Spine Procedures

Anterior Cervical Discectomy and Fusion

This surgery removes a herniated or diseased disc and relieves neck and radiating arm pain caused by parts of the disc pressing on nerve roots.

ALIF (Anterior Lumbar Interbody Fusion):

Often, patients may have a problem with degenerative disc disease on only one vertebral level which means there isn’t a great deal of spine instability, in these cases, surgeons may perform an ALIF which uses an anterior (or front) approach through the abdominal area to completely remove the damaged disc. Upon removal, the space is filled with bone to achieve a spinal fusion (sometimes more stability will be ensured by using a cage or another medical device as well). The significant advantage with an ALIF is that the abdominal muscles run vertically and are easily retracted; therefore, they do not have to be dissected. Additionally, with an ALIF the back muscles and nerves remain undisturbed.

Decompression

This term actually refers to a number of surgical techniques which are all aimed at freeing up space in the spine to alleviate nerve compression. Decompression methods include: laminectomy, laminotomy, lamioplasty, foraminectomy, foraminotomy, and discectomy. The best method will depend on several factors including which spinal level(s) needs decompression, the elements that are causing the problem, the stability of the spine and the experience of the surgeon.

Discectomy/Microdiscectomy

Discectomies are also performed when there is a problem with one vertebral disc that has herniated or slipped. These procedures can be cervical (neck), thoracic (upper back), or lumbar (lower back) and involve the removal of either the entire disc or the portion of the disc that is bulging into the nerve and causing the problems – if possible, the healthy portion of the disc will remain intact. Depending upon the location of the problem, the incision will be made either in the front or back of the spine.

A minimally invasive procedure, a microdiscectomy is exactly same as a discectomy (see above); however, in this instance, the surgeon will use smaller incisions and high powered microscopic equipment enabling these cases to be performed on an outpatient basis. Through the use of magnification, the surgeon is able to carefully dissect tissues and remove the portion of the herniated disc material without dissecting the muscles, so recovery from this treatment is relatively short.

Foraminotomy/Foraminectomy

(Both terms may be used for the same procedure) The foramen is the tunnel in the vertebrae of the spine through which the nerve root exits from the spinal canal on its way to a specific organ or area of the body. When the tunnel gets narrowed the nerve may be pinched or irritated creating nerve pain and dysfunction. This condition can be referred to as spinal stenosis, lateral disc herniations, or facet arthritis. The process of removing bone and soft tissue to enlarge the nerve passage is called a foraminotomy. This surgery is commonly performed with other procedures, such as a laminectomy, for an overall decompression of the spinal canal. During this surgery, specific medical instruments called Kerrison Rongeurs are used to remove portion of bones from the laminae facet. When the surgery involves removing a large amount of bone and tissue it may be called a forminectomy. Often this procedure will require a fusion procedure as well to fully correct the problem.

Kyphoplasty (Balloon Vertebroplasty)

A relatively new, minimally-invasive procedure, kyphoplasty is a technique of reinforcing the spinal column with bone cement in the case of bone fracture or collapse due to osteoporosis or bone destruction as a result of tumors or other trauma. The purpose is to not only stabilize the spine but also to replicate the original height and structure of the damaged vertebra. With the assistance of a flouroscope, an x-ray/imaging device, the surgeon will insert a special needle into the collapsed vertebra. Once in place, a balloon will be passed into the vertebra and  filled with a liquid solution to create the cavity within the area. Once the desired space is achieved, the balloon is deflated and withdrawn and bone cement is injected into the space. The specialized cement hardens quickly and typically patients are able to go home shortly thereafter.

Laminectomy (Cervical)

In cases where the patient suffers from spinal stenosis, a laminectomy, (also called a decompression),  may be the course of action. Here, the nerves may be compressed throughout the spine because stenosis is a degenerative disease that can affect more than one level. Each vertebra has two portions of vertebral bone over the nerve roots in the back of the spine. These small, flat bones are called the lamina, and during this operation, the surgeon will remove all or a significant portion of the lamina on affected levels to give the nerve root more room. In addition, the facet joints may also be enlarged where the nerve leaves the side of the spine, so they may be trimmed or cut down as well. If the condition is extensive the surgeon may  also have to perform a fusion for stability. In a laminotomy, a smaller portion of the lamina bone(s) are removed; this is generally the case when dealing with a herniated or bulging disc. The surgeon must perform a laminotomy to gain access to the damaged disc.

In a laminoplasty, the laminae, which act like a set of double doors, are split down the middle and hinged open. They are then kept open through the implementation of plates or bone struts.  A laminoplasty, which is most often performed in the cervical spine, can be done over several levels and lead to significant enlargement of space for the nerves to travel. This may be a good alternative to an anterior cervical spinal fusion and decompression.

Laminectomy (Cervical) with Fusion

This procedure removes a section of bone from the rear of one or more vertebrae to relieve the painful and disabling pressure of stenosis. The spine is then stabilized with rods and screws.

Lumbar Disc Microsurgery

This minimally-invasive procedure relieves pressure on nerve roots caused by a herniated disc. It can eliminate the pain of sciatica.

Occipito-Cervical Fixation (OC Fusion)

This surgical procedure aligns and stabilizes the cervical spine to correct instability at the junction of the spine and skull, which can be caused by rheumatoid arthritis, spinal tumors, and spinal trauma.

Spinal Cord Stimulation (Boston Scientific)

Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

Spinal Fusion (Lumbar)

In some cases, the decision must be made to limit the mobility of the spine on more than one level. In these instances, a lumbar spinal fusion is suggested by the surgeon for the best possible outcome. Fusions may be recommended for a variety of back pain problems, such as, degenerative disc disease or spinal stenosis. Generally speaking, the surgeon will perform a combination of procedures if a spinal fusion is required. For example, a laminectomy may be the course of action to solve the nerve compression, but the physician will go a step further and perform a fusion to keep everything in place once the laminectomy is done. Here the spinal canal is decompressed and screws and rods are placed to fuse two or more back levels together. Additionally, small bits of bone tissue are placed either in front of or along the back of the spine so that the vertebrae from more than one level will grow together. The treatment is designed to eliminate movement in the segment of the spine that has been fused together, thereby decreasing or eliminating the back pain created by motion and nerve compression.

*** It should be noted that the spine is not actually fused at the time of the surgery. The procedure creates a condition where the spine will begin to fuse itself by growing bone to create a solid mass, a process that starts about three months post surgery and can ultimately take up to a year to complete.

TLIF – Transforamenal Lumbar Interbody Fusion

Basically the same procedure as a PLIF (see above), but the approach and removal of the disc is from a more lateral (side) angle, and in some cases only one side of the disc needs to be exposed, right or left, in order to perform the procedure.