Surgery is an aggressive and invasive therapy that should not be tried unless all other treatments have been ruled out. All surgery is an invasive procedure that always carries a risk of infection, and cutting damages a lot of healthy tissue along the way. Surgery is irreversible and, last but not least, surgery causes plenty of pain by itself.
Do not go under the knife unless you understand every step of the surgical procedure and what its results will be.
The goal of this pain surgery is to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. All lumbar spinal fusion surgery involves adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebrae to fuse them. Bone graft can be taken from the patient’s hip during the fusion surgery, or harvested from cadaver bone. Although spinal fusion hastens pain relief compared with more conservative approaches, it should be used only as a last resort. Fusion may result in additional stress on the joints adjacent to the fusion site.
When abnormal bone growth or a herniated disk pinches one or more nerve roots in the lower spine, the most common operation to relieve pressure is a lumbar laminectomy. The procedure is done through a 2 to 5 inch incision in the back. The surgeon separates the muscles overlying the spine, then removes part of the lamina, which is the bone roof of the spinal canal. This gives the surgeon access to the compressed nerve and whatever is causing the pressure—part of a herniated disk, a bone spur, or a tumor—can be removed.
In a microdiscectomy, a small incision is made in the back, the muscles over the bony arch are moved aside, and only a small portion of the vertebral bone over the compressed nerve is removed. Once the affected nerve is seen, bone fragments and/or disk material are removed from around the nerve to relieve the pressure. As with a laminectomy, a microdiscectomy is more effective for treating leg pain than for lower back pain. Patients usually get relief from leg pain almost immediately after the procedure.
This pain surgery is based on the theory that discogenic pain can be relieved by strengthening the torn, weakened disk wall and deadening the pain nerves within. Under local anesthetic, a hollow needle is inserted into the disk. Through the needle, a thin wire is passed into the disk and then heated for several minutes up to 90 degrees Celsius. The heated wire is kept in place for 15 minutes, during which time it shrinks the fibers that make up the disk wall, closing any tears, and also burns the tiny nerve endings within the disk, making them less sensitive to pain.
Total joint replacement (arthroplasty) restores smooth surfaces by replacing the damaged cartilage with artificial materials. The results of knee replacements are usually excellent—about 90 percent of patients have pain relief for 10 years. Candidates for knee surgery are generally people older than 55 who’ve already had an adequate trial of nonoperative management, including NSAIDs, local injections, activity modification, weight reduction, and physical therpy, and who also have:
For patients with osteoarthritis in only half of the knee, osteoarthritis in either the medial or lateral compartment, a less invasive knee replacement procedure called unicompartment surgery may be an option. In this operation, only the affected half of the knee is resurfaced. Through a small incision, part of the surfaces of the femur and tibia are removed and small femoral and tibial prostheses are attached. There is minimal damage to the surrounding muscles and tendons.
A small fiberoptic telescope is inserted into a joint through a small incision. Saline is then pumped into the knee to distend it and to allow the surgeon to see the structures within it. He views the inside of the knee on a monitor, and inserts additional instruments through one to four additional small incisions to carry out the procedure.
The operation begins with a long vertical incision on the side of the hip. Muscles and ligaments are separated, the head of the femur is cut off, and the acetabulum is reamed out and shaped to the exact configuration of the socket prosthesis, which is then inserted.
Chino, Allan F. & Davis, Corinne D. Validate Your Pain! Bloomington, IA: AuthorHouse, 2004.
Dillard, James N. The Chronic Pain Solution: Your Personal Path to Pain Relief. New York, NY: Bantam Book, 2002.
This page was first published on May, 15th, 2008 and was last updated on May, 20th, 2008