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Sciatica: surgical procedures SCIATICA: SURGICAL PROCEDURES
The operation most commonly used in an effort to permanently cure back troubles caused by one or more discs is spinal fusion. Much more popular in the United States than in this country, this is an operation in which two or more vertebrae are essentially welded together and any troublesome discs between them removed. There are various ways of performing this procedure, but the one used most nowadays involves both anterior and posterior fusion of the vertebrae, the spine being approached from the front (via the abdomen) and then through the back. The damaged disc is then replaced by a bone graft.
Just how good the results of spinal fusion are is still a matter for debate by experts as the operation so far has not been the subject of a properly-controlled trial. Certainly, there are many patients who have benefited greatly from spinal fusion; in other instances, the results have been less favourable. More may be known in a year or two about the true benefits - and risks - of spinal fusion as a trial to compare its results with those achieved through non-surgical rehabilitation programmes is being set up.
Laser disc decompression is an alternative way of dealing with bulging discs that is currently being pioneered in America, but it also remains the subject of some controversy about just how effective and free from long-term side-effects it is.
This method has proven itself useful in dealing with a disc that bulges but where no part of the disc's soft centre is actually protruding from it, the pressure on the nerves resulting purely from the fact that the disc is larger than it would normally be.
Here's how this procedure is performed. A silicon optical fibre is temporarily inserted into the disc. Energy from a laser is transmitted into the disc via the fibre and this causes the loss of water and some of the substance that makes up the centre of the disc. As the pressure within the disc is decreased because of the loss of material, it shrinks and pulls the offending bulge off the nerve root, so decreasing or eliminating the pain.
The procedure takes about 15 to 30 minutes, followed by two to three hours in the recovery room. The advantages of this method is that operating time and hospitalisation is kept to a minimum, and that it can be suitable for patients who are surgical risks, for example, those with heart trouble or age-related problems. The proponents of this approach say that there have been no major complications to date and the degree of success is about 80 per cent so far.
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