Low Back Pain Surgery: An Overview

Introduction

The human spine is the most important part of the skeletal system. It provides posture and stability to the body. It is made of various small bones called vertebrae. Within the spine is the spinal cord (a tube-like tissue band that connects the brain with the back). It is also called the backbone, vertebral column, or spinal column.

Pain in the backbone is a common condition worldwide. It is seen in people of every age, whether a child or an adult. Sometimes the pain is acute (sudden) or chronic (gradual). It can lead to disability, changed body movement, posture and instability. Different treatment modalities for back pain include medications, surgical, or physical.

What Is Back Pain?

Pain in the back (spinal cord) is the most common condition experienced by people in their lives. However, the cause of the pain and severity may vary from person to person.

What Are the Causes of Back Pain?

There are various causes of pain, such as:

• Injury to the tissues of the spinal cord, spine, or discs.

• Pregnancy.

• Osteoarthritis in the spinal cord. It is the wearing of the soft tissues in the bones.

• Inflammation such as sacroiliitis. It is the inflammation of sacroiliac joints present in the lower part of the spine.

• Cancer such as bone marrow cancer.

• Infections in the spine such as an abscess.

What Is the Epidemiology of Back Pain?

As back pain is common worldwide, according to research, up to 23% of people suffer from long-standing or chronic pain in their lower spine. Moreover, the recurrence rate of back pain is up to 80%. It is seen in all the age groups but is more common in adults and older age.

How to Diagnose Back Pain?

1. Medical History - It is essential to ask about the pain-related characteristics such as onset, location, pain severity, and so on. Family history helps identify the underlying cause, such as a history of cancer or inflammation. Other factors such as exercise and medications also help identify the cause of pain.

2. Physical Examination - The doctor may inspect the spine, apply gentle pressure (palpate) and check sensation to identify any neurological cause.

3. Straight Leg Raise - It is a test in which the patient is asked to lift the leg up to 30-70 degrees. The patient may feel pain while lifting the leg, indicating a positive test for a disc problem.

4. Stork Test - The doctor asks the patient to stand on one leg. It is used to evaluate sacroiliac joint-related pain.

5. Adam Test - The patient is asked to bend forward with joined palms. The presence of a thoracic lump on any side will indicate scoliosis.

6. Imaging Test - Magnetic resonance imaging will help identify the soft tissues' lesions, malignancy, or any other inflammatory condition of the tissues in the spine.

How to Treat Back Pain?

Non-Pharmacological Approach

1. Exercises, traction (pulling bone to its original position) and spinal manipulative therapy (a force exerted on the spinal joint) are a few therapies that may help in reducing back pain.

2. Applying heat and muscle relaxants also have shown some benefits in reducing back pain.

3. Physical therapy such as acupuncture, tai chi, yoga and many more positively affect back pain.

Medications

1. Non-steroidal anti-inflammatory drugs and duloxetine help manage back pain. However, the effect of medications is temporary and short-term.

Surgical Approach

The surgery for back pain is indicated if:

• The quality of the patient's life is affected negatively.

• The patient is disabled.

• The pain has been present for the last six months.

• Other treatment therapies have failed.

A few surgical procedures are mentioned below:

1. Injection Therapy - It is generally the first line of treatment. Steroids and local anesthetic are injected into the affected area. It provides temporary relief from the pain.

2. Non-Fusion Stabilization - Various devices fill the space between the different spine bones to provide stability. These devices are attached to the spine bone through sutures or bands. Dynesys stabilization is an example of this surgical technique.

3. Total Disc Replacement - A prosthesis or a metal disc is inserted into the spine and helps prevent arthritis.

4. Facet Replacement - A prosthesis is inserted or implanted with the help of bone cement. It helps in restoring the motion and stabilizing the spinal movement. However, this surgery is not commonly performed.

5. Lumbar Fusion - In this surgery, two spine columns are fused to act as a single bone. The fusion occurs through bone grafts taken from the donor site. This helps prevent pain caused by the extra motion of the spinal bones or columns. It is the gold standard back pain surgery. In this surgery:

• Local or general anesthesia is given to the patient.

• An incision is made on the abdomen of the patient.

• The spine is accessed and the damaged spinal discs are removed.

• The space is filled with bone grafts.

• After complete healing, the grafts fuse two discs by acting as a bridge.

• Sometimes, a metal plate and screw are used to strengthen the bone graft.

1. Minimally Invasive Fusion - Extreme lateral interbody fusion and axial lumbar interbody fusion are techniques in which the spinal discs are fused by approaching them through the lateral side of the body. These techniques involve small incisions and minor damage to the healthy tissues.

What Are the Complications of Back Pain?

Based on the cause of back pain, the complications are:

Physical Complications:

• Prolonged standing or chronic pain in the back.

• Negative impact on the nervous system of the patient.

• Deformity because of abnormal spine posture and movement.

• Involvement of the bladder.

Social Complications:

• Low productivity at work.

• Disability.

• Absenteeism.

• Low self esteem.

Conclusion

Back pain is a common condition among people of all ages. The pain can be sudden or prolonged standing that may result in an emergency. Several causes of back pain include pregnancy, old age, trauma, inflammation and so on. Medications and other non-pharmacological therapies such as yoga and exercise help provide temporary relief. Surgical treatment is indicated when other therapies fail. Various surgical techniques are available, out of which lumbar fusion is considered the standard gold treatment.