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Spondylosis (cont.)

What Are Surgical Treatment Options for Spondylosis?

Spondylosis is a chronic condition. 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.

However, surgery is sometimes necessary when spondylosis or spinal stenosis causes a nerve problem that is severe or worsening, progressive nerve damage, or difficulty walking. 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 involves various surgical procedures that can 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.

Are Minimally Invasive Procedures and Injections Effective Treatments for Spondylosis?

Steroids (cortisone) can be injected into the epidural space (the space surrounding the spinal cord). This is commonly known as an epidural injection. Steroids can also be injected into the facet joints that connect the vertebrae, trigger points in the soft tissue, or directly into the intervertebral disc spaces. These procedures may have a role in managing acute pain, especially radicular pain, which radiates into a limb.

Other procedures for back and neck pain include intradiscal injections (cortisone injection directly into an intervertebral disc), trigger point injections of steroid, anesthetic, or both, facet joint steroid injection, steroid injection into the sacroiliac joints, steroid injection into the piriformis muscle for piriformis syndrome, and radiofrequency denervation (destruction of painful nerves using a radiofrequency current) among others.

Medically Reviewed by a Doctor on 6/20/2016

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