Decompressive Spine surgery vs Spinal Fusion
In a recent interview Dr. Remi Nader, one of the top rated Neurosurgeons in Houston Texas, was asked to explain in a nutshell the major differences between decompressive spine surgery vs a spinal fusion.
We try to achieve different goals when we decompress the spine versus when we fuse the spine. There are different indications for each.
A lot of times when we see patients, or people with problems related to the spine for example, they have a pinched nerve in their spine.
The way to treat that, given they've tried other conservative means, such as medication, injection and therapy; is surgery.
And the type of surgery that we do, when we have a pinched nerve or a compressed nerve, is a decompressive surgery.
What we do is that we remove a part of the bone. For example, most commonly we remove part of the lamina. So the lamina is part of the bone on the back of the spine over here, so we make some cuts in these areas to remove part of that bone.
We find the nerve that's being compressed. And then we essentially create a wider space for that nerve by shaving off some bone around it ,or by shaving off part of the disc that's around it and that's compressing It.
So essentially this is decompressive Spine surgery in a nutshell If you will.
Now what about Fusions? When do we refuse the spine?
We fuse the spine when there's some kind of an instability in the spine. Or in conditions that are also related.
In addition to having an unstable segment or a segment that has severely degenerated, when there's a lot of pain in the back, what we call mechanical pain; the pain related to the discs being severely degenerated.
So the discs are the little cushions that we see here between the bones. When they degenerate, we lose some of that height and the bones get closer together.
And this, lot of times can cause back pain and in some cases, when it's advanced or when the bones start shifting forward, sometimes we have to stabilize that.
Typically we will try again conservative treatments; therapy, injections, medications…
When this doesn't work, sometimes we have to stabilize the spine and this is where we have to go in and put something in to hold it together. For example, we put something to replace the disc like a piece of bone or graft, and then we put some screws and rods or screws and plates to hold it there, so it doesn't move anymore.
This will help with the mechanical component that is unstable in the spine. Which is very different than the nerve component ,or what can be called 'Electrical Component'.
That's treated with Decompression