Each of the three common problems has a typical surgical solution. All of the problems may respond to time and non-operative care so surgery generally follows a course of unsuccessful therapy. If the situation requires it, more than one procedure may be done at the same operation.

Discotomy

What is it?
Discotomy is the surgical removal of part of the disc that has herniated (bulged), is pressing against a nerve root and has caused it to become inflamed. (The name of the operation can be confusing—some doctors call it a “discectomy” or a “partial discectomy.”)

Why is it done?
This surgery is usually recommended for people with constant leg pain who have not been helped by other treatment strategies. In most cases, the herniation that’s causing the problem is fairly recent.

How is it done?
The surgeon may use microsurgical techniques. This means operating through a small incision in the skin, using an operating microscope and specially designed instruments. But no matter how it is done, the actual surgery is the same – removal of the offending portion of the disc. This can be with a scalpel, a sharp curette or even a laser.

Some patients undergo a general anaesthetic while others may have local anaesthesia and sedation. In most cases, people go home from the hospital the same day or the next morning. You should be able to resume most normal activities within a few days and be fully back to normal within a few weeks or a month or so.

How successful is this surgery?
Most studies show that at least 90% of people who undergo discotomy report relief from their leg pain. Because the operation offers no protection against further aging of the spine, it’s possible that another disc will herniate in the future and the whole process can start again. This happens in about 15% of people who have undergone a discotomy procedure.

Decompression surgery

What is it?
Decompression surgery is done to remove any part of the spine, usually a bony part, which is causing pressure on the nerves. Obviously discotomy is a type of decompression but it has its own name.

Why is it done?
The most common reason for decompression is to remove the bony overgrowths that produce symptomatic spinal stenosis compressing the nerves and causing problems with leg pain on walking. The goal is to relieve pressure on the nerves to allow them to function normally again.

How is it done?
Decompression surgery may be done through a standard surgical incision or using microsurgical techniques. The choice of anaesthetic, how long the patient stays in hospital, and the speed of recovery all depend on the size of the decompression. If only a small amount of bone is removed, the operation can be done on an out-patient basis and patients can resume close-to-normal activity within several days or a week. More complex procedures, particularly in older patients with extensive spinal stenosis, may require a longer stay in hospital as well as supervised rehabilitation.

How successful is this surgery?
? People who undergo a limited decompression for spinal stenosis enjoy improvements in quality of life similar to those with a total knee replacement. Because the procedure can’t prevent future degenerative changes (in a spine that is already significantly worn) the estimated chance of recurrence is fairly high—between 20-30% over the next five to 10 years. This doesn’t mean the operation has failed. But it is a clear reminder that spinal surgery is meant to relieve current symptoms and local problems. It isn’t a cure for back pain.

Stabilization surgery

What is it?
Stabilizing the spine means preventing unwanted, abnormal and presumably painful movement. This can be done is a few different ways. The most common is fusion and that is the choice for surgically treating most spondylolistheses.

Why is it done?
Fusion is the creation of a bony bridge between two normally separate parts of the spine. In the case of spondylolisthesis the goal is to anchor the bone that has moved out of place, stop it from slipping more and end any painful movement. The bony link takes the place of the failed facet joints.

How is it done?
The operation temporarily stops movement between the vertebrae and allow bone to grow across the gaps. Metal screws are inserted into the bones and joined together with rods or plates. The vertebrae are pulled into contact. The adjacent surfaces of the vertebrae are roughened to simulate a fracture which triggers the body’s normal healing response. Additional bone, bone substitutes or specially tailored proteins that stimulate bone formation can be added. The aim is to “trick” the body into creating and strengthening the bony bridge started by the surgeon. But even if everything is perfectly prepared, the hoped-for fusion still may not take place because the body’s biological response can’t be completely predicted. Fusion surgery ranges from a fairly simple procedure done through small skin incisions to longer, more complicated operations. The type of anaesthetic, the time in surgery, the length of the hospital stay and the speed of recovery vary with the size of the procedure.

How successful is this surgery?
Success is not as predictable as it is for discotomy or decompression and depends on many factors, some of which, like the body’s response, are outside the surgeon’s control. For that reason success is difficult to predict. Newer techniques are improving the success rate but there is much more to be learned. Newer forms of stabilization, like the artificial disc or devices that create stability but allow some residual movement are available but, so far at least, their results for restoring function are no better than fusion.