Back pains are as common as headaches. Most back pains disappear on their own with some rest and / or medication. Some may stay longer but can still be managed with conventional treatments of medication, therapy and back building exercises. But, there are a few types of back pain that are so chronic that they render the person disabled. Such chronic conditions necessitate surgery so as to improve the person’s condition.

There are different reasons that cause backaches. In this article we take a look into conditions caused by compression of the structures that form the spinal column, and the surgical solutions to these spine problems .

Conditions associated with spinal compression are: disc herniation, sciatica, spinal stenosis and spondylolisthesis. To relieve pressure on one or many pinched nerves of the spinal column caused by the compression, spinal decompression surgery in its different forms - discectomy, laminectomy and foraminotomy - is employed. Let us start with a description of each of these conditions followed by an understanding of the surgical options.

CONDITIONS

Disc herniation: Discs or disks are pads of cartilage between two adjacent vertebrae (i.e. spinal bones) that separate the vertebrae and provide cushioning to them. When the disc herniates (moves out of place), the soft gel inside pushes through the wall of the disc putting pressure on the spinal cord and nerves that are coming out of the spinal column thereby resulting in a severely painful condition. Disc herniation can occur in any disc in the spine - cervical (neck), thoracic (upper back) or lumbar (lower back) region. Disc herniations occur especially in jobs that require lifting, but can also occur from jobs that require constant sitting.

Sciatica: Sciatica refers to pain, weakness, numbness, or tingling in the leg caused by injury to or compression of the sciatic nerve located in the back of the leg. Sciatica is a symptom of another medical problem, not a medical condition on its own. The sciatic nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg and the sole of the foot. Sciatica may be caused by degenerative disc disease (DDD), pelvic injury or fracture, piriformis syndrome (a pain disorder involving the narrow piriformis muscle in the buttocks), slipped disk, spinal stenosis, tumors, etc.

Spinal stenosis: Affecting mainly middle-aged or elderly people, spinal stenosis is a narrowing of the spinal canal in the lumbar (lower back) or cervical (neck) region that results in compression of the nerve roots. It may be caused by osteoarthritis or Paget’s disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

Spondylolisthesis: Spondylolisthesis is a condition in which a vertebra in the lower back slips forward and onto a vertebra below it. The slip usually occurs between the fourth and fifth lumbar vertebrae. In adults, it is most commonly caused by a degenerative disease such as osteoarthritis. Other causes are stress fractures (caused during gymnastics), traumatic fractures, and bone diseases.

TREATMENT OPTIONS

Depending upon the underlying reason behind the above conditions, surgical decompression might be used to help relieve the pain. Surgical spinal decompression can take the form of a diskectomy, a laminectomy, or a foraminotomy.

Spinal discectomy: Diskectomy or discectomy is the removal of all or part of the affected disc. Spinal discectomy can be done in a few different ways:

Microdiscectomy or microdiskectomy: This is a minimally invasive way of carrying out the discectomy procedure so that the bones, joints, ligaments or muscles of your spine are not touched resulting in faster healing and recovery.

Lumbar diskectomy: Lumbar discectomy, as the name implies, is performed to address conditions of the lumbar spine or lower part of the back. It may also be part of a larger surgery that also includes a laminectomy, foraminotomy, or spinal fusion (fusing the vertebrae together to stop motion at the painful joint).

Cervical diskectomy: Cervical discectomy is performed to treat conditions of the cervical spine or the neck region of the spine. It is most often done with laminectomy, foraminotomy, or fusion.

Spinal laminectomy: A laminectomy is the removal of a small portion of the arch of the vertebra to increase the size of the spinal canal to alleviate the pressure on the spinal cord and the pinched nerve. Laminectomy is most commonly performed to treat spinal stenosis. It is usually done along with a diskectomy, foraminotomy, and spinal fusion. Laminectomy can be done either using the conventional open method or using the minimally invasive method.

Spinal foraminotomy: A foraminotomy is the removal of bone and other tissue to expand the openings for the nerve roots to exit the spinal cord. Foraminotomy, which be performed on any level (region) of the spine, takes pressure off of a nerve in the spinal column and allows it to move more easily. The procedure is commonly performed as a minimally invasive procedure.

Spinal decompression surgery is successful in relieving pressure and pain in 80% to 90% of patients. When your back pain is getting the better of you, a decompression surgery can greatly help improve your quality of life.

As for Jill Misangyi, she feels her life after surgery has taken a total turn around for the good. She is off all pain medication and is back exercising building muscle. Her 16 years of painful prolonged waiting for surgery at an NHS hospital in Canada are wasted but she considers herself lucky to have found out about Healthbase and affordable medical tourism in India. She now has a second chance at life.

The author works for Healthbase (www.healthbase.com), a medical tourism facilitator that connects patients to high quality healthcare in USA and abroad for a fraction of the typical cost of care in US, Canada and UK.

But, this convenience comes with its share of baggage. Problems of the back are all too common, sometimes resulting from your lifestyle habits, sometimes caused by illnesses and injuries, and at other times due to other reasons. Treatment options for back pain range from conventional methods to surgical means. Read more about treatment options at Healthbase.

Anatomy of the spine

Your back and neck contain the spinal column or vertebral column which is made up of 33 individual bones called vertebrae and runs down from your skull to your pelvis. Between the vertebrae are circular pads of cartilage (connective tissue) called discs that are responsible for cushioning the vertebrae when you jump or run.

The spinal column can be divided into four regions (from top to bottom):

The 7 vertebrae at the top constitute the neck region or cervical spine

The next 12 vertebrae make the upper back or the thoracic region

The next 5 vertebrae are the lower back or lumbar vertebrae

The last group of bones at the base of the spine are fused together into what is known as the sacrum and coccyx

The lumbar region (low back) is where most of the pain is felt as it supports the weight of the upper body.

Types of back pain

When you have a backache, the pain may originate from the muscles, nerves, bones, vertebral joints, discs or other structures in the spine or the spinal column.

Most back pains are temporary and can be managed with rest and / or medication. Your physician may also prescribe therapy and regular back exercises to keep the pain at bay and your back in shape. However, there are some cases of back pain that are severe or chronic and require surgical invervention.

Spinal osteoarthritis

One cause of such a chronic long-term back pain is spinal arthritis or osteoarthritis of the spine. It is the mechanical breakdown of the cartilage between the vertebral joints in the back portion of the spine leading to mechanically induced pain.

In spinal osteoarthritis, the joints become inflamed and pain may be felt when performing even the simplest of activities like standing, sitting or walking. Over time, bone spurs i.e. small irregular growths on the bone, also called osteophytes, typically form on the vertebral joints and around the spinal vertebrae which may become so large as to cause irritation or entrapment of nerves passing through spinal structures and result in spinal stenosis (diminished room for the nerves to pass).

Classification of spinal osteoarthritis

When stiffness and pain are in the lower spine (lumbar spine) and sacroiliac joint (between the spine and the pelvis), it is classified as lower back osteoarthritis or lumbosacral arthritis. When the stiffness and pain are in the upper spine, neck, shoulders, arms and head, it is classified as neck (cervical spine) osteoarthritis or cervical spondylosis.

Causes of spinal osteoarthritis

The most common causes of spinal osteoarthritis are repetitive trauma to the spine from repetitive strains caused by accidents, surgery, sports injuries and poor posture. Other risk factors include aging, gender (more common in post-menopausal women), excess body weight, genetics, and associated diseases (like infections, diabetes, rheumatoid arthritis, etc.).

Spine fusion surgery

For spinal arthritis, the only effective surgical treatment is spine fusion surgery which stops motion at the painful joint. In fusion, one or more of the vertebrae of the spine are united (fused together) using bone grafts so that motion no longer occurs between them.

Spinal fusion surgery is used to treat:

a fractured (broken) vertebra e.g. spondylolisthesis

deformity e.g. scoliosis or kyphosis (spinal curves or slippages)

pain from painful motion

instability

some cervical disc herniations (fusion together with discectomy)

weak or unstable spine caused by infections or tumors

If you need a spine fusion surgery and are uninsured, check out the medical tourism option that enables you to receive top quality surgery at a substantially discounted price.

About the author: The author works for Healthbase (www.healthbase.com), a medical tourism facilitator that connects patients to high quality healthcare in USA and abroad for a fraction of the typical cost of care in US, Canada and UK.