If you've ever had back pain, you’re not alone; eight in 10 Americans will experience this discomfort at some point in their lives. Often, the pain subsides on its own, but in rare cases, interventions are the only hope for relief.
When medication, physical therapy and lifestyle modifications won't quiet the ache, surgery may be warranted. Fortunately, back surgery isn't as scary as it might sound, and newer techniques including minimally invasive spine surgery can be done using small incisions that help reduce recovery time.
"It's not your mother's spine surgery," says Michael Madsen, MD, an orthopedic surgeon with Sky Ridge Medical Center in Lone Tree, Colorado. "Minimally invasive techniques enable surgery to be done with much higher precision and much less trauma than back in the day."
Not sure what minimally invasive spine surgery entails? Here are your top questions, answered.
What is minimally invasive surgery?
Minimally invasive procedures can be performed on a number of body parts, but most are done using one or more small incisions, rather than the large incisions associated with open surgeries.
"Most surgeries these days can be done with minimally invasive techniques, although that might mean something different for each surgery," Dr. Madsen says. "Compared to open surgeries, minimally invasive surgeries typically involve less soft tissue damage and smaller incisions, leading to a quicker recovery."
What are the types of spine surgery?
When it comes to operating on the spine, procedures vary based on what needs to be treated, but three main types are:
Diskectomy
Disks are the thin cushions of connective tissue between the vertebrae. When one bulges or ruptures, it can press against a nerve, causing pain or numbness. A diskectomy is designed to remove the portion of the disk causing the discomfort.
Spinal fusion
Instability of the spine or arthritis can result in painful movement, and is often caused by injured or worn-down disks. During this procedure, damaged disks will be removed and vertebrae joined together to prevent movement between them.
Laminectomy
If the back portion of the vertebrae that covers the spinal cord, known as the lamina, compresses the spinal cord or spinal nerves, pain and discomfort can result. A laminectomy is designed to remove the lamina in portions of the spine to relieve pressure.
Who really needs spine surgery?
Surgery is rarely necessary, and most pain will go away spontaneously or can be managed with nonsurgical measures, like medication, heat or physical therapy. If these interventions fail, and debilitating pain persists, it’s a good idea to chat with your doctor about next steps.
There are a number of back problems that can be treated with surgery, including instability, pinched nerves or injured spinal disks. Surgery most successfully relieves back problems that cause pain or numbness to radiate to your arms or legs.
What’s the outlook for recovery?
"Recovery time very much depends on the surgery we're doing. For the smallest surgeries, it’s a week to a month," Madsen says. "For larger surgeries, even with minimally invasive techniques, full recovery can take several months."
Some patients may be well enough to return to normal activities within just a few weeks. Others, predominantly those undergoing fusion surgeries, will need several months to fully recover, according to Madsen. Although length of recovery will vary between patients, most people who elect minimally invasive surgeries can expect a hospital stay of one or two days, compared with three to five days for an open surgery. Those with the most minor procedures may even return home the same day.
Patients should expect some pain following surgery, which can typically be managed with physician-prescribed medication. You can also ask your healthcare provider about taking over-the-counter medications to help relieve discomfort.
Physical therapy may be recommended to help strengthen the muscle around the spine and speed recovery. Your doctor will schedule follow-up appointments to check on your recovery, but don’t hesitate to reach out with any concerns. Call your doctor immediately if you experience:
- Severe pain
- Trouble breathing
- Increase in fluid leaking from incision
- Signs of infection, like redness, tenderness or swelling around incision
- Fever
- Extreme headache
- Blood clot signs, like a swollen calf, ankle or foot or redness or tenderness in the leg
What are the benefits?
"Minimally invasive procedures involve less soft tissue damage” than open spinal surgery, Madsen says, “and because the incisions are smaller, recovery times—including hospital stays—tend to be shorter."
Sometimes, minimally invasive procedures can be performed using local anesthesia, which decreases the risk of adverse reactions to a general anesthetic. Cosmetic results of smaller surgeries are often more favorable as well, with incision sites starting at about two centimeters in length, rather than several inches. Incision scars are often completely healed and almost invisible three months after the surgery. There may also be less post-operative pain following minimally invasive surgeries, allowing patients to resume normal activities more quickly than after a more involved procedure.
More research is needed to compare the effectiveness of minimally invasive procedures to open surgeries and nonsurgical interventions. But, Madsen notes, "when the appropriate minimally invasive techniques are chosen for the appropriate situations, there are virtually no drawbacks."
Are there potential risks?
As with any surgery, there is always the possibility that not everything will go according to plan. Potential surgery-related complications include:
- Adverse or allergic reactions to anesthesia
- Blood loss
- Infection
- Nerve damage
- Blood clots
- Persistent pain
Madsen believes minimally invasive techniques may decrease spine surgery-related risks, but they won't completely eliminate them. "We think the risks may be lower with minimally invasive surgeries, because incisions are smaller," he says. "We also believe infection risks are lower, and because hospitalizations tend to be shorter, we think that hospital-acquired complications—such as blood clots and pressure ulcers—are also lower."
To further minimize risks, Madsen suggests taking a few important steps prior to surgery. Achieving and maintaining a healthy weight, getting diabetes under control and quitting smoking are all positive pre-surgery goals. Depending on the severity of your back condition, physical therapy may also be prescribed to build strength and increase mobility before surgery.
It’s important to recognize that not everyone who experiences back pain or injury will need surgery, and not all procedures can be performed with less invasive techniques. Speak with your healthcare provider about whether one of these pain-relieving procedures may be right for you.
