The spine (also known as the vertebral column or back bone) comprises of 33 individual bones arranged one above the other. It forms the major supporting system of your body and also facilitates movement. Back pain also called lumbago is very common among adults aged between 35 and 55 years. Pain in the lower back may be connected to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal organs, and the skin around the lumbar area. Pain in the upper back may be linked to disorders of the aorta, tumors in the chest, and spine inflammation. Back pain can be treated by both non surgical or surgical methods depending on the severity.
Non Surgical Methods:
Pain medications (NSAIDs, Narcotics, and Oral steroids), hot/cold compression, therapeutic massage and regular exercise are few non surgical methods available for relieving back pain.
When non-surgical treatment and medication fails, it is necessary to consider spine surgery. Surgery is only considered in cases where the exact cause of pain can be determined; such as a herniated disc, scoliosis, or spinal stenosis.
Normally, spine surgery is performed as open surgery. This requires opening the operative site with a long incision so the surgeon can view and access the spinal anatomy.
Minimally invasive surgery:
This procedure does not involve long incisions, open manipulation of the muscles and tissue surrounding the spine is avoided. Thus it entails shorter operative time. In general, reducing intraoperative manipulation of soft tissues results in less postoperative pain and a faster recovery.
Whether open surgery or Minimally invasive surgery, the spine can be accessed from different directions. These are referred to as surgical approaches and are listed below:
- Anterior approach:As the name indicates, the surgeon accesses the spine from the front of your body, through the abdomen.
- Posterior approach:An incision is made in your back.
- Lateral approach:The pathway to your spine is made through your side.
Types of Surgery:
Spinal fusion. It is the most common surgery for back pain. The procedure involves the joining of spinal bones, called vertebrae, together. This limits the motion between the vertebrae and how far your nerves can stretch. But this would not limit your activity
Laminectomy. In this method, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This decrease pressure on spinal nerves and can relieve pain or weakness.
Foraminotomy. The surgeon cuts away bone at the sides of your vertebrae to widen the space where nerves exit your spine. The extra space may relieve pressure on the nerves and decrease your pain.
Diskectomy. In some cases a disk, the cushion that separates your vertebrae, can slip out of place; press on a spinal nerve, and cause back pain. In a diskectomy, the surgeon removes all or part of the disk.
Disk replacement. A surgeon removes the damaged spinal disk and inserts an artificial one between your vertebrae.
Interlaminar implant. The surgeon implants a U-shaped device between two vertebrae in your lower back. It helps keep the space between them open and eases pressure on your spinal nerves.
The spinal instrumentation includes plates, bone screws, rods, and interbody devices. The motive of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.
- An interbody cage is a permanent prosthesis left in place to maintain the foraminal height and decompression following surgery.
- Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it requires less exposure to place within the spine and therefore is a MISS procedure.
- Pedicle screws help to hold the vertebral body in place until the fusion is complete.
Preparation for the Surgery:
By eating a balanced diet with vitamin & essential nutrients in the weeks before your surgery, you will help to increase the chance for healthy wound healing. It also reduces the risk for infection. Weak muscles and low cardiovascular tolerance make recovery from the surgery more difficult and slow. Discuss with your caregiver about how to start an exercise program that is right for your condition before and after spine surgery. Back pain can make losing weight or weight maintenance a difficult task. If you are overweight it is a good idea to reduce weight before your surgery. Try to quit smoking to help ensure a safe and successful surgery.
In some cases, patients are at risk for their fusion not to heal properly or completely. Your surgeon may refer to this as a non-fusion, pseudarthrosis or a failed fusion. To help avoid fusion problems, your surgeon may recommend bone growth stimulation. There are different types of stimulators; those implanted internally and others that are worn about the body area, such as the neck or low back.
Patients who want to resume work, the elderly or those with major spinal problems, often attain a higher level of function once symptoms are lessened.
Recovery after the surgery depends on how bad your condition was before surgery .It may
take a few weeks to months depending on the type of procedure.
The bandages will fall off within 7 to 10 days. The incision may be numb, painful or a bit reddish. But this will get healed in few days. The incision area needs to be kept dry for at least a week. It is advised to avoid lifting heavy weights and strenuous activities. Do not smoke or use tobacco products after surgery. Avoiding tobacco is even more important if you had a fusion or graft.
Cost of Surgery:
Spinal surgery cost in India is amongst the lowest in the world. The cost of spinal surgery in India is about 20% of the cost in the United States of America. Cost of spine surgery in India ranges between INR 60,000 to INR 4, 50,000 depending on complexity and hospital you choose. You can find the cost effective centers for spine surgery in India here.