Through a tube about the width of a dime, which parts the muscle along its fibres rather than stripping it off the bone. Takes the pressure off the nerve and leaves the joint and the rest of the disc intact. The commonest operation on this page.
Read the full procedure →A one- or two-level fusion done through tubes and percutaneous screws. Decompresses the nerve and stabilises the segment in the same sitting — the answer when the level that is pinching the nerve is also the level that is moving.
Read the full procedure →An artificial disc instead of a fusion, from the front. Candidacy is genuinely narrow — narrower than in the neck — and most people who ask about it will not qualify. The disc replacement page explains exactly why.
Read the full procedure →These overlap, and more than one can be present at the same level — which is why the operation is chosen from the whole picture rather than from a single line of the report.
Legs tire and ache on walking
The canal narrows and every nerve in it is crowded, rather than one root being pinched. The giveaway is distance: the legs give out after a few hundred yards and come back after sitting down or leaning on a trolley.
Instability rather than crowding alone
One vertebra has shifted forward on the one below. This is the finding that turns a decompression into a decompression and a fusion, because taking bone off an already unstable level makes it more unstable, not less.
Open, across three or more levels, for stenosis that runs the length of the lower back. Its own page argues at length against adding a fusion to it where the spine is stable, which is the more common mistake.
Read the full procedure →From the side, through the psoas muscle. A large spacer restores the height of the disc and opens the nerve tunnels indirectly, often without entering the canal at all. It cannot reach L5–S1 — the iliac crest blocks it — which is why constructs that need that level pair it with an ALIF.
Read the full procedure →From the front, through the abdomen, with the back muscles never crossed. Takes the largest graft of any lumbar approach and is the best of them at restoring the forward curve of the lower spine, which is why it is the usual answer at L5–S1.
Read the full procedure →The largest operation described on this site: deformity, revision, and restoring the balance of the spine over the pelvis. Reserved for the cases that genuinely need it, and planned on standing full-length films rather than on an MRI.
Read the full procedure →This is the question that matters most, and the one worth asking your surgeon directly.
Everything above treats a nerve that is being compressed or a segment that is moving. Pain in the back itself — deep, central, no leg symptoms — usually comes from the facet joints or from the vertebral body, and both of those are treated through a needle rather than with an operation.
The index lists every procedure in one place; the approach page explains how the choice between a tube and an open exposure actually gets made, and the conditions list names what comes through the clinic most often.