Your doctor may discuss with you conservative treatments such as traction, anti-inflammatory drugs, physical therapy, or local cortisone injections
Surgery is usually considered only after all nonsurgical options fail to give you relief from your pain or you are unable to function at an acceptable level for your lifestyle. Another concern arises if you begin to experience numbness in other parts of the body, especially the legs and feet. This typically indicates some kind of nerve damage, which may also be called a neurological deficit. If these symptoms become progressively worse in spite of more conservative treatment, then surgery is often recommended.
The good news is, in the vast majority of cases, modern spinal surgery is extremely successful in alleviating pain and restoring mobility. Of course, spinal surgery, as with any major surgery, is not without risks. You and your doctor should discuss possible complications and how you can help reduce your risks both before and after surgery.
There are a number of different surgical approaches to relieving back and neck pain, including:
You and your doctor should discuss which type of procedure is likely to offer you the best results.
One of the leading causes of back pain is compression fractures of the vertebrae of the spine. These are most often the result of osteoporosis — a disease that causes bone to become brittle and vulnerable to fracture. Other causes of vertebral fracture include trauma, infection, and tumor.
During percutaneous vertebroplasty (PVP), the surgeon injects “bone cement” — used for decades in joint replacement — into the crushed vertebral body. In minutes, the cement hardens around the bone fragments, fusing them together in a solid mass. The action of bone cement as a bone filler works to strengthen the bone fragments and alleviate pain.*
PVP offers significant advantages over such standard treatments as pain medication, reduced activity, or invasive back surgery. A minimally invasive (small incision) outpatient procedure, PVP provides substantial pain relief in up to 90% of patients*, with minimal risk.
Neurosurgery & Neurospinal Treatment
Neurosurgery is a highly specialized field that covers conditions affecting the spinal cord, spinal column, brain, and peripheral nerves. Neurosurgeons receive some of the most extensive training of any medical specialists and are the only physicians trained in the treatment of the entire spine, including the spinal cord and all its surrounding structures.
Treatment for many spine conditions has been revolutionized in recent years with advances like minimally invasive spine surgery, computer-guided surgery, “Gamma knife” radiosurgery, microsurgery, endoscopic procedures, and pain management programs.
* http://www.totaljoints.info/bone_cement.htm — January 2006.
Kyphoplasty is a type of minimally invasive spinal surgery used to treat the painful collapse or fracture of a vertebra. The vertebrae are the bones of the spine that encase and protect the spinal cord, provide support for the back, and allow the body to bear weight. The vertebral bones may fracture because of osteoporosis (an age-related weakening of the bones) or by a tumor that has spread to the vertebrae. These conditions cause the spine to weaken and collapse, which results in a sudden onset of intense pain and a resultant deformity of the spine.
During kyphoplasty, a balloon is inserted into the vertebral bones and is expanded, serving to “inflate” the vertebrae to restore height and shape. The vertebra is then strengthened by injecting acrylic bone cement. This procedure is performed under anesthesia.
Kyphoplasty has been shown to provide effective pain relief for a vertebral body collapse and, in most people, provides a return to full functioning. One of the main advantages of kyphoplasty is that there is usually no need to undergo rehabilitation or physical therapy after the procedure. This is because the bone cement hardens within 15 minutes and doesn’t require additional tissue healing. Some people may experience some pain after the procedure because of irritation during the operation; however, this usually diminishes within two weeks. Pain experienced after the operation may in fact be attributed to underlying degenerative changes of the spine. In these cases, nonsteroidal anti-inflammatory medications (NSAIDs) and physical therapy may help.
Although the acrylic cement helps prevent the weakened bone from fracturing again, the surrounding vertebral bones may still be at risk for injury. This risk is greater for people who suffer from osteoporosis, and have bones that are prone to fracture. For this reason, your doctor will continue to manage the cause of the bone weakening or injury through the use of bone-strengthening medications. If surrounding vertebrae are damaged, kyphoplasty can also be used at those levels. Your doctor may also discuss the use of hormonal-replacement therapy if you have osteoporosis.