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Spine is one of the most important parts of our body. It gives our body structure and support. Without it we could not stand up or keep our self upright. Spine protects our spinal cord which is a column of nerves that connects our brain to the rest of body, allowing us to control our movements. The spinal column has three main segments; from top to bottom they are cervical spine, thoracic spine and lumbar spine.
Indications for spine surgery
- Relieve Pressure from The Nerves- Conditions, such as spinal stenosis or disc herniation, puts pressure on the nerves, which causes pain, numbness, muscle weakness, tingling and more severe symptoms like loss of bladder/bowel control, foot drop etc. Spinal surgery is required here to avoid permanent impairment. This can be achieved through surgeries like decompression laminectomy, fusion surgeries like ALIF, or XLIF.
- Stabilization of an Unstable Spine- An unstable spine is defined as the inability of the spinal column to maintain its natural form under normal usage conditions. A healthy spine provides structure, protection, and support to the body. Unstable spine occurs in spondylolisthesis, spinal fractures, and in disc injury. Surgery is often required if symptoms progress to intractable back pain, leg pain, or significant neurologic problems from a chronic pinched nerve. It can be accomplished by fusion of the unstable spine through a PLIF, or TLIF.
- Realignment of Deformed Spine- Conditions, such as scoliosis, kyphosis, and flat-back syndrome, changes the natural healthy curvature of the spine and result in various problems. Scoliosis and kyphosis can be usually treated non-operatively by bracing and physical therapy, but when the spinal curvature outdoes a certain degree, surgical intervention is mandatory for the realignment of spine. The same is done for flat-back syndrome when symptoms are not relieved through non-operative procedures.
Other Indications for spine surgery
- A slipped disc that isn’t getting better on its own
- Trouble walking (Claudication)
- Bone spurs in spine that is putting pressure on spinal cord (Facetal Arthropathy)
- A degenerative spinal condition like Stenosis, Degen Scoli
- Weakness or numbness in arms and legs
- Lost bladder or bowel control
- Spinal infection (Pott’s Spine)
- Broken or dislocated bone in back (Spondylolysis)
- Tumor in spinal cord
Spine surgery: When is it recommended?
Spine surgery can be an option when conservative treatments haven't provided satisfactory relief and back pain is persistent and disabling. Mostly back pain symptomsusually resolve within three months. Spine surgery often more predictably relieves associated pain or numbness that goes down one or both arms or legs.
Different types of back surgeries include:
- Discectomy- removal of the herniated/extruded disc to relieve inflammation of the nerves. Discectomy involves a procedure (laminotomy) used to access the ruptured disc by partial removal of the bone (lamina) overlying the spinal cord.
- Laminectomy- removal of the bone enlarges the spinal canal and relieves the nerve pressure caused by spinal stenosis.
- Spinal Fusion- Spinal fusion permanently connects two or more bones together. It relieves pain by giving stability to the spinal column by eliminating painful motion between vertebrae that can result from a degeneration or injury.
- PLIF- A posterior lumbar interbody fusion, called a PLIF, is done to prevent movement at the unstable segment of the spine. A PLIF can be done in lumbar spine.
- TLIF- Transforaminal lumbar interbody fusion (TLIF) is a procedure which fuses the anterior and posterior columns of the spine through a posterior approach. A bone graft and interbody spacer stabilize the anterior portion while the posterior is locked in place with pedicle screws, rods and bone graft.
Artificial discs replacement
Implanted artificial discs are a treatment alternative to spinal fusion for painful movement between two vertebrae.
Back and leg pain can be a difficult condition, may need a team of doctors to diagnose and treat, and remember, consulting a spine surgeon doesn’t mean you’re agreeing to a surgical intervention. Rather, it’s an opportunity to explore more options.