1. Laminectomy (Decompression Surgery)

The lamina — the bony arch forming the posterior wall of the spinal canal — is removed to create more space for compressed nerves or the spinal cord. Laminectomy is the primary treatment for lumbar spinal stenosis causing neurogenic claudication (leg pain, heaviness, and weakness brought on by walking that is relieved by rest or leaning forward). Performed through a posterior midline incision, the nerve roots are decompressed. Laminectomy may be performed at one or multiple levels. If significant instability is present, it may be combined with fusion. Recovery: 2–4 weeks for single level, 4–6 weeks for multi-level.

2. Spinal Fusion Surgery

Spinal fusion permanently joins two or more vertebrae together using bone graft and metallic instrumentation (pedicle screws, rods, cages), eliminating painful abnormal movement at the fused segment.

TLIF (Transforaminal Lumbar Interbody Fusion) — the most common lumbar fusion technique. Performed from the back (posterior), the disc is removed, a cage filled with bone graft is placed in the disc space, and pedicle screws connect the adjacent vertebrae. Can be performed minimally invasively (MIS-TLIF) through 2cm incisions with tubular retractors, dramatically reducing muscle damage and recovery time compared to traditional open fusion.

PLIF (Posterior Lumbar Interbody Fusion) — disc removal and cage insertion through bilateral posterior approach. Provides excellent fusion surface area.

ALIF (Anterior Lumbar Interbody Fusion) — disc access from the front (anterior), allowing placement of a larger cage without disturbing posterior muscles. Often combined with posterior instrumentation (360° fusion).

XLIF/LLIF (Lateral Lumbar Interbody Fusion) — approach from the patient’s side, through the psoas muscle, accessing the disc laterally. Avoids both posterior muscle disruption and major abdominal vessels.

3. Vertebroplasty and Kyphoplasty

Vertebroplasty — bone cement (PMMA) is injected percutaneously into a fractured vertebral body under fluoroscopic guidance, stabilising the fracture and relieving pain. Day procedure, extremely effective for painful osteoporotic compression fractures. Pain relief in 90%+ of patients, often immediate.

Balloon Kyphoplasty — a balloon is first inflated within the collapsed vertebra to restore height before cement injection. Creates a cavity for cement placement, reducing leakage risk and partially restoring vertebral height. Preferred for patients with significant height loss and kyphotic deformity.

4. Scoliosis Surgery

Significant scoliosis (spinal curvature greater than 40–50° that is progressive or causing symptoms) may require surgical correction. Multi-level instrumented fusion uses multiple pedicle screws, rods, and correction manoeuvres to straighten the spine and fuse it in the corrected position. Complex deformity surgery requires specialised spinal deformity surgical expertise.