Spinal Surgeries

How do you know when you need spine surgery?

When someone comes to us with extremity symptoms, we almost always suggest they first get an evaluation with their primary care physician. If a person is experiencing low back pain or neck pain, we will usually watch them over time and encourage them to maintain good, stable physical activity to see if the issue resolves. If the issue is not resolving with physical activity, over the counter treatments, or pain management and anti-inflammatory medication, the next step would be to see a doctor for an evaluation.

The only two things that are really proven to help a patient who is experiencing problems with their spine are time and surgery. Everything else is used to manage symptoms while your body fixes it naturally. If your body doesn’t fix it, then surgery becomes a good option.

The vast majority of patients with spine problems can be treated in a conservative and non-surgical fashion. With very few exceptions, we recommend that all patients try physical therapy, home exercises, medication and often times spinal injections prior to considering surgery.

If the person has problems with their spinal cord, has significant weakness in an arm or leg or limb, or if they have tried all of the conservative treatments and have been unsuccessful, we might recommend they go directly to surgery.

What are some types of back surgery?

• Vertebroplasty and kyphoplasty. ...

• Spinal laminectomy/spinal decompression. ...

• Discectomy. ...

• Foraminotomy. ...

• Nucleoplasty, also called plasma disk decompression. ...

• Spinal fusion. ...

• Artificial disk replacement.

Common spine surgical procedures

There are a number of conditions that may lead to spine surgery. Common procedures include:

• Discectomy or Microdiscectomy: Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve. Microdiscectomy is a MISS procedure.

• Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.

• Laminotomy: Removal of a portion of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.
  
  Both laminectomy and laminotomy are decompression procedures. “Decompression” usually means tissue compressing a spinal nerve is removed.

• Foraminotomy: Removal of bone or tissue at/in the passageway (called the neuroforamen) where nerve roots branch off the spinal cord and exit the spinal column.

• Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one.

• Spinal fusion: A surgical technique used to join two vertebrae. Spinal fusion may include the use of bone graft with or without instrumentation (eg, rods, screws). There are different types of bone graft, such as your own bone (autograft) and donor bone (allograft). A fusion can be accomplished by different approaches:

ALIF, PLIF, TLIF, LIF: All pertain to lumbar interbody fusion used to stabilize the spinal vertebrae and eliminate movement between the bones.

• Anterior Lumbar Interbody Fusion

• Posterior Lumbar Interbody Fusion

• Transforaminal Lumbar Interbody Fusion indicates a surgical approach through the foramen.

• Lateral Interbody Fusion in which the minimally invasive approach is from the side of the body.

Spinal instrumentation

Examples of spinal instrumentation include plates, bone screws, rods, and interbody devices; although, there are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.

• An interbody cage is a permanent prosthesis left in place to maintain the foraminal height (eg, space between two vertebral bodies) and decompression following surgery.

• Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it requires less exposure to place within the spine and therefore is a MISS procedure.

• Pedicle screws help to hold the vertebral body in place until the fusion is complete.

Some patients are at-risk for their fusion not to heal properly or completely. Your surgeon may refer to this as a non-fusion, pseudarthrosis or a failed fusion. To help avoid fusion problems, your surgeon may recommend a bone growth stimulation. There are different types of stimulators; those implanted internally and others that are worn about the body area, such as the neck or low back.

Should surgical treatment be your only recourse, it may help to understand that minimally invasive spine surgery offers many benefits. Patients who want to return to work and active play, as well as the elderly or those with major spinal problems, often achieve a higher level of function once symptoms are alleviated.