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Lumbar surgery refers to any type of surgery in the lumbar spine, or lower back, between one or more of the L1-S1 levels. There are two general types of lumbar spine surgery that comprise the most common surgical procedures for the lower back:
The goal of a decompression surgery is usually to relieve pain caused by nerve root pinching. There are two common causes of lumbar nerve root pressure: from a lumbar herniated disc or lumbar spinal stenosis.
This type of pain is usually referred to as a radiculopathy, or sciatica.
A decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal. The most common types of decompression surgery are microdiscectomy and laminectomy.
There are also a few alternatives available to the above two standard procedures, such as an X-STOP which is a possible option instead of a laminectomy for lumbar spinal stenosis.
The goal of a lumbar fusion is to stop the pain at a painful motion segment in the lower back. Most commonly, this type of surgery is performed for pain and disability caused by lumbar degenerative disc disease or a spondylolisthesis.
A spinal fusion surgery involves using a bone graft to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices), bone graft procedures, and a bone stimulator are sometimes used along with spinal fusion.
There are also many surgical approaches to performing spinal fusion, such as ALIF, PLIF, XLIF, TLIF, posterolateral gutter fusion, anterior/posterior fusion, and certain minimally invasive approaches.
In addition to the above conditions, decompression and/or spinal fusion may be performed to address other types of lumbar spine pathologies, such as infection or tumors.
Lumbar Spine Surgery Alternatives
In addition to the traditional one-level fusion or decompression surgery that is done for lumbar degenerative disc disease or spinal stenosis, respectively, there are a number of surgical alternatives available. Several of the most common ones include:
Artificial Disc Replacement
Artificial disc technology can be used in specific cases of lumbar degenerative disc disease.
Motion Preservation Technologies
It should be known that while spinal fusion has been a classical treatment for ongoing pain and disability from the lumbar spine, alternatives to fusion do exist for posterior conditions (problems in the back of the lumbar spine) such as spinal stenosis. Inserting an interspinous process spacer, such as the X-STOP device, can actually preserve motion as opposed to stopping it via fusion.
A surgery called vertebral augmentation may be done to treat pathological fractures from tumors or osteoporosis.
Multilevel Lumbar Fusion
Lumbar spine fusion surgery for symptomatic degenerative disc disease is typically done on one level of the spine (most commonly toward the bottom of the spine, at L5-S1 or L4-L5). In certain cases it may be done on two levels, and only very rarely would it be considered on 3 or more levels. Multilevel spine fusion may be indicated in cases of scoliosis.
There are only two things that surgery can do. Surgery can decompress a nerve root or it can stabilize a painful motion segment. So we have to identify a nerve root that’s pinched or we have to identify a painful motion segment. And if we can do that, that would make you a candidate for surgery. Just having pain and having failed conservative treatment is not an indication for surgery if there is no pathological cause of the pain – it doesn’t mean there’s not pain, but we have to identify the cause of pain in order to be able to correct it. The only thing surgery can do is actually correct an anatomical defect, so we have to be able to identify it.
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