your recovery is quick and future spine problems can be avoided.

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