Lumbar spinal surgery is used by a spinal surgeon to treat three main conditions; leg pain, back pain or deformity. Clearly it can be used to treat a combination of these.
A spinal surgeon will nearly always consider surgery as the last option behind the physical therapies, physiotherapy, osteopathy and chiropractic. Non operative pain control of injection techniques such as caudal epidurals and facet joint injections to give a ‘window of opportunity’ to allow further physical therapy are considered next.
The time when spinal surgery is considered before these therapies is when there is a serious pathology such as tumour or infection or when there is serious concern about nerve function such as in cauda equina syndrome.
This article on spinal surgery is written by Andrew Quaile, Consultant Spinal and Orthopaedic Surgeon, Hampshire and Surrey.
Leg pain surgery is largely concerned with removing anything that is irritating a nerve. These operations are discectomies or decompressions and are non controversial and traditional. Operations for back pain are newer and are often combined with a discectomy or decompression. Deformity surgery is more extensive and not discussed here. There is increasing interest in keyhole or percutaneous techniques for nerve pain. These have to be matched against the more traditional techniques to see if they are worthwhile. Their most obvious advantage is the faster recovery time and reduced collateral damage. Currently they are not quite as successful as a micro or mini discectomy in reducing sciatica.