What are the Types of Open Back Surgery?
Depending on the condition, back surgery aims to relieve pressure of discs or joints contributing to narrowing of the space where the spinal nerve roots exit the spinal canal, or to decompress the central spinal canal itself. Sometimes surgery can involve removal of the entire disc and fusing the bones with or without placement of a spacer in place of the disc. There is also an option in a small subset of patients for an artificial disc replacement.
Different types of back surgery include:
Discectomy involves removal of the herniated portion of a disk to relieve irritation and inflammation of a nerve. Discectomy typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
Laminectomy involves the removal of the bone overlying the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
Fusion permanently connects two or more bones in the spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
Artificial disc replacement
Artificial disc replacement is a newer alternative to fusion. A prosthetic disc could help preserve normal range of motion and spine mechanics. This could reduce the long-term degenerative changes in adjacent vertebral segments following spinal fusion. However, the evidence suggests that the efficacy of this approach is similar to that of spinal fusion.
What is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome is an umbrella term that covers a group of conditions that cause persistent back pain (with or without sciatica) following one or more spine surgeries[ii]. An estimated 30-40% of back surgery patients can suffer from Failed Back Surgery syndrome in the long term. Each successive surgery after the first increase this estimate, with up to 85% of patient reporting Failed Back Surgery Syndrome symptoms after four surgeries[iii].
What Causes Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome symptoms are generally caused by residual scarring, inflammation, or anatomical abnormalities that alter the normal mechanics of the spine and create pressure on the nerves. A more comprehensive list of causes includes:
- Psychological and mood factors (depression, anxiety, or other mood disorders) and tobacco use may decrease response to surgical and non-surgical treatment
- Obesity increases risk of intraoperative and postoperative complications
- Scar tissue formation after back surgery
- Recurrent or persistent disc herniation
- Spinal stenosis
- Post operative infection
- Epidural post-operative fibrosis
Failed Discectomy Surgery
Epidural fibrosis and scarring occurs following spinal surgery, which may cause nerve roots to become tethered. This surgery may also alter the distribution of weight among the structures of the spine, destabilizing of the lumbar facet joints. Discectomy surgeries can even experience a recurrence of the original disc prolapse after 2 years (4% of percutaneous endoscopic lumbar discectomy patients and 10.3% after open lumbar microdiscectomy[iv]). Patients experienced up to a 9.5% recurrence of disc herniation 12 weeks after tubular microdiscectomy[v].
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