Newswise — It is estimated that between 75 and 85 percent of all Americans will suffer from low back pain at some point in their lives, according to the American Association of Neurological Surgeons (AANS). Fortunately, only about 10 percent of people with low back pain will require surgery. In the majority of cases, conservative treatment will help alleviate low back pain. Nonsurgical treatment options include physical therapy, weight reduction, steroid injections (epidural steroids), nonsteroidal anti-inflammatory medications, rehabilitation, and limited activity. All of these treatment options are aimed at relieving the inflammation in the back and irritation of the nerve roots.
You may be considered a candidate for spinal surgery if:
"¢Back and leg pain limits normal activity or impairs your quality of life "¢You develop progressive neurological deficits, such as leg weakness and/or numbness "¢You experience loss of normal bowel and bladder functions "¢You have difficulty standing or walking "¢Medication and physical therapy are ineffective "¢You are in reasonably good health
Lumbar interbody fusion may be indicated if conservative treatment has not helped and you have any of the above disabling symptoms. The word "interbody" is used because this procedure is performed between the "bodies" of the vertebral bones and across the diseased disc space. This surgical procedure may be used to treat spondylolisthesis, scoliosis, degenerative disc disease, and recurring herniated disc. It is sometimes performed in conjunction with other spinal surgery procedures.
Your neurosurgeon will gather a variety of information before recommending spinal fusion surgery. In addition to your medical history and physical exam, diagnostic studies may include x-rays, magnetic resonance imaging (MRI), computed tomography (CT or CAT scan), and myelogram.
"There are several types of lumbar interbody fusion, but the goal common to all methods is to create solid bone between two or more vertebrae," said Christopher Shaffrey, MD, a spine surgeon and AANS spokesperson. "A solid fusion between two vertebrae stops the movement between the bones, which can help reduce pain from motion and nerve root inflammation," added Shaffrey. Fusion may or may not involve use of supplemental hardware (instrumentation) such as plates, screws or cages. The different methods of lumbar interbody fusion are:
"¢Anterior Lumbar Interbody Fusion (ALIF): Removal of the degenerative disc by going through the lower abdomen. Bone graft material or a metal device filled with bone is then placed into the disc space.
"¢Posterior Lumbar Interbody Fusion (PLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves, and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. The spine is approached through a three-to-six-inch long incision in the midline of the back. This procedure is typically performed on both sides of the spine.
"¢Transforaminal Lumbar Interbody Fusion (TLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves, and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. The spine is approached through a three-to-six-inch long incision in the midline of the back. Similar to a PLIF, but an entire facet joint is removed, often from only one side.
If you are considering spinal fusion surgery, you should be aware of the risks. Other than failure to achieve a fusion between the vertebrae, the risks include infection, bleeding, a bone graft that does not heal, pain that does not subside despite a successful fusion, and the need for a follow-up operation. These complications are fairly rare, affecting about 1 to 3 percent of patients. Research has indicated that patients with any of the following risk factors may have higher rates of fusion failure:
"¢Prior spine surgery"¢Smokers/smokeless tobacco use"¢Obesity or high body mass index (BMI)"¢Multiple level fusion"¢Disease which inhibits bone healing or requires therapy which can do so
The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of patients report significant pain relief after lumbar fusion surgery, there is no guarantee that surgery will help every individual.
To find out more information about neurological disorders or to locate a qualified neurosurgeon in your area, visit: www.NeurosurgeryToday.org. A wide variety of detailed information is available on spine-related topics at: http://www.neurosurgerytoday.org/what/, under Conditions & Treatments.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,800 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves.
RSS