Types of Lumbar Spine Surgeries: What You Need to Know

There are several types of back surgeries that can help stabilize the spine and manage back pain and leg weakness. The surgical management of spinal disorders is multi-disciplinary and involves an evidence-based approach after carefully analyzing the potential benefits and risks and overall benefit to the patient.

Surgical treatment does not guarantee 100% symptom relief, but learning about the available options and the pros and cons of each procedure can help patients make informed decisions about their health and treatment.

Lumbar Decompression: Surgery that Helps Relieve Nerve Compression

Decompression is a surgical procedure that is performed to alleviate pain caused by pinched nerves. Pinched nerves cause pain, numbness, and abnormal sensations in the areas that they supply, such as the back, buttock, thigh, leg, and/or foot.

During a lumbar decompression surgery, a small portion of the bone over the nerve root or disc material from under the nerve root is removed to give the nerve root more space and provide a better healing environment.

Decompression surgeries can be of 2 types:

Lumbar discectomy

Lumbar discectomy is a type of surgery that removes the herniated or bulged portion of a disc in the lower back (lumbar disc) that pinches or compresses a nearby spinal nerve. When the bulged part of the disc is removed, the nerve gets more space near the bony opening (foramen) and does not cause inflammation and pain.

Discectomy is most commonly done to treat sciatica symptoms in the thigh, leg, and foot. ¹ Truumees E, Geck M, Stokes JK, Singh D. Lumbar Microdiscectomy. JBJS Essent Surg Tech. 2016;6(1):e3. Published 2016 Jan 27. doi:10.2106/JBJS.ST.N.00093

Lumbar laminectomy

Lumbar laminectomy, also called open decompression, is a surgical procedure performed to treat the symptoms of central canal stenosis (narrowing of the spinal canal). The surgery involves the removal of all or part of the lamina (posterior part of the vertebra) to provide more space for the compressed spinal cord and/or nerve roots.

Lumbar laminectomy treats sciatica symptoms as well as more serious medical conditions, such as cauda equina syndrome. ² Gagliardi M, Guiroy A, Sícoli A, Masanés NG, Ciancio AM, Asghar J. Spinous process splitting laminectomy for lumbar spinal stenosis: 2d operative video. World Neurosurgery. 2022;159:107. doi:10.1016/j.wneu.2021.12.088 ^{, 3} Yankang L, Leiming Z, Lewandrowski KU, et al. Full endoscopic lumbar discectomy versus laminectomy for cauda equina syndrome. Int J Spine Surg. 2021;15(1):105-112. doi:10.14444/8014

Microdiscectomy and laminectomy may include smaller procedures such as:

• Facetectomy, where the facet joints are trimmed, undercut, or removed to relieve nerve root pressure
• Foraminotomy, where the opening for the spinal nerve (intervertebral foramen) is enlarged by removing bony overgrowth

Less common decompression surgeries are corpectomy—removal of the body of a vertebra and the discs and costotransversectomy—removal of a part of a rib along with the transverse process of a vertebra. These surgeries help relieve pressure on the spinal cord from conditions such as spinal tumors and cancers.

Lumbar Spinal Fusion: Surgery that Helps Stabilize the Low Back

Fusion of a motion segment typically involves creating a living bone bridge between two contiguous vertebrae, either behind the disc, through the disc space, or both. This bridge stabilizes the spine and stops any motion at the fused motion segment. A bone graft is commonly used to bridge the vertebral bones, which is then replaced by the patient’s new native bone.

Lumbar spinal fusion surgery is designed to improve spinal stability and reduce pain in conditions that cause spinal malalignment or spinal degeneration, such as scoliosis, degenerative spondylolisthesis, and isthmic spondylolisthesis. ⁴ Li T, Shi L, Luo Y, Chen D, Chen Y. One-level or multilevel interbody fusion for multilevel lumbar degenerative diseases: a prospective randomized control study with a 4-year follow-up. World Neurosurgery. 2018;110:e815-e822. doi:10.1016/j.wneu.2017.11.109

A combination of anterior and posterior lumbar fusion surgery may be performed if the front and back of the spine need to be fused.

This type of surgery is typically indicated when a high degree of spinal instability is present (such as in complex spinal fractures), or in a revision surgery if the initial fusion did not set up.

Multilevel Spinal Fusion: Fusing more than 2 Levels of the Spine

Some fusion surgeries may involve fusing 2 or more motion segments of the spine to become one single unit. This type of surgery is called a multilevel spinal fusion. This surgery is designed to improve spinal stability and reduce pain in conditions that cause spinal malalignment or spinal degeneration.

Multilevel spinal fusion is almost always performed on contiguous spinal levels. The commonly fused spinal levels in the lower back are the motion segments in the lower half of the lumbar spine.

Interspinous Spacer: Preserving Posterior Spinal Motion

Posterior motion preservation spine surgery is a surgical technique that includes the implantation of small, specialized devices that help open up bony spaces in the spine that compress or pinch spinal nerves. The commonly used device is an interspinous spacer, which is designed to open up the foramen—the bony opening through which the nerve endings pass out of the spinal cord and into the legs. Nerve compression from spinal degeneration and lumbar degenerative disc disease may benefit from an interspinous spacer. ⁵ Baliga S, Treon K, Craig NJ. Low Back Pain: Current Surgical Approaches. Asian Spine J. 2015;9(4):645-657. doi:10.4184/asj.2015.9.4.645

The interspinous device implantation surgery can be performed under mild sedation and local anesthesia as an outpatient/day surgery procedure and the patient can go home the same day. In select patients, the implantation of this device may serve as an alternative to a more complex spinal fusion surgery.

Facet Arthroplasty: Arthritic Facet Joint Replacement in the Spine

Total facet arthroplasty (TFA) is an implant intended to replace painful and stiff arthritic facet joints. This surgery may be combined with a spinal decompression surgery and aims to restore function and improve spinal stabilization.

The joint implant is inserted through an open surgical approach. The implant is fixed into the vertebral pedicles using bone cement. TFA surgery is new, and the long-term results of this surgery are not established in the literature.

Spinal Cord Stimulation (SCS): Reducing Back Pain Through Electric Stimulation

Spinal cord stimulation, also called neurostimulation, is a treatment where mild electrical pulses are directed to the nerves in the spinal cord. These impulses stimulate the nerves and interfere with pain signals, stopping them from reaching the brain.

Spinal cord stimulation surgery includes the implantation of a small device (similar to a cardiac pacemaker) near the spine, which generates these pulses. One of the potential benefits of this procedure is that it can be tried for a short time before a person commits to having the implant or having any lasting negative effects.

Separation Surgery: Separating Spinal Tumors from the Spinal Cord

Metastatic spinal tumors (tumors that spread to the spine from cancer elsewhere in the body) pressing on the spinal cord may be treated with a special surgical technique called separation surgery. The goal of this surgery is to remove enough of the tumor to separate it from the spinal cord to achieve spinal cord decompression. After the tumor is separated and removed, radiation therapy can be performed on the remaining part of the tumor with lesser risk to the spinal cord. ⁶ Di Perna G, Cofano F, Mantovani C, et al. Separation surgery for metastatic epidural spinal cord compression: A qualitative review. J Bone Oncol. 2020;25:100320. Published 2020 Sep 26. doi:10.1016/j.jbo.2020.100320

When indicated, a combination of separation surgery and radiation therapy enables more of the vertebra to remain intact compared to more traditional spinal decompression surgeries.

Robot-Assisted Lumbar Surgery: A Modern Advancement to Spine Surgery

With less invasive and higher precision abilities, robot-assisted spine surgeries have emerged as a modern advancement in the surgical field. The several advantages of robot-assisted surgeries over manual surgical methods are ⁷ D'Souza M, Gendreau J, Feng A, Kim LH, Ho AL, Veeravagu A. Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends [published correction appears in Robot Surg. 2019 Dec 23;6:25]. Robot Surg. 2019;6:9-23. Published 2019 Nov 7. doi:10.2147/RSRR.S190720 :

• They provide real-time intraoperative navigation
• Potentially lower radiation exposure
• Potentially lower complication rates
• Potentially lower surgical time
• Faster recovery in some cases

Spinal fusion surgeries and surgeries requiring the placement of spine fusion instrumentation may be performed through robotic assistance. ⁷ D'Souza M, Gendreau J, Feng A, Kim LH, Ho AL, Veeravagu A. Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends [published correction appears in Robot Surg. 2019 Dec 23;6:25]. Robot Surg. 2019;6:9-23. Published 2019 Nov 7. doi:10.2147/RSRR.S190720