The spine is made up of 26 bones called vertebrae, these are linked together with cushions of tissue, called discs which sit between the vertebrae acting as shock absorbers.
The prevalence of low back pain in developed countries has been estimated to be nearly 40%. More than 70% of individuals experience a significant acute low back pain episode at some time during their lifetime. In addition all of us develop various structural changes within our spinal motion segments as we age. Given the astonishing prevalence of symptoms and the universal age related changes that develop within the spine, it is not particularly surprising to learn that a considerable number of people undergo lumbar spine surgery every year.
Back to article indexNerve compression can happen when a disc bulges out from between two vertebrae. This is called a herniated or prolapsed disc, more commonly referred to as a slipped disc. The disc wall may tear and a gel like nucleus may leak out, causing the disc or its contents to press on a nerve.
When a herniated disc does not heal, it dries out and flattens and is referred to as degenerative. Discs also degenerate as a normal part of aging, making them a less effective cushion between the vertebrae.
Back to article indexWhen discs degenerate there is more strain on the facet joints. This can lead to narrowing (stenosis) of the spaces between the vertebrae though which nerve roots pass. There may also be narrowing of the spinal canal itself.
Acquired degenerative lumbar stenosis is a common cause of low back symptoms with or without leg pain. People with degenerative spinal stenosis are generally older with the majority experiencing increased pain when walking, this can be relieved by resting.
The diagnosis of lumbar spinal stenosis is suspected on clinical grounds and confirmed with imaging studies of which MRI imaging has become the investigation of choice. Once the diagnosis of stenosis has been confirmed non-operative treatment including judicious use of non-steroidal anti-inflammatory medication, epidural steroid injections and after symptom control is achieved through aerobic exercise programmes, and trunk strengthening exercises can also be initiated.
The presence of spinal stenosis by itself does not justify surgical intervention. There have been many people with high grade stenosis who continue to enjoy a quality of life that is consistent with their goals and objectives. Surgery should be reserved for people who have attempted to improve on a good programme but who still have an adverse quality of life.
Back to article indexSometimes a slip occurs between the vertebrae, causing compression of the nerve. This is called Spondylolisthesis. This condition is generally the result of wear and tear but can also appear in people who are born with underdeveloped facet joints. This is a common and less controversial disorder of the lumbar spine.
Procedures that are commonly performed for this condition include decompression alone or decompression with fusion and finally decompression with instrumentation and fusion. In general it has been shown that a higher fusion rate and a better outcome with relief of back pain and leg pain was achieved in people who underwent decompression instrumentation and fusion.
Back to article indexLumbar disc prolapse is associated with both back pain and unilateral (single) or bilateral (both) leg pain caused by pressure upon and tension of the nerve root corresponding to the level of the disc prolapse.
To relieve pressure on one or more compressed nerves in the lumbar spine, spinal surgery is usually performed.
Widely accepted clinical criteria that are indications for elective lumbar *discectomy include the following:
Is a procedure to remove the part of the herniated disc that is compressing on the nerve root. There are several techniques for disectomy and your surgeon will advise on the most suitable technique for your condition.
Back to article indexPeople who have a degenerative lumbar spinal deformity in addition to nerve root compression present a significant surgical challenge. Most will have evidence of spinal stenosis in addition to spinal deformity. There will also be symptoms of low back pain with or without sciatica, which may be increased during walking or standing. Unlike degenerative spondylolisthesis or disc prolapses or spinal stenosis, the correct surgical approach for degenerative spinal deformity remains elusive.
Non-operative treatment programmes tend to be less effective in these cases. However before any major surgical procedure is considered, it is quite important to try and achieve resolution of symptoms without aggressive surgery when possible.
Limiting factors include age and physiology, activity profile both before and after symptoms occurred and the objectives and expectations of the person.
These factors indicate the difficulties encountered in the satisfactory management of adult degenerative scoliosis.
Back to article indexLower back surgery may be an option for people with lower back or leg pain. Depending on the procedure that is carried out, a back operation can be major surgery.
It generally results in an improved quality of life, but the outcome depends entirely upon the specific problem and the exact procedure that is performed.
The above information is only intended to give the reader a general overview and better understanding of lower back surgery. Treatment may vary according to individual diagnosis and following advice from their surgeon.
Not all the information included will be appropriate for every individual.
Article kindly supplied by
Mr R Krishnan Consultant Orthopaedic Surgeon
MBBS MS MCh (hons) PhD (London)