Surgical Procedures for Failed Back Surgery Syndrome

Your NYU Langone orthopedic surgeon may perform additional spinal surgery to manage failed back surgery syndrome.

Surgery for this condition typically includes decompression, in which the surgeon relives pressure from a part of the nervous system, such as a nerve or the spinal cord; stabilization, in which metal devices hold the spine still while a segment of the spine is fused, or joined together; and a realignment of the spine, which is then fused into position using metal devices.

Most types of spinal surgery require general anesthesia.

Laminectomy

A laminectomy may be used if you have spinal stenosis, which is a narrowing of the open spaces in the spine, or compression on the vertebrae caused by bone spurs in people with osteoarthritis.

In this procedure, the surgeon removes the lamina, the rear part of the vertebrae. This surgery creates more space in the spinal canal, relieving pressure on the spinal nerves. This can help to reduce or eliminate pain.

During this procedure, the doctor also removes any bone spurs and disc fragments.

Laminotomy and Foraminotomy

A laminotomy and foraminotomy widens the foramen, the opening in the vertebrae through which nerves travel from the spinal canal. This helps relieve pressure on the nerves, reducing pain.

The surgeon makes an incision in your back and moves the skin, muscles, and ligaments aside. He or she uses a special microscope to view the spine. Next, he or she removes part of the lamina to reach the spinal canal. He or she then cuts or shaves bone to widen the foramen.

Sometimes, a spinal fusion is also performed during laminotomy and foraminotomy.

Spinal Fusion

Surgeons may perform a spinal fusion—in which unstable vertebrae are permanently joined together—to correct a painful misalignment or overalignment of the spine caused by failed back surgery.

In this procedure, the surgeon makes an incision in the middle of the back and uses a special tool to separate skin, muscle, tissue, and blood vessels. Next, he or she uses metal screws and rods to hold, or fuse, the bones together and keep them in the correct position.

The doctor may also place a small piece of bone between the vertebrae to provide additional stability. This piece of bone, which is called a graft, can be from your own body—typically taken from the hip—or from a donor. The graft may be placed directly between the vertebrae or inside a small, thimble-like metal device that is placed between vertebrae.

As the joined vertebrae heal, they fuse into one bone mass, providing stability and reducing pain by removing pressure on nerve roots or the spinal cord that was caused by the poorly aligned spine.

During a spinal fusion, the surgeon may also widen the foramen, the opening in the spine where the facet joints fit together. He or she may also trim protruding facet joints or remove herniated, or bulging, discs or bone spurs. These procedures can reduce pain by creating more space in the spinal canal and decompressing impinged nerves.

Diskectomy

A diskectomy may be performed to remove part of or an entire herniated disc. This helps relieve pressure on the nerves or spinal cord.

Your surgeon may perform this as an open procedure, accessing the affected disc through an incision in the back, or as a minimally invasive procedure, called a microdiskectomy. In this type of procedure, the surgeon makes smaller incisions and uses tiny surgical instruments to remove any disc fragments from the spine.

A diskectomy may be performed at the same time as a laminectomy or spinal fusion.

What to Expect After Spine Surgery

After surgery, you spend several hours in the recovery room. Depending on the type of procedure performed, you may recuperate in the hospital for one or more days.

During this time, NYU Langone pain management specialists are available 24 hours a day to ensure you’re comfortable. Before you return home, your doctor prescribes pain medication to take by mouth for several weeks after surgery.

After surgery, a physiatrist—a doctor who specializes in rehabilitation—helps you adjust to the changes in your spine. He or she also demonstrates simple exercises to rebuild strength in the muscles that support the affected area.

You may receive a walker or a cane to help you walk. A back or neck brace can keep the spine stable during the healing process.

Your doctor schedules a follow-up appointment for 10 days after surgery. After that, you typically visit your doctor every six weeks until your bones have healed. During these visits, your doctor may recommend imaging tests, such as X-rays or CT scans, to further monitor your healing.

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