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Sometimes, surgery is the only treatment. However, there’s good news. The vast majority of back problems can be remedied with non-surgical treatments—often referred to as non-surgical or conservative therapies.

Aging, improper body mechanics, trauma and structural abnormalities can injure your spine, leading to back pain and other symptoms such as leg pain and/or numbness or even leg weakness. Chronic back pain is a condition that generally requires a team of health professionals to diagnose and treat. Before resigning yourself to surgery, consider getting opinions from several spine specialists. This investment of time and information-gathering will help you make an informed treatment decision that will best support your lifestyle and desired level of physical activity.



As with all non-emergency spinal surgeries, a trial of non-operative treatment, such as physical therapy, pain medication—preferably an anti-inflammatory, or bracing should be observed before surgery is considered. The trial period of conservative treatment varies, but six weeks to six months is the general timeframe.

Spine surgery may be recommended if non-surgical treatment such as medications and physical therapy fails to relieve symptoms. Surgery is only considered in cases where the exact source of pain can be determined—such as a herniated disc, scoliosis, or spinal stenosis.



Whether open surgery or MISS, the spine can be accessed from different directions. These are referred to as surgical approaches and are explained below:

  • Anterior approach: As the name implies, the surgeon accesses the spine from the front of your body, through the abdomen.
  • Posterior approach: An incision is made in your back.
  • Lateral approach: The pathway to your spine is made through your side.


There are a number of conditions that may lead to spine surgery. Common procedures include:

  • Discectomy or Microdiscectomy: Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve. Microdiscectomy is a MISS procedure.
  • Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.
  • Laminotomy: Removal of a portion of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.

Both laminectomy and laminotomy are decompressionprocedures. “Decompression” usually means tissuecompressing a spinal nerve is removed.

  • Foraminotomy: Removal of bone or tissue at/in the passageway (called theneuroforamen) where nerve roots branch off the spinal cord and exit the spinal column.
  • Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one
  • Spinal fusion: A surgical technique used to join two vertebrae. Spinal fusion may include the use of bone graft with or without instrumentation (eg, rods, screws). There are different types of bone graft, such as your own bone (autograft) and donor bone (allograft).

A fusion can be accomplished by different approaches:

ALIF, PLIF, TLIF, LIF: All pertain to lumbar interbody fusion used to stabilize the spinal vertebrae and eliminate movement between the bones.

  • Anterior Lumbar Interbody Fusion
  • Posterior Lumbar Interbody Fusion
  • Transforaminal Lumbar Interbody Fusion indicates a surgical approach through the foramen.
  • Lateral Interbody Fusion in which the minimally invasive approach is from the side of the body.


Examples of spinal instrumentation include plates, bone screws, rods, and interbody devices; although, there are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.

  • An interbody cage is a permanent prosthesis left in place to maintain the foraminal height (eg, space between two vertebral bodies) and decompression following surgery.
  • Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it requires less exposure to place within the spine and therefore is a MISS procedure
  • Pedicle screws help to hold the vertebral body in place until the fusion is complete.



Most patients who undergo spinal surgery have weeks or months to prepare for their procedure. It's important to learn as much as you can about your spine surgery. In this article, you will learn about the pre-operative steps to help you prepare for your procedure.



Surgical procedures of any type carry varying amounts of risk. A surgical risk assessment combines this risk percentage with the patient’s physical and emotional health. During the preoperative evaluation, facts about the patient’s health (eg, pre-existing conditions such as diabetes) are investigated enabling medical staff to take pro-active steps to reduce surgical risk.

This evaluation includes an in-depth review of the patient’s medical history, findings from x-rays, CT scans, MRI studies, and/or other diagnostic tests. The patient’s general health is reviewed during a physical and neurological examination.

The preoperative evaluation identifies physical conditions (existing and unknown) that could cause surgical complications (eg, cardiac or breathing difficulties). In some cases, the patient may be referred to a medical specialist for consultation prior to surgery.



The pre-operative evaluation helps the medical staff provide the patient with the correct amount of:

  • Anesthesia
  • Pre-operative medical treatment
  • Monitoring during surgery
  • Post-operative pain management and care.

The pre-operative process also provides opportunities for the patient, primary care physician, treating specialists, surgeon, and anesthesiologist to communicate concerns before and after surgery.



A detailed medical history gathers information about allergies (eg, to medication, food, allergens), side effects from medication, medication and/or dietary supplements taken daily, pre-existing medical conditions, family history, tobacco and alcohol use, bleeding history and previous surgical experiences (eg, problems with anesthesia).

Any condition affecting the cardiovascular, pulmonary, gastrointestinal, endocrine, and nervous systems can increase surgical risk. Understanding these problems and addressing them before and during surgery can make the spinal procedure safer.




A small blood sample can provide a wealth of information about the patient’s general health. A low red blood cell count (hemoglobin) may indicate the presence of anemia. Red blood cells are needed to carry oxygen throughout the body. White blood cells (WBC) are needed to fight infection. Platelets are the smallest cells in the blood and are essential to blood coagulation. A partial thromboplastin time (PTT) test reveals clot formation time. The level of glucose (sugar) in the blood (blood glucose level) is helpful in determining if the patient has diabetes or is hypoglycemic (low blood sugar).



Electrolytes are needed for metabolic function. For example, calcium is necessary for contraction of skeletal muscle as well as relaxation of cardiac muscle. Blood urea nitrogen (BUN) indicates metabolic function of the liver and kidney efficiency.



A urinalysis detects urinary tract infection, kidney function, diabetes, and the body’s state of hydration/dehydration.



Male patients over age 50 and female patients over age 60 may be given a preoperative electrocardiogram (EKG). Patients with a history of cardiovascular surgery, angina, diabetes, peripheral vascular disease, or smokers are usually EKG candidates, whatever their age. These same patients may also be given a chest x-ray their separately or together. During this consultation, you and your surgeon and/or anesthesiologist will review your medical records, the benefits of the proposed surgery, type of anesthesia, the surgical procedure(s), potential risks and complications, pain management, pre- and post-hospitalization, rehabilitation, and recovery.

The surgical and anesthesiology plan is put into writing in a document termed a Consent Form. By signing this document, the patient gives their permission to the surgeon and/or anesthesiologist to perform procedure(s). The surgical and anesthesiology Consent Forms may be separate documents.