Back pain is one of the most common reasons people seek medical care, but when the path to finding relief involves surgery – it can be a little intimidating.
Joshua Schwind, MD, surgeon with Avera Orthopedics takes a closer look at the different types of surgery designed to correct debilitating nerve pain.
What is a decompression surgery?
These types of surgeries are looking to relieve nerve pressure by creating more space for the nerves. This becomes an option when non-surgical treatments like physical therapy and medications have failed.
Some of the typical procedures for decompression include: laminectomy, this is where your surgeon will remove part of the lamina which is the bony roof of the spinal canal to widen it. There is also microdiscectomy where a portion of a damaged spinal disc is removed to prevent it from pressing against an impacted nerve.
Generally, if you're just doing a decompression alone, the patient's issue is stenosis, or narrowing around the spinal cord or nerves. That can manifest with sciatica, it can manifest with claudication. But what you're trying to do is alleviate the nerve pinching. And so you are carving away bone, you're trimming the joint, you're taking away the ligament at the affected levels to "unpinch" those nerves and in that way provide relief.
What is a fusion surgery?
These types of surgeries are looking to eliminate painful motion and provide stability to your back and spinal cord so that discs and vertebrae aren’t constantly causing pain. They often using bone grafts, screws or rods to stabilize the spine and eliminate painful motion, but the fusion is irreversible.
Sometimes you do a fusion in concert with a decompression, but a fusion operation is indicated when there is instability or deformity of the spine. If the patient's nerves are pinched very severely, sometimes doing the fusion affords you the opportunity to do a larger, more aggressive decompression than you could do otherwise.
What is a discectomy?
A discectomy involves removing a portion of a herniated or damaged disc that is pressing on a nerve. It’s a very limited decompression operation where you identify typically a disc herniation, access it with disrupting as little tissue as possible, remove the disc herniation and leave everything else. By removing the damaged disc and replacing it with a device that maintains, rather than restricts, joint movement, you can find relief from pain. The implant that you put in is basically two metal shims with some cleats to keep it in place and a plastic dome that it rotates and rolls on.
How do you calm patient fears about surgery?
Some people can get intimidated or scared of back surgery and there's plenty of reason why. And I think it's justified. But what I would say is that when you're doing surgery for the right reasons, the correct indications on appropriate patients, they largely do better. They have historically good to excellent outcomes and I would also say that for patients that may have just recently undergone surgery, remember that progress is not linear. There will be good days and there will be bad days and trying to measure your progress day to day can sometimes be discouraging. Nerve recovery is really protracted and prolonged and so I tend to tell patients to look at things in longer terms, see where you are now versus three months ago and 12 months ago and look at your improvement.
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