Return to Index
Surgical Procedures for Low Back Pain and Sciatica
Surgery may be indicated for persistent back pain that involves an anatomical problem such as a herniated disc , spinal stenosis , or spondylolisthesis . Rarely, surgery may be performed on an emergency basis if there are severe symptoms, such as loss of bowel or bladder control, or if a tumor is present.
The 2 main surgical options to treat a herniated disc are laminectomy (with or without spinal fusion ) and discectomy . Spinal decompression may be done to treat spinal stenosis. Spondylolisthesis is treated either with a fusion or with a fusion and a decompression.
Laminectomy (Spinal Decompression)
A laminectomy, also called spinal decompression, is an open surgical procedure. It involves removing a small portion of the lamina. The lamina is the small part of the vertebral bone over the area where the nerve is being pinched. It is removed to relieve pressure on spinal nerves. Along with bone, fragments of a ruptured disc also may be removed.
The surgeon makes an incision in the back, spreads the overlying muscles, and removes the lamina. After the bone is removed, the surgeon can see what is compressing the nerve and may remove the offending disc. The incision is closed with stitches or staples.
Spinal fusion is a procedure that joins 2 bones (vertebrae) in the spinal column together to eliminate pain caused by movement.
Most of the time when a patient has a laminectomy and disc removal, a spinal fusion is not done. If a spinal fusion is to be performed, the adjacent vertebral bones are joined together with bone collected from the patient or a bone donor bank. Additional internal devices, such as metal rods and pins, may be used to provide added stability. The actual fusing of the vertebral segments occurs as the body stimulates new bone growth between the vertebrae over the course of the healing period. This process may take 3 to 6 months or longer.
Discectomy is the removal of the protruding disc and part of the backbone. The doctor makes an incision in the back. A small part of the bone is removed to obtain access to the disc. The disc is then removed to take pressure off the nerve.
In certain cases, the doctor can perform a microdiscectomy to remove a herniated disc. A microdiscectomy is a less invasive procedure. The doctor makes a smaller incision and uses a magnifying instrument to see the disc and nerves. It is not always possible to do a microdiscectomy.
Surgery is not always the better choice. People have been able to improve with nonoperative treatment options. Talk to your doctor about risks and benefits of surgery and other treatment options.
A relatively new procedure, total disc replacement, is now available as an alternative to fusion. It is chosen when the cause of the injury is a degenerated disc. In the procedure, an artificial disc is used to replace the damaged disc. In theory, it offers the ability to repair the damaged portion of the spine while still maintaining the mobility of the spine. However, this new procedure remains controversial. It may be appropriate for only a limited group of patients. Patients with multiple degenerating discs or those who have had multiple failed back surgeries may not be candidates for artificial disc replacement. There is also a device to replace only the nucleus pulposus. This is the soft inner part of the disc. The role of these new technologies is not yet established and long-term outcome data are lacking.
Nucleoplasty is one of the newer, less-invasive surgical procedures. This procedure typically uses radio waves to treat patients with low back pain caused by a contained or mildly-herniated disc. In nucleoplasty, the surgeon inserts a wand-like transmitter into the disc. Guided by x-ray imaging, the surgeon sends radiofrequency pulses into the center of the disc. The radiofrequency energy heats and shrinks the gel-like tissue. This results in less volume and relieves pressure on the nerve. You are awake, but lightly sedated. The entire procedure lasts about 30 minutes.
Radiofrequency denervation treats the nerves to stop them from sending pain messages to the body. During the procedure, a needle is placed in the nerve that is connected to the damaged joint. An anesthetic is injected. Then, the needle is heated to damage the nerve so it stops sending pain signals. The procedure is done on an outpatient basis.
Intra-articular Steroid Injections
An intra-articular steroid injection is a steroid medication that is injected into the joint space of a vertebrae to reduce pain.
Acute low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114958/Acute-low-back-pain. Updated August 12, 2016. Accessed October 4, 2016.
Babu MA, Coumans JV, et al. A review of lumbar spinal instrumentation: evidence and controversy. J Neurol Neurosurg Psych. 2011;82(9):948-51.
Bhagia SM, Slipman CW, et al. Side effects and complications after percutaneous disc decompression using coblation technology. American Journal of Physical Medicine & Rehabilitation. 85(1):6-13, 2006 Jan.
Bridwell KH, Anderson PA, et al. What's new in spine surgery. Journal of Bone & Joint Surgery - American Volume. 90(7):1609-19, 2008 Jul.
Chronic low back pain. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain Updated August 18, 2016. Accessed October 4, 2016.
Cohen SP, Williams S, et al. Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc. Journal of Spinal Disorders & Techniques. 18 Suppl:S119-24, 2005 Feb.
Guyer RD, Pettine K, Roh JS et al. Comparison of 2 lumbar total disc replacements: results of a prospective, randomized, controlled, multicenter Food and Drug Administration trial with 24-month follow-up. Spine. 2014;39(12):925-31.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/chronic%5Fpain/detail%5Fchronic%5Fpain.htm#3084%5F16. Updated November 3, 2015. Accessed December 16, 2015.
Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256.
Radiofrequency facet denervation. Oregon Health & Science University website. Available at: http://www.ohsu.edu/xd/health/services/spine/getting-treatment/conditions-treatments/radiofrequencyfacetdenervation.cfm. Accessed December 17, 2015.
Sciatica. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351. Updated December 2013. Accessed December 17, 2015.
Sciatica. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115166/Sciatica. Updated February 8, 2016. Accessed October 4, 2016.
Weinstein JN, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451–9.
Weinstein JN, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296:2441–50.
Zindrick MR, Tzermiadianos MN, et al. An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine. 33(11):1262-9, 2008 May 15.
11/11/2013 DynaMed Pluss Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116935/Chronic-low-back-pain. Lakemeier S. Lind M, et al. A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain: a randomized, controlled, double-blind trial. Anesth Analg. 2013 Jul;117(1):228-235.
- Reviewer: Laura Lei-Rivera, DPT
- Review Date: 12/2015
- Update Date: 12/20/2014