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Chronic Back Pain- Understanding Your Surgical Options

Chronic back or neck pain can be the worst and most limiting types of pain. Surgery is sometimes necessary to treat spine pain either caused by a serious accident, injury, or medical condition, or when chronic pain does not respond to nonsurgical treatment options.

Spine surgery is more advanced than ever and many spine procedures can now be performed using minimally invasive techniques and performed at an outpatient surgical center. To help you understand your surgical options, it helps to know the key differences between open spine surgery and minimally invasive spine surgery and how Columbia Orthopaedic Group and COG's outpatient surgical center are positioned to deliver a wide array of spine care needs.

What is minimally invasive spine surgery? How is it different than open spine surgery?
Minimally invasive spine surgery (MISS) is an alternative to traditional open surgical procedures performed to treat different spinal disorders (back and neck).

Very small instruments are used to remove pieces of damaged vertebral bone, cartilage, and/or spinal disc. This type of minimally invasive spine surgery (MISS) results in less damage to the muscles and soft tissues that surround the spine, which leads to an expedited recovery and less post-operative pain. When compared to patients who undergo open surgery, patients who undergo minimally invasive surgery usually experience the following:

  • Less blood loss during surgery
  • Less postoperative pain
  • A faster recovery (Most patients are discharged within 2 or 3 days but some procedures can be performed on our outpatient surgical center)
  • Less rehabilitation
  • A smaller and less noticeable scar
  • Less risk of infection

The two most commonly performed minimally invasive spine surgery procedures are a discectomy and a spinal fusion.

In addition, some MIS surgeries are performed as outpatient procedures and utilize only local anesthesia — so there is less risk for an adverse reaction to general anesthesia.

Open Spine Surgical Procedure
During standard open spine surgery, the surgeon creates a large incision (usually about six inches long) in the back and dissects the spinal muscles to pull them away from the bone in a process called retraction. Once they visualize the bones of the spine, they will begin the necessary spinal procedure. Certain open spine surgeries require the surgeon to go in from the front through a large abdominal incision. According to the American Aca Open surgery requires:

  • Anesthesia
  • Large incisions
  • Muscle retraction
  • Long surgery times
  • Hospitalization
  • Long recovery times



Minimally Invasive Spine Surgery

Whether minimally invasive or traditional, the goals are the same for the long-term; at COG, we want to accomplish overall improvement in symptoms or a halt in degeneration. Ultimately, we want our procedures to result in less blood loss, shorter hospital stays, lower infection rates and faster recovery in the weeks following surgery. Minimally invasive surgery typically results in an easier recovery process for patients, however, not every patient or surgical condition is appropriate for minimally invasive surgery. It is important that you partner with your spine surgeon to identify the best treatment option for your condition.

Patients who would like a solution to their spine pain problem are encouraged to make an appointment with one of our Orthopaedic spine specialists at COG. Our spine specialist team will customize an appropriate treatment plan based on your unique condition and lifestyle.

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  • Why might I need minimally invasive spine surgery?

    Most people who have neck and back pain will not need surgery. At COG, our surgical team will advise spine surgery if you have a neck or back problem that hasn't improved with non-surgical treatment options, such as medicine or physical therapy. If you still have a lot of pain, surgery on your spine might fix the problem. Spine surgery can't fix all types of back problems, though. Your healthcare provider will only advise spine surgery if you have a type of problem that surgery may help. This includes conditions such as:

    • Herniated disc
    • Radiculopathy
    • Myelopathy
    • Spinal stenosis (narrowing of the spinal canal)
    • Spinal deformities (like scoliosis)
    • Spinal instability
    • Spondylolysis (a defect in a part of lower vertebrae)

    Whether spine surgery is performed open or minimally invasively, two main goals remain the same.

    1. Decompression: Spinal decompression involves removing tissue that is compressing nerve structures, such as a spinal nerve root and/or the spinal cord. Bone spurs and/or fragments from a herniated disc are examples of tissues that can cause neural compression.
    2. Stabilization: Abnormal movement of one or more levels or segments of the spine can cause back or neck pain. Surgical procedures that stabilize and stop movement of the spine involve
  • Minimally invasive spine surgery offers many benefits: smaller incisions, less pain, fewer risks, and quicker recovery times. However, MISS is still a surgical procedure. Keep in mind that less than 5% of people with back or neck pain need spine surgery— and, surgery should be the last resort for treating pain caused by a spinal disorder.

    If non-surgical treatments, such as medications, physical therapy, and/or spinal injections do not effectively reduce symptoms in 3 to 6 months, then you may be a candidate for spine surgery. Of course, certain types of spinal disorders warrant urgent or immediate surgical intervention. Talk openly with your doctor or spine specialist about your pain and symptoms, along with the results of different therapies you've tried. There are many considerations you and your doctor need to discuss before making a surgical decision to treat back or neck pain — and if minimally invasive spine surgery may be an option for you.

  • Make sure to communicate to your healthcare provider all medicines you currently take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you'll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking. Exercise on a regular basis to keep your body and muscles in shape to shorten your recovery time.

    Before your surgery, you may need imaging tests. These may include X-rays or magnetic resonance imaging (MRI).

    Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever. You may be given antibiotics to take before and after your surgery. Antibiotics help prevent infection.

  • MISS is done by an orthopedic spine surgeon and a trained medical team. The details of MISS vary depending on what part of the spine is being treated, and other factors. Your healthcare provider can help explain what to expect for your surgery. The following is an example of how MISS is done:

    • You may have a type of anesthesia that numbs part of your body. You'll also be given sedation. This will make you relaxed but awake during surgery. Or you may be given general anesthesia. This prevents pain and causes you to sleep through the surgery.
    • A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.
    • You may be given antibiotics before and after the surgery. This is to help prevent infection.
    • During the procedure, your surgeon will use a special type of X-ray to view the surgery.
    • The healthcare provider will make a small incision on your neck or back in the area that needs to be treated. This will expose the part of the spine to be treated.
    • The surgeon will then use small tools to correct the problem. This includes a tiny camera and a light.
    • Your healthcare provider will then make the needed repairs to the spine.
    • When the repairs are done, the tools and retractor are then removed. The incision or incisions are closed with stitches, glue, or staples. A small bandage is put on the wound.
  • Some types of MISS can be done as an outpatient procedure. This means you can go home the same day. You will need to stay for a couple of hours after the procedure so your healthcare provider can watch for problems. Or, you may need to stay one or more nights in the hospital. When you're ready to go home, you'll need to have someone drive you.

    You will have some pain after the surgery. This can be relieved with pain medicines. Ask your healthcare provider if there are any over-the-counter pain medicines you should not take. Often, the pain will go away fairly quickly.

    You can resume a normal diet as soon as you are able to.

    A small amount of fluid may leak from your incision. This is normal. Tell your healthcare provider right away if the amount of fluid increases, or if you have a fever or pain that gets worse. Call your healthcare provider right away if you have severe symptoms, such as trouble breathing or a severe headache.

    Your healthcare provider will give you instructions about how you can use your back after surgery. You may need to limit lifting or bending. You may need to wear a back brace for a time after the procedure. And you may need physical therapy after the surgery. This is to help strengthen muscles around the spine and help you recover. Your recovery time will vary depending on the type of surgery you had and your general health. You may be able to go back to normal activities in a few weeks.

    Make sure to follow all of your healthcare provider's instructions about treatment and follow-up appointments. This will help make sure the surgery works well for you.

    • Ask if they do outpatient spine surgery?
    • Ask if they only do surgery at the hospital?
    • Ask how their treatment techniques vary from patient to patient?
    • Ask directly if this is a minimally invasive procedure?

    Next steps
    Before you agree to the test or the procedure make sure you know:

    • The name of the test or procedure
    • The reason you are having the test or procedure
    • What results to expect and what they mean
    • The risks and benefits of the test or procedure
    • What the possible side effects or complications are
    • When and where you are to have the test or procedure
    • Who will do the test or procedure and what that person's qualifications are
    • What would happen if you did not have the test or procedure
    • Any alternative tests or procedures to think about
    • When and how will you get the results
    • Who to call after the test or procedure if you have questions or problems
    • How much will you have to pay for the test or procedure