Lower Back Surgery
The Lower Spine
Many people will experience some kind of back pain at some point in their lives. For many, rest and medication will solve the problem. However, for those whose symptoms worsen over time, surgery may be needed.
Five vertebrae make up the lower spine (lumbar) and protect the spinal cord. Each vertebrae is separated by an intervertebral disc that cushions the vertebrae as you move around, stretch, or bend. This disc is made up of a nucleus (with a soft center) and tough outer rings called an annulus.
Nerves branch from the spinal cord to the lower parts of your body through the foramina. These nerves provide feeling.
Pain in your back or legs is most commonly due to a damaged disc in the lumbar spine. A disc may be injured by:
- sudden movement
- herniation
- degeneration or gradual wearing out
A hernitated disc occurs as the nucleus protrudes through the annulus, or the annulus tears. This herniated part of the disc often rubs against a nearby nerve. This results in pain that runs from your buttocks down your legs.
A degenerative disc disease causes your disc to flatten over time. This causes the surrounding vertebrae to touch, which in turn may cause the nerves running through the foramen to pinch. If bone spurs should form, the nerve will be further irritated.
Your Doctor's Role
A doctor will diagnose your disc problem by conducting a medical evaluation which includes a medical history and physical examination. When your doctor has identified what may be causing the pain, he may recommend bed rest, medication, and physical therapy. However, if this treatment fails to alleviate the pain, he or she may suggest surgery.
Candidates for lower back surgery involve the following factors:
- Pain in legs that exceed back pain;
- Poor response to 6 weeks of medical therapy
- A positive MRI or CT showing a herniation;
- Patient showing neurological findings such as wasting or weakness;
- Positive straight leg raising test.
In disc surgery, the surgeon will perform a discectomy, a microdisectomy, or a percutaneous discectomy.
A discectomy is the removal of all or part of a disc that is responsible for the pain. After making a two to three inch incision in the middle of your back, the surgeon removes all or part of the lamina to reach the damaged disc. Once the lamina is removed, the surgeon removes the damaged disc.
A microdiscectomy is the same operation with the main difference in the size of the incision, usually no more than one inch.
A percutaneous discectomy involves the surgeon using X-ray pictures and a video screen as a way to locate and remove the damaged disc. Normally, the patient is awake for this procedure and is under anesthesia. With the help of the video screen, the surgeon does not need to remove the lamina. After this surgery, the surgeon places a bandage over the incision and you can return home the same day, or the day after.