Recent evidence suggests that physiotherapy and other exercise treatments are as good as surgical treatments in the majority of patients with chronic back pain, where there are no referred nerve root symptoms.
However, there remains a place for the surgical management of back pain either where non‐operative treatment has failed or where the situation is more complex with nerve root symptoms or other pathology such as spondylolithesis.
This article on developments in spinal surgery has been written by Gavin Bowden, Consultant Spinal and Orthopaedic Surgeon, Oxford.
Fusion is the gold standard, but there are new devices which can stabilize the spine without fusion or using different kinds of fusion and many of these are being assessed at the moment (such as the Wallis device or Dynesys system).
Spinal decompression and discectomy
With the advent of microsurgery most patients with a disc prolapse can now be treated with an overnight stay if they are young and fit, some being able to go home on the day of surgery. Results of microdiscectomy are good with up to 90% of patients achieving acceptable results.
Spinal stenosis can cause difficulties with standing and walking. Decompressive surgery is effective in 70‐80% of patients. Consultant surgeons are seeing and treating older patients in greater numbers. This is largely attributable to the benefits of less invasive techniques but also patient preference and keenness to maintain more active lifestyles. A recent method for treating these patients is called Inspace where a spacer is placed in the interspinous region to stretch the spine, which indirectly results in the decompression of the appropriate level.
This is not suitable for all patients but it means that patients who are otherwise unfit for surgery can now be considered and can be treated either as day surgery patients or short stay.