Back Pain And Surgery

Lower back pain (LBP) refers to pain in back arising between the D12 vertebra and pelvis. LBP can be due to specific causes- protruded lumbar intervertebral disc (PIVD), lumbar canal stenosis, spondylolisthesis, deformity, infection (tuberculosis or pyogenic), post traumatic – fracture / spondylolysis, tumor or metastasis of lumbar vertebrae, osteoporotic fracture. LBP occurring in absence of specific cause is referred as non-specific LBP which usually responds to physiotherapy and life style modification.

If there is no major neurological weakness / major disability, these conditions can be managed with rest, medication, physiotherapy, lifestyle modification, weight reduction.

LBP can be associated with severe leg pain, restriction of mobility, difficulty in walking / standing / activities of daily living. There can be neurological weakness. Patient presenting with severe disability and/ or weakness, warrants surgery. Depending on the condition and the pathology, the approach and type of surgery is determined. Surgery also depends on medical condition and other factors.

Surgeries for Spine Treatment:

• Discectomy –indicated in PIVD (sciatica). This involves removal of disc fragment compressing nerves. Minimal or no bone fragment is excised. This can be done through traditional discectomy, fenestration discectomy, micro- discectomy, endoscopic discectomy.
• Lumbar Decompression –indicated in lumbar canal stenosis. This involves removal of lamina, medial halves of facets, hypertrophied flavum and at times, disc fragment- depending on causative factor.
• Lumbar Decompression and Fusion – indicated in cases presenting with severe back pain, existing or expected instability. Lumbar decompression is accompanied with screw fixation in pedicle of vertebrae and bony fusion. Depending on type of fusion- surgery is called – postero-lateral (inter transverse process) fusion; PLIF (posterior lumbar interbody fusion); TLIF (transforaminal lumbar interbody fusion); ALIF (anterior lumbar interbody fusion); Axial LIF, XLIF (extreme-lateral lumbar interbody fusion).
• Lumbar Fusion Surgery – only fusion is done. Indicated in cases presenting with instability without neural compression.
• Minimal Invasive Spine Surgery (MISS) – above mentioned surgery achieved through smaller incision and lesser tissue handling.
• Revision Surgery – surgery done in previously operated cases.
• Deformity Correction Surgery – done for lumbar scoliosis or kyphosis deformity.
• Tumor Excision / Resection – for metastasis or primary spinal tumor.

Depending on indication variety of surgery can be performed for LBP.