Back and Spinal Treatments
Spinal fusion is surgery to permanently join together two or more vertebrae (bones in the spine). This is done by placing grafts (normally bone) between the affected vertebrae so that eventually they will grow together. The fusing of these vertebrae will stabilise and strengthen your spine.
It may be recommended for a variety of reasons: if you have an injury or fracture to the bones in the spine, a weak or unstable spine caused by infections or tumours, spinal osteoarthritis such as spinal stenosis, spondylolisthesis (a condition in which one vertebra slips forward on top of another) and scoliosis or kyphosis (abnormal curves in the spinal column).
Spinal fusion is typically recommended after conservative treatment methods fail.
Spinal decompression surgery
Spinal decompression is a narrowing of your spinal canal. It can be due to the natural ageing process, wear and tear or an inherited predisposition. When your spinal column becomes too narrow the nerves within the spinal canal become compressed and cause persistent pain and numbness in your legs.
Spinal decompression surgery is used to treat: spinal stenosis (narrowing of a section of the spine), a bulging or collapsed disc causing sciatica (irritation of the sciatic nerve), fracture to the bones in the spine and metastatic spinal cord compression (when cancer spreads into the spine and presses on the spinal cord or nerves).
During spinal decompression surgery your spinal column is widened by removing a small section of bone. This releases the build-up of pressure on your nerves inside the spinal canal. Spinal decompression surgery is achieved by way of one or more procedures including: laminectomy (the removal of a section of bone from one of your vertebrae), discectomy (the removal of a section of a damaged disc) and spinal fusion. It is recommended when non-surgical treatments haven't helped.
Degenerative scoliosis is an abnormal side-to-side curving of the spine that is occurs due to a degenerative disease or condition such as spinal stenosis, degenerative disc disease, osteoporosis and compression fractures of the vertebrae.
If you’ve degenerative scoliosis you may present postural problems such as: listing to one side, having one shoulder higher than the other, a humpback and a poor sense of balance. You may also suffer from pain especially in your back, spinal rigidity, stiffness in your back, tingling in the legs, muscle weakness, breathing and heart problems.
The treatment of degenerative scoliosis is individualised. Options include: medication (for pain management), physiotherapy, massage therapy, braces and surgery. Surgery is not the first-line approach but it may be recommended if the curvature is extreme, your pain becomes severe or the scoliosis is causing problems with your heart or lungs.
Revision spinal surgery
Revision spinal surgery is a reparative procedure performed most commonly if you have continuing pain immediately or some months after you’ve undergone spinal surgery. The goal of the revision surgery is the same as the goal of your first procedure: to reduce or eliminate pain and to allow you to resume normal activities.
Revision spinal surgery can be required following failed spinal discectomies, decompressions, fusions, disc replacements, scoliosis and kyphosis surgery. It may be a repeat surgery, where the same procedure is being performed again or it may be a revision of another kind.
A spinal microdiscectomy is a common minimally invasive operation performed to relieve back and leg pain typically due by an invertebral disc causing neural impingement.
During a spinal microdiscectomy the part of the intervertebral disc that’s putting pressure on your nerve root and/or a small portion of the bone over the nerve root is removed to relieve the compression on the nerve and to provide space for it to heal.
Spinal injections are placed into or near your spine to deliver a combination of local anaesthetic and steroid. They offer pain relief for chronic back pain and can reduce swelling and inflammation. They can also be used to identify the source of back or leg pain by blocking pain in certain areas.
The four main injection techniques for chronic back pain include: epidural injection (targets the space around your spinal cord and is used for disc-related pain), nerve root block injection (targets individual nerves in your spine), intra-articular facet or sacroiliac joint injection (targets the joints that link the bones of your spine and medial branch block injection (used to diagnose your back pain).
Rhizolysis is a procedure that uses an electrical current to deliberately destroy your nerve fibres that carry pain signals to the brain. It’s performed in an outpatient setting under X-ray guidance.
Rhizolysis is offered if you’ve had success using facet joint injections in the past but the effects haven’t lasted. Rhizolysis may offer you long term back pain relief.
Balloon kyphoplasty and vertebroplasty
Balloon kyphoplasty and vertebroplasty are similar minimally invasive procedures used to treat painful vertebral compression fractures (VCF) of the spine. VCFs occur when the bones of your spine collapse and can lead to a humped back called kyphosis.
If you suffer from osteoporosis or multiple myeloma (cancer of the bone marrow) you may be more prone to VCFs. They can also be caused by lifting heavy objects, sneezing or coughing.
In kyphoplasty a balloon is inserted and inflated to expand the compressed vertebra to its normal height and then bone cement is injected through a hollow needle to fill the space. In vertebroplasty bone cement is injected into the fractured bone without the use of a balloon. The procedures are repeated for each affected vertebra.
After balloon kyphoplasty or vertebroplasty you will be able to stand straight, pain will be reduced and further fractures should be prevented.
Mr David Chapple, Consultant Spinal and Orthopaedic Surgeon at New Hall Hospital, Salisbury, explains Facet Joint Rhysiolysis treatment – a day-case procedure used to treat back and neck pain – and what to expect during, and after the procedure: