Top 6 Spine Surgeries

Most cases of back pain go away either by themselves or with conservative treatment, but if you do need surgery, you have a lot of choices. Here are some of the most common—and effective—spine surgery procedures.

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Nearly everyone gets a backache now and then: you lift something you shouldn’t (your kid’s 50-pound backpack), twist in a weird way (trying to get both child and backpack into the car at the same time), or do something physical you’re not used to doing (yep, like shoveling snow.)  For many, the pain is acute and goes away within a few days or weeks. For others, though, back pain becomes chronic and as the days drag into weeks or months, you may wonder…do I need surgery? 

Doctors performing most common back surgeryIf you need back surgery, it's probably one of these procedures.

How Do You Know When You Need Surgery?

Acute back pain lasts for a few days or weeks and may just resolve with some self-care measures. When back pain continues for 12 weeks or longer, it is considered chronic. Some 20 percent of people who have acute low back pain end up developing chronic low back pain after a year. Treatment can relieve chronic back pain, but in some instances, pain continues even after surgery.1    

Doctors try to treat most back pain through non-surgical ways, relying on medications and physical therapy. But there are some instances when surgery may be recommended. “When the pain radiates to the legs or if it is causing problems with your bladder or bowels, these are clear signs that back surgery may be needed,” says Raul Vasquez, MD, neurosurgeon and director of Complex Spine Surgery at Baptist Health’s Miami Neuroscience Institute. 

Doctors in many cases will recommend surgery as a last resort, says Jonathan D. Krystal, MD, an orthopedic surgeon at the Montefiore Health System in New York City. “If the pain and dysfunction continue despite adequate non-surgical treatment, surgery may be recommended as a way to preserve and improve your strength and function,” he says.

Here are some commonly performed spine surgeries – why they are done, how successful they are, and how long it takes to recuperate.

Microdiscectomy

Microdiscectomy is the most common back surgery in the U.S. says Magdy Shady, MD, chief of neurosurgery at St. Charles Hospital in Port Jefferson, NY and St. Catherine of Siena Hospital in Smithtown, NY and a member of the faculty of Stonybrook University School of Medicine on Long Island, New York. “The best candidate for a microdiscectomy is the patient with lower back pain who also has leg pain, tingling, numbness and weakness,” he says. 

In between your vertebrae you have shock-absorbing discs. These discs have the potential to bulge out—a bulging or herniated disc—and press on a nearby nerve root, which can cause pain, tingling, numbness, or weakness. A microdiscectomy addresses this by removing the portions of the disc pressing on the nerve. The procedure is called “micro-“ because surgeons wear specialized glasses called loupes that act as microscopes so they can better see where they’re operating.

Microdiscectomy is a minimally invasive spine surgery. “The surgery is done through a small incision either in the middle of the back or on the affected side,” Dr. Krystal says. Most patients go home within a few hours after the surgery and can return to most activities within two weeks. “The patient is on their feet within a couple of hours after surgery and they go home the same day,” Dr. Shady says. “They can go up and down stairs, and when they come see me in a week or so after surgery, they may leave my office and be able to drive.” 

Success rates are as high as 85 to 95 percent, especially if the surgery is done within six months of the start of symptoms, Dr. Krystal says.

Laminectomy

Your spinal canal has a lining through which nerves and ligaments pass, explains Dr. Shady. As a result of getting older and wear and tear on the body, the ligaments thicken, bone spurs may occur due to osteoarthritis, and discs in your back may bulge, or rupture (herniate). “All of these encroach on the space where the nerves are supposed to go through,” he explains. This narrowing is known as spinal stenosis. “A laminectomy opens up the space and relieves pressure on the nerves,” Dr. Shady says.

During the procedure, part of the back of a vertebra, which is called the lamina, is removed to enlarge the spinal canal and remove pressure from the nerves, Dr. Krystal says. Traditionally, this procedure is done through a small incision in the middle of the back although it can sometimes be done through a smaller "minimally invasive" incision. “Leg pain often improves immediately after surgery, but the incision takes time to heal and full recovery takes from 6 to 12 weeks,” Dr. Krystal says.  The success rate is about 85 percent, Dr. Vasquez says.

Spinal Fusion

spinal fusion permanently joins two or more bones in your spine. It may be performed when someone has severe compression of the nerves in the spine due to instability or if a spinal revision surgery is needed, explains Dr. Vasquez. If there is a spinal fracture, a fusion can help stabilize it. Among the other reasons for a spinal fusion are spine deformity, cancer of the spine, and occasionally for intractable pain, Dr. Shady says. 

During a fusion, the spine is stabilized with screws and rods, Dr. Vasquez explains, and the disc causing the compression can be replaced with a fusion device and bone graft. This surgery is often performed along with a laminectomy. Sometimes the surgeon will recommend a bone graft in between the vertebrae to help the spine to be better aligned, Dr. Krystal says. “This is a bigger procedure,” Dr. Krystal says. “I counsel patients that they will not be able to return to full activities for about three months after this procedure.” 

It takes several weeks or more to recover from a spinal fusion, and there is a success rate of more than 85% with pain improvement, says Dr. Vasquez. 

Kyphoplasty

A compression fracture in the spine is a common injury in someone with osteoporosis, and when it occurs, it is so painful that braces and medication may not help, explains Dr. Shady. In some instances, kyphoplasty offers relief from pain. 

It usually is performed by a pain management doctor, interventional radiologist, or surgeon and can be done in an outpatient X-ray facility, Dr. Krystal says. It also can be done in an operating room, says Dr. Shady. The procedure is done during conscious sedation, says Dr. Vasquez, sometimes accompanied by general anesthesia. 

Using X-ray guidance, a small instrument is inserted into the vertebra and a balloon is inflated to make room for the bone cement that will be injected next. After the bone cement has been injected, patients typically go home within a few hours of the procedure and do very well, Dr. Krystal says.  There is a success rate of around 85%, and the recovery time is several days, Dr. Vasquez says.

Disc Replacement

This is a relatively new procedure that can replace spinal fusion in some patients, Dr. Krystal says. A disc replacement can be done in the lumbar or the cervical spine. It is done to treat a pinched nerve or spinal cord compression in the cervical or lumbar spine. 

“Once the disc is removed, an artificial disc is inserted into the disc space,” Dr. Krystal explains. “The device allows motion, whereas the traditional fusion procedures fused the bone and prevented motion.”

A disc replacement can be a good alternative to a spinal fusion for younger patients who do not have significant arthritis because it is motion-sparing. This procedure has a recovery period of about six weeks. “Intense activity and contact sports are off limits for more time after the initial two or three weeks,” Dr. Krystal says. After the first two or three weeks, the person typically feels much better and the success rate is more than 90% in terms of the improvement of arm and neck pain, Dr. Vasquez says. 

Anterior Cervical Discectomy and Fusion (ACDF) 

This is one of the most commonly performed cervical spine operations. The surgery, a type of neck surgery, can relieve the pain, weakness, tingling, and numbness of the arms caused by a pinched nerve or stenosis in the cervical spine, explains Dr. Krystal. During the surgery, the damaged disc is removed through a small incision in the side of the front of the neck (off the midline of the center of the neck). Then the disc is replaced with a bone graft or specialized spacer, along with a small plate with screws, in order to stabilize the spine, Dr. Vasquez says. 

“It can be very effective in relieving arm pain from a pinched nerve and for halting neurological decline from spinal cord compression,” Dr. Krystal explains. The recuperation period is up to 12 weeks before a full return to normal activities, although most people begin feeling better by two weeks following the surgery, Dr. Krystal says. The risk for complications is relatively low, Dr. Shady says. However, complications can occur. 2

Will You Get Better Without Back Surgery?

Most back pain gets better without surgery and can be managed with physical therapy, heat, medications, and other types of conservative treatment. In fact, the majority of cases of back pain—between 80 and 90%, according to some sources—get better all on their own. But if you are not getting relief from more conservative measures, it’s good to know that there is such an array of surgical procedures that may help.

Updated on: 06/30/21
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Spine Surgery Overview
Raul Vasquez, MD
Jonathan Krystal, MD
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