As we age, our bones will show subtle changes that reflect the degree of physical activity we have engaged in over the years. These changes also affect our spine and may cause pain when they result in nerve compression or damage.
Loss of calcium (osteoporosis or “brittle bones”) and structural protein may also cause severe changes, which may result in damage to vertebras and the disks that separate them, from the neck down to our lower back. Our spine has many openings between the vertebras that allow for nerves to exit the spinal cord and reach several parts of our body. Bone changes may cause some of the edges of the vertebras to reduce the size of these openings and compress on the spinal nerves, which in turn cause pain that often radiates or is felt not only on our neck or back, but also downwards, particularly down to our legs.
Millions of Americans suffer from back pain; fortunately many of them benefit from medications that reduce inflammation and pain. Physical therapy, exercise, and weight control also help, as other measures do, such as local application of heat, ice or massages.
Back surgery is actually helpful only when conservative measures do not bring a sustainable relief. Sometimes, surgery not only does not help with the pain, but may also increase it. Surgery is necessary when proper imaging diagnostic techniques such as X-rays, CT, and MRI studies clearly show nerve compression, bone displacement, abnormal bone growths and other changes that could cause nerve pinching.
In general, surgery may be indicated when sustained and severe pain radiates down the legs (Sciatica, related to the Sciatic nerve in the back of the thighs), or shoulders and long the arms. Other important symptoms that may accompany or precede pain are muscle weakness, numbness, tingling or other sensation changes.
Sometimes, nerve damage may result in the loss of control of pelvic muscles that control the bladder and the last portion of the bowel.
There are several types of back surgery, depending on the degree and type of lesions. For any type of back surgery, we should always obtain a second opinion from a qualified, experienced surgeon specialized on spine surgery. The most frequent procedures performed in the US at this time are diskectomies or removal of damaged or herniated disks between the vertebras, laminectomies, or removal of the lamina, which is part of the vertebras, when they affect nerve tissues. There are some new surgical techniques applicable mainly to compressed vertebras, that requires minimal skin incisions and short hospital stays.
Sometimes it is necessary to immobilize adjacent vertebras in order to free nerves. This procedure is called fusion, which may be applied to two or more vertebras. Metal devices may be used for this purpose, as well as bone grafts, usually obtained from the pelvic bones of the patient.
Surgery is also indicated when there is narrowing of the spinal canal, which may affect the spinal cord and spinal nerves. Abnormal bone growth or ‘spurs’ usually causes narrowing, which may be present for many years before they cause any changes that might originate pain or sensory changes. The presence of a spinal canal narrowing or spurs is not necessarily an indication for surgery.
Spinal bone fractures, either caused by trauma or bone loss (osteoporosis) may have to be surgically repaired particularly when the stability of the spine is compromised. Sometimes, tumors or infections cause fractures or significant vertebral changes. Tuberculosis may cause the weakening or even destruction of vertebras, particularly on the neck; this chronic infection affects mostly patients from countries where it is endemic and poorly treated.
Surgery is also indicated on cases where significant changes have affected the spine’s integrity and shape. Severe scoliosis is one of these situations.
Recent advances in spine surgery allow for the application of techniques that shorten the postoperative period and for patients to return to normal activities sooner, particularly when a herniated disk causes pain. Small incisions, magnification, and lasers are becoming part of many surgeons’ resources. Also, the injection of synthetic materials that become as hard as bones, are used to repair vertebras and to stabilize the spine; some techniques use a balloon first to separate bones before injecting these substances.
Back surgery does relieve pain for many patients, but sometimes it does not quite work, and patients may still have the same symptoms for weeks or months after it is performed. Physical therapy, medications, exercises, and weight control are part of back pain treatments after surgery.
By Charlene M. Jackson, M.D