Surgery for Osteoarthritis of the Spine
NYU Langone doctors may recommend surgery to treat osteoarthritis of the spine if the results of diagnostic tests show that spinal changes have caused the joints and vertebrae to move out of position or to pinch nearby nerves. Orthopaedic surgeons and neurosurgeons at NYU Langone specialize in procedures designed to restore spinal stability and decompress affected nerves, resulting in improved mobility and less pain.
If advanced osteoarthritis of the spine has led to other conditions, such as spondylolisthesis or spinal stenosis—conditions that compromise joint stability or cause pinched nerves—NYU Langone surgeons may recommend a procedure to stabilize the spine, relieve pressure on the spinal cord or nerves, or both. Your surgeon may also recommend one or more of these procedures if degenerative disc disease has led to significant pain or instability.
A surgeon may use one or more techniques to relieve pain and restore stability. Factors such as your age, how much of the spine is affected, whether the spinal cord or nerves are involved, and whether instability occurs in the lower or upper part of the spine help the doctor to determine the technique to use. Two of the most common are spinal decompression and spinal fusion.
Spinal decompression relieves pressure on nerves traveling through and near the spine. If a nerve is pinched by part of the spine as a result of osteoarthritis, pain signals can travel up the spinal cord to the brain, resulting in the sensation of pain in the back, legs, neck, or arms. Relieving pressure on the nerve can alleviate pain and improve function in the spine.
Our surgeons may use one of several decompression techniques. These include procedures to remove part or all of the lamina, which is the bony roof of each vertebra. This is called a laminectomy.
The spinal canal is the central opening in the vertebrae through which the spinal cord travels. The roots of the nerves coming off the spinal cord travel through one of two smaller openings in the vertebrae, called the neural foramens; from there, the nerves travel to other parts of the body. Surgeons may enlarge one of these openings to relieve pressure on a pinched nerve in a surgical procedure called a foraminotomy.
A third type of decompression allows surgeons to remove part or all of a spinal disc that has herniated, collapsed, or pinched a nerve. This is called a discectomy.
Depending on your symptoms and anatomy, any or all of these decompression techniques may be required during surgery.
Surgeons often perform spinal fusion in people with osteoarthritis of the spine. Spinal fusion stabilizes the spine by permanently joining vertebrae using small screws and rods, eliminating movement between them.
Typically, small pieces of bone, called grafts, are placed in between vertebrae to help them fuse. A surgeon may obtain a bone graft from your own body—often from the top of the hip—or from a donor bank. In time, new bone grows over the graft. The screws and rods placed during surgery hold the vertebrae solidly together while the bone growth occurs.
Spinal fusion may be performed to join two or more vertebrae. If severe osteoarthritis affects more than one joint or vertebra, surgeons may fuse more bones in order to stabilize and realign the spine.
What to Expect After Spinal Surgery
The duration of surgery and the recovery time vary widely, depending on the procedure performed. A discectomy may not require an overnight hospital stay, whereas a spinal fusion may require several days of hospitalization for observation.
Regardless of the surgery performed, NYU Langone’s pain management specialists ensure that you have the medication you need to remain comfortable while you recover. In addition, rehabilitation experts assess your level of mobility and help you get back on your feet as quickly as possible. Many people stand or walk the day after surgery, although movement may be minimal at first. Older people may need more time to recover in bed.
After spinal fusion, you may wear a back or neck brace at home for a few weeks to provide additional stability. During this time, you can gradually begin to move and walk.
In the days and weeks after surgery, your activity should be limited to gentle, low-impact movements as the spine heals, though bed rest is not recommended. Walking and moving at least a little bit every day can help to speed recovery and prevent complications. Under a doctor’s supervision, you should begin physical therapy, strengthening core muscles and improving flexibility and movement.
Follow-up appointments with your NYU Langone surgeon occur two weeks after any type of surgery, and then every three months for the first year if spinal fusion was performed. The doctor usually conducts an X-ray at each appointment to confirm that the spine is stable.
Every person’s recovery timeline is different. Your doctors ensure that you are making appropriate progress and can help you to prevent any complications or setbacks.