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Surgical Options In many cases, pain and the causes of pain can be treated by using nonsurgical treatment options. Below are some surgical procedures offered for certain pain disorders. Spine Surgical Options | Hip Surgery | Knee Surgery | TMJ Disorders Surgical Options Spine Disorder Surgical Options
While studies show that more than half of spine surgeries are unnecessary, there are times when surgery is the answer. Below are common spine surgeries used to treat spine disorders. Common Spine Surgeries: Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary to myths, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae. An injury, or damage from a lifting incident, may cause
the jelly center to break through the wall of the disc. When the disc
herniates, the jelly center can press on nearby nerves. This causes back
or leg pain when the herniation is in the low back, and arm pain if the
disc is in the neck area. Cervical is the medical term for "neck." Just as in a lumbar discectomy, the surgeon will remove a piece of damaged disc tissue in the neck area to relieve pressure on the spinal cord or nerve roots. In some cases, by removing a piece of the shock-absorbing disc that separates the two vertebrae, the structures may become less stable. Consequently, when the disc is removed, a surgeon may recommend "fusing" the vertebrae to prevent instability. This fusion surgery may require a second incision in the front of the neck to gain access to the disc area. A cervical discectomy is best left to surgeons who specialize in spine. A surgeon may use bone from the patient's hip or from a bone bank to stabilize two vertebrae after a discectomy. During a fusion surgery, the disc is removed, and the surgeon inserts a small wedge of bone in between the two vertebrae to restore the disc space. Over time, the two vertebrae "fuse" together into a solid structure. While this limits movement and flexibility, it can also help to ease pain. The decision to fuse or not to fuse can be a complex one. It will probably be based on the surgeon's assessment of two factors: the amount of instability that a discectomy will cause and how much disc space is necessary to restore. If the surgeon opts not to do a fusion, a different follow-up surgery may be recommended. A laminectomy involves the removal of part or all of the bone covering the spinal canal. The purpose of this procedure can be to free nerve roots, remove a tumor, bone spur or to perform certain types of fusion procedures. Removing the lamina (laminectomy) is much like removing the cover on a fuse box to access the wiring. By removing the lamina, the surgeon gains access to the disc area and frees more space for the nerves inside. During the surgery, a one to two-inch incision is made in the low back. The spine surgeon then chips away the lamina of one or more vertebrae to gain access to the disc area. The surgeon will then remove any fragments that may have broken away from the disc, as well as the area of disc that is herniated and pressuring a nerve root. The entire disc is not removed. If it was, you would lose the shock-absorbing function of the disc between the vertebrae. Instead, the surgeon typically removes the part of the disc that has ruptured outward, along with another 10 or 20 percent of the disc, in order to prevent future problems from arising. A laminectomy is often used to treat recurrent disc herniations, or where scar tissue is involved. Laminectomy may also be used in cases of spinal stenosis in which the entire canal is narrowed like a ring on a swollen finger. Rhizotomy is a procedure in which the physician may use heat or cold to intentionally damage the ability of a problematic nerve to telegraph pain signals to the brain. While pain signals serve to warn us about danger or injury, sometimes a nerve can end up in a "stuck" position, sending a continuous pain signal to the brain. "Neuroablation" is another word used to describe the surgical procedure to purposely inhibit the nerve's ability to transmit a pain signal. During the procedure, the spine surgeon can destroy the problematic nerve by cutting it or by using extreme heat or cold. This intentional "short circuit" can be temporary or permanent, depending upon the procedure. Trying to mask this signal with drugs can have damaging long-term implications. Drugs can have dangerous side effects to internal organs. By using rhizotomy, the pain signal is turned off at the source. Through the placement of hooks, rods and screws, a spinal curve can be corrected and stabilized. A fusion often follows scoliosis surgery, in order to maintain the correction permanently. Scoliosis is not the result of an injury and usually appears without cause. It can be inherited, and it usually affects more women than men. In the case of most spinal curves, the spine is not only bent but twisted like a bent corkscrew. Some cases of scoliosis are not serious. Over time, if a curve worsens, surgery may be required to correct the curve. In extreme cases, if the curve is not corrected, the spinal deformity can place pressure on internal organs, which can shorten a person's life expectancy. During scoliosis surgery, the surgeon may use special instruments that hook onto various vertebra segments. These surgical rods are the adjusted to "de-rotate" the twisted and bent corkscrew. Decades ago, Harrington Rods were used to surgically straighten the spine. However, this technique did not untwist or correct the spine. Current state-of-the-art instrumentation achieves much better spine correction than older rods did. Generally speaking, the younger the patient, the more flexible the spine and the better the result from scoliosis surgery. As the patient becomes older, say over 40 years old, the spine is less flexible, and there may be a greater risk involved in attempting to correct the curve. Because the spinal cord is involved, only spine surgeons who specialize in scoliosis should perform scoliosis surgery. Dorsal column stimulation, also known as spinal cord stimulation, is used in complex cases of back pain that cannot be resolved nonsurgically or with another surgery. In most cases, it is used when leg pain is worse than back pain. The intent of dorsal column stimulation is to use an electrical signal, instead of drugs, to mask pain that cannot be removed any other way. During this procedure, the patient is awake, and the surgeon delicately places tiny electrodes under the skin in the back. At that point, a tiny electrical current is transmitted through the wires to the desired location in the back. This sensation feels like a tiny tickle, as the electrical current interrupts the pain signal that may be sent to the brain from the damaged nerve. The patient helps instruct the surgeon as to which electrical setting and placement of wires produces the most pain relief. It is important to note that this technique is only used in the most extreme cases of back and leg pain. [Top] Total hip replacement surgery has been shown to provide successful outcomes for 90-95 percent of those who qualify. According to the American Academy of Orthopaedic Surgeons, over 193,000 hip replacements are performed each year. The procedure has helped countless patients achieve a return to function and activity. Current developments in hip replacement surgery involve using new, advanced materials to extend the life of the total joint replacement. These materials include titanium, ceramic and new plastic joint liners. [Top] Quality of life is never to be underestimated and when a knee problem is so debilitating that it is impossible to enjoy hobbies that are important to you like gardening or playing with your children or grandchildren, than it is crucial to seek medical help. Fortunately, before even considering knee replacement surgery as an option, generally physicians will try to find other ways of assuaging the pain. For instance, physical therapy, analgesics and walking aids might be the answer to many knee problems including those stemming from arthritis. However, it is also nice to know that when other treatments prove to be futile, knee replacement surgery is an option. So prevalent is this surgery, in fact, that over 250,000 knee surgeries are performed each year in the United States alone. It is estimated that in 2040, more than 500,000 knee and hip replacement surgeries will be performed due to the influx in aging Baby Boomers. Knee replacement will help renew the ability to participate in several fun, day to day activities such as gardening, going on walks, golfing, and overall mobility. It is important to try other options before knee replacement surgery, however, since they only last for 15 to 20 years and are not easily replaced. For this reason, physicians are very selective about the types of candidates for the surgery. [Top] Surgical options available for TMJ Disorders include the following:
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