While studies show that more than half of spine surgeries
may be unnecessary, there are times when surgery is the best solution.
PacificaSpine is a spine center of excellence for comprehensive, innovative
and patient-centered care of the spine.
There are two surgical specialties that perform spine surgery, orthopedic surgery and neurosurgery. Like most of medicine, spine surgery has become more and more refined and sub-specialized over the years. Now, fellowship-training programs that provide additional training in the specialty of spine are available to general orthopedic surgeons and neurosurgeons.
In consideration of all these factors, we recommend a spine surgeon with fellowship training and extensive experience in any particular surgery offered, such as artificial disc.
The following is a list of common surgical problems and
issues.
COMMON SPINE SURGERIES
Cervical Spine (Neck) | Lumbar
Spine (Low Back) | Scoliosis | Spinal
Fusion | Artificial
Disc
Cervical Spine
/ Neck
Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary
to myths, the disc does not slip out of position like a watermelon
seed. Instead, the disc is like a jelly donut, acting as the functional
shock absorber between two bony vertebrae. An injury, damage from a
lifting incident or a twist may cause the jelly center to break through
the wall of the disc. When a disc herniates, the jelly center can press
on nearby nerves. In the neck, this causes arm, shoulder, scapula and,
in extreme cases, spinal cord compression.
Posterior Cervical Foraminotomy
/ Discectomy
For some herniated discs or bone spurs in the neck affecting only the
nerve roots, a posterior discectomy and foraminotomy can be performed.
This avoids spinal fusion, and with a microscope or a minimally invasive
technique, can minimize recovery time and speed a patient back to work
or activities.
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Anterior Cervical
Discectomy
Cervical is the medical term for "neck." Just
as in a lumbar discectomy, the surgeon will remove a piece of damaged
disc tissue in the neck area to relieve pressure on the spinal
cord or nerve roots. In some cases, by removing a piece of the
shock-absorbing disc that separates the two vertebrae, the structures
may become less stable. Consequently, when the disc is removed,
a surgeon may recommend "fusing" the vertebrae to prevent
instability. A cervical discectomy is best left to surgeons who
specialize in spine. |
Corpectomy
A corpectomy is often performed for patients suffering from multiple
levels of cervical stenosis with cord compression. The goal of a
corpectomy is complete decompression of the spinal canal when stenosis
encompasses more than just disc space and has moved into vertebral
bodies.
Bone spurs forming toward the back of a vertebral body
or the ligament behind vertebral bodies can cause the cervical spinal
canal to narrow. Therefore, it may be necessary to remove one or more
degenerating vertebrae and the discs above and below in order to decompress
the spinal cord and nerve roots.
A corpectomy involves a vertical incision in the neck.
The middle portion of the vertebra and its adjacent discs are removed
to achieve decompression of the cervical spinal cord and nerve roots.
A fusion accompanies a corpectomy surgery, using bone harvested from
the patient's hip or from a bone bank. This bone graft is used to reconstruct
the spine and provide stability.
Anterior Cervical Fusion
A fusion accompanies a anterior cervical discectomy or corpectomy.
During fusion surgery, a disc Is removed, and the surgeon inserts
a small wedge of bone between two vertebrae to restore disc space.
Over time, the two vertebrae "fuse" together into a single
solid structure. While this procedure limits movement and flexibility,
it also helps relieve neck pain.
Bone graft for the purpose of spinal fusion may be harvested
from the patient's hip (autograft bone), from a cadaver bone (allograft
bone), or from synthetic bone graft substitutes, which are currently
being developed more extensively. Your surgeon will help you decide
what is best for you.
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Laminoplasty
A laminoplasty, similar to a laminectomy, is often performed on patients
suffering from spinal stenosis in the neck (narrowing of the cervical
spinal canal). It is also referred to as an "open-door laminoplasty." A
laminoplasty creates more space for the spinal cord and roots. The
actual procedure involves cutting a “hinge” into one
side of the lamina and swinging it open like a door. It relieves
pressure on the spinal cord by increasing the diameter of the spinal
canal and room for the spinal cord. The surgery approach is through
the back of the neck. This procedure creates excellent spinal canal
decompression without the instability that may be created by multiple
level cervical laminectomies.
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Lumbar surgery/low
back
Microdiscectomy / Minimally invasive discectomy
Discectomy is the removal of the herniated portion of a disc to relieve
the pressure on nearby nerves as they exit the spinal canal. Contrary
to myths, the disc does not slip out of position like a watermelon
seed. Instead, the disc is like a jelly donut, acting as the functional
shock absorber between two bony vertebrae. An injury, damage from a
lifting incident, or a twist may cause the jelly center to break through
the wall of the disc. When a disc herniates, the jelly center can press
on nearby nerves. This causes back or leg pain when the hernation is
in the low back, and arm pain if the disc is in the neck area (see "cervical
spine/neck").
In a lumbar discectomy, the surgeon typically only removes
the portion of the disc that is causing a problem, not the entire disc.
If you have a herniated disc, keep in mind that a disc has a purpose.
When you remove a disc, it may cause instability in the joint, and
a surgeon may recommend a fusion to re-stabilize the area.
The surgeon can remove the damaged piece of disc through
a traditional incision in the back. However, at PacificaSpine, the
surgeons typically use a microscope to minimize incision size, tissue
trauma and recovery time. In addition, in some cases, minimally invasive
discectomy can provide an even less invasive approach.
Depending on the nature of your disc problem, your surgeon
will recommend the most appropriate type of surgery for you.
Anterior lumbar interbody fusion
(ALIF)
In this type of spinal fusion surgery, back muscles and nerves remain
undisturbed. The space between discs is fused by approaching the spine
through the abdomen. This procedure is used when the spine is relatively
stable, when there's a significant amount of disc space collapse, and
in cases of one or two level degenerative disc disease. The surgeon
will approach the abdomen through an incision (minilaparotomy) or by
using an endoscope.
Posterior lumbar interbody fusion
(PLIF)
This spinal fusion surgery is very similar to the anterior lumbar interbody
fusion, except that the surgeon approaches the spine through the low
back. This method is used when there is a greater amount of instability
in the patient's spine. An advantage to this surgery is that it can
also provide anterior fusion of the disc space without having a second
incision.
Lumbar laminectomy
A laminectomy involves the removal of part or all of the bone covering
the spinal canal. The purpose of this procedure can be to free nerve
roots, remove a tumor, bone spur or to perform certain types of fusion
procedures. Removing the lamina (laminectomy) is much like removing
the cover on a fuse box to access the wiring. By removing the lamina,
the surgeon gains access to the disc area and frees more space for
the nerves inside.
A laminectomy in the lumbar spine is often used to treat
recurrent disc herniations or where scar tissue is involved. Laminectomy
may also be used in cases of spinal stenosis in which the entire canal
is narrowed like a ring on a swollen finger, squeezing all of the nerve
roots at that level of the spinal canal.
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Scoliosis and spinal
deformity surgery
Through the placement of hooks, rods and screws, a spinal curve can
be corrected and stabilized. A fusion often follows scoliosis surgery,
in order to maintain the correction permanently.
Scoliosis is not the result of an injury and usually
appears without cause. It can be inherited, and it usually affects
more women than men. In the case of most spinal curves, the spine is
not only bent but also twisted like a bent corkscrew. Some cases of
scoliosis are not serious. Over time, if a curve worsens, surgery may
be required to correct the curve and prevent pain and worsening deformity.
In extreme cases, if the curve is not corrected, the spinal deformity
can place pressure on internal organs, which can shorten a person's
life expectancy.
During scoliosis surgery, the surgeon may use special
instruments that attach onto various vertebra segments. These surgical
rods are the adjusted to "de-rotate" the twisted and bent
corkscrew spine. Decades ago, Harrington Rods (the “first-generation” of
instrumentation) were used to surgically straighten the spine. However,
this technique did not untwist or correct the spine. Today, there are “fourth-generation” techniques
to improve corrections, minimize levels fused and minimize the need
for post-operative bracing.
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Spinal fusion
Unusual movement at a vertebral segment will probably result in pain,
especially if the person already has or displays symptoms of degenerative
disc disease, fractures, scoliosis or a weak spine. This movement
may require a discectomy, and subsequently, a lumbar interbody
fusion. Anterior and posterior fusion techniques can be performed
in the neck and the low back.
Not all patients who have spinal problems need spine
surgery. They can be managed with microscopic decompression or minimally
invasive techniques. Spinal fusion is reserved for patients who have
spinal instability, spinal deformity or painful degenerative pain.
Obviously, this is only after a patient has failed all conservative
measures.
In fusion surgery, the goal is to cause bone graft to
grow between two vertebrae and stop the motion at a particular segment
by adding bone graft to it. This results in one long bone rather than
two separate vertebrae. Anterior and posterior lumbar fusions may be
done separately or can be used together for the most severe problems
of the cervical (neck), thoracic (chest level) and lumbar spine (low
back). Your spinal surgeon will help you decide which technique is
right for you.
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Artificial disc
implantation
Surgeons must complete specific training and become certified in order
to perform artificial disc procedures. PacificaSpine’s
consulting orthopedic spine surgeon is not only certified in artificial
disc procedures, he actually teaches other spine surgeons these techniques
and is widely known as a world leader in this new technology.
Click
here to learn more about artificial disc implantation.
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