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Medical Author:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Surgery for patients with chronic low back pain is controversial, because while some studies do show improvements in pain and disability, most studies do not show improvement as compared to nonsurgical treatment such as physical therapy and pain management. Also, many patients continue to have chronic back pain after the surgery.

Surgery is rarely necessary in patients with acute back pain, unless progressive neurologic problems develop. This is because most patients improve dramatically after treatment with medications and physical therapy, and most patients improve within days to weeks after back pain starts. Surgery is sometimes performed for acute sciatica, if nerve problems such as weakness and numbness are severe and worsen rather than improve, and cauda equina syndrome, a syndrome where the nerves at the bottom of the spinal cord are compressed by an intervertebral disc or a mass, causing neurologic problems.

Spinal decompression surgery is a general term used to describe various surgical procedures which are performed to relieve pressure on the nerves in the back due to spinal stenosis, herniated intervertebral discs, or foraminal stenosis (narrowing of the openings between the facet joints due to bone spurs). Common techniques for decompression include the following:

• Laminectomy is a procedure to remove the bony arches of the spinal canal (lamina) subsequently increasing the size of the spinal canal and decreasing pressure on the spinal cord.



• Discectomy is a procedure to remove a portion of an intervertebral disc that is putting pressure on a nerve root or the spinal canal.



• Foraminotomy or foraminectomy is a procedure to expand the openings for the nerve roots to exit the spinal canal. During a foraminectomy, generally more tissue is removed than during a foraminotomy.



• Osteophyte removal is a procedure to remove bone spurs from an area where they are causing pinched nerves.



• Corpectomy is a procedure to remove a vertebral body and discs.

Fusion of the vertebrae is sometimes combined with one or more of these procedures in order to stabilize the spine.

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