Nonfusion Surgeries for Treating Back Pain

When treating back pain and back problems, a nonsurgical approach is usually best, as any type of back surgery carries with it some very serious risks. However, if the nonsurgical methods are not effective, surgery may be required.

The most common types of surgeries are fusions, which fuse together segments of the spine, and decompression, which involves removing a portion of the spine to alleviate pinched nerves and filling it back in with a bone graft. There are, however, several other types of surgery used to treat back pain.

Artificial Disc Replacement

Artificial Disc Replacement has been around for about ten years and is most common in Europe. While this type of operation can be very effective, it is also extremely risky and not always sucessful. The FDA is currently allowing several studies to be preformed in the United States, with only one type of artificial disc, the Charite, currently approved for use in the United States. However, even the use of the Charite is very limited.

Basically, during artificial disc replacement, one or more discs is removed and replaced with a manmade disc. Unfortunately, removing these discs is very complicated, which is why the FDA is proceeding with a great deal of caution regarding this technology.


Kyphoplasty uses a small balloon passed through a needle to inflate a portion of the spine. The idea is to help lift the portion of the vertebra that is pinching a nerve. Once the area has been expanded, it is filled back in with bone cement, but it is important to note that it is not possible to restore the full height of the spine.


Vertebroplasty works very similarly to kyphoplasty, except instead of using a balloon to first inflate the spine, bone cement is simply inserted into the area. The bone cement causes the area between the vertebrae to re-expand. It is very important to ensure the needle is in the correct location before inserting the bone cement, so x-rays are usually used during the operation.


Thoracoplasty is usually preformed during a posterior fusion to treat scoliosis. However, instead of using a bone graft from the hip, a portion of several ribs is removed and used. The advantage of using the ribs is that it is often less noticeable and the healing time is greatly reduced. However, it still takes at least a month and a half for the ribs to completely heal.

Artificial Ligaments

Recently, many doctors have begun to use artificial ligaments to improve back stability in situations where a fusion would normally be used. The idea is not knew and has been preformed since the eighties, but it is becoming more popular. However, it was found that there was no evidence to support the effectiveness of the operation in the past. Today, a different type of artificial ligament is used, but they are still too new for any meaningful data to have been collected regarding their effectiveness.

Interspinous Spaces

Again, this is a procedure that does not have a great deal of evidence to support its use. It involves using small spacers, usually made of plastic or metal, between the spinious processes.

Pars Interarticularis Repair

This type of operation is used to treat isthmic spondylolysis and involves removing the bone defect that causes the disorder. Only one vertebra is affected by this operation, so it is not considered a fusion. After the deformity and surrounding tissue is removed, a bone graft is inserted, as well as some sort of fixation device, which is often metallic.

Treating Chronic Back Pain with a Morphine Pump

During this type of operation, a small tube is inserted next to the nerves or spine. The tube, or catheter, is then connected to a pump that is implanted under the skin, which sends morphine to the affected area. To refill the pump, a needle can be used.

Typically, the morphine pump is fairly effective at treating chronic pain.

Treating Chronic Pain with Spinal Cord Stimulation

This type of surgery involves implanting small electrodes on the surface of the dura. A device very similar to a pacemaker is then implanted under the skin and attached to the electrodes. Small electrical impulses are then sent to the electrodes, which helps block pain signals from reaching the brain.

While very effective, it is important to note that anytime a technology like this or something like a morphine pump is used, the actual cause of the problem is not being addressed. Instead, these only offer pain relief.

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