Surgical Treatments

Decompressive laminectomy is the most common type of surgery done to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on the spinal nerve roots caused by age-related changes in the spine. It also is done to treat other conditions, such as injuries to the spine, herniated discs, or tumors. In many cases, reducing pressure on the nerve roots can relieve pain and allow you to resume normal daily activities.

Goals of Lumbar Laminectomy Surgery

Lumbar laminectomy surgery aims to accomplish the following goals:

• Relieve neural tissue compression – Stenosis of the spinal canal in the lumbar region may cause compression of the spinal cord, thecal sac, spinal dura, and/or the cauda equina. When one or more of these structures are compressed, neurogenic claudication (leg pain while walking or bending the spine backward) may occur, typically affecting both legs. Laminectomy helps relieve the compression of these neural tissues by widening the spinal canal.
• Improve leg function – Lumbar stenosis often causes decreased mobility due to pain and weakness in one or both legs. Laminectomy helps decrease pressure on the nerves, reducing leg pain, and potentially improving weakness and functionality of the lower back and legs.

When Is Decompression Surgery Necessary?

Decompression surgery is performed for the treatment of:

• Stenosis
• Radicular pain
• Spondylosis
• Other conditions associated with nerve compression

What Is a Discectomy?

A discectomy is a surgical procedure performed to treat pain that is caused by a prolapsed or herniated disc. It is the removal of the intervertebral disc that causes compression or irritation to the adjacent nerve root.

Why Do I Need a Discectomy?

Discectomy is usually recommended to patients who experience chronic pain (caused by the prolapsed disc) that has not been alleviated by rest, medications, or injections. Surgeons also suggest this type of procedure to individuals who developed progressive neurological deficits or signs and symptoms like weakness, numbness, and loss of sensation. Other conditions that may indicate the need for discectomy include:

• Immobility – as a result of pain or weakness
• Nerve damage – a condition that affects nerve function
• Cauda Equina syndrome – a serious condition that results from nerve impingement

How Do You Prepare for a Discectomy?

• Blood and urine tests may be carried out to assess current patient’s health.
• Physical examination and assessment is done to rule out other conditions.
• Certain medications may be prescribed or stopped to prevent complications.
• The surgeon may also order diagnostic scans prior to the procedure.
• The patient should be placed on NPO (nothing by mouth) few hours before the surgery.
• Smoking and drinking alcohol should be avoided several days before the surgery.

What Happens After Discectomy?

After the procedure, the patient will be monitored in the recovery room for a few hours. If the patient remains without any complications, he or she will be transferred to his or her room and may be able to discharge home that evening.

Spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery, and all involve the following process:

• Adding bone graft to a segment of the spine
• Set up a biological response that causes the bone graft to grow between the two vertebral elements to create a bone fusion
• The boney fusion which results in one fixed bone replacing a mobile joint – stops the motion at that joint segment

For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a lumbar fusion may be considered:

• Lumbar Degenerative Disc Disease
• Lumbar Spondylolisthesis (isthmic, degenerative, or post laminectomy spondylolisthesis)

Other conditions that may be treated by spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis, or deformity.

What Is Coflex®?

The Coflex® Interlaminar Stabilization® device is a single-piece titanium implant that goes in the back of your spine to treat moderate to severe spinal stenosis. It’s amazingly simple, very strong, and flexible enough to support your spine without having to fuse your bones together. The Coflex®device comes in five sizes to fit most patient anatomy and is implanted directly following surgical decompression.

How It Works

After your surgeon has performed a direct decompression, the Coflex® device is inserted through a minimal incision to keep that area of the spine open and stable. Decompression procedures are more durable and sustainable when Coflex® is added on for treatment.

What Is Anterior Cervical Fusion (ACF)?

Anterior cervical fusion is a spinal fusion surgery in the neck, or cervical, spine. The surgeon makes an incision in the front of the neck. The contents of the neck are gently retracted, enabling the front part of the spine to be seen. Fluoroscopy is used to determine the correct levels before the disc material is removed and the fusion graft is inserted. A surgical plate is then screwed in place over the fusion level.

What Does Anterior Cervical Fusion Treat?

Anterior Cervical Fusion is the last option provided when all other less invasive methods have been exhausted. This procedure is performed for the treatment of:

• Herniated Disc
• Painful Disc Degeneration
• Radicular Syndrome
• Spondylosis
• Stenosis
• Myelopathy

What Is Posterior Cervical Fusion (PCF)?

Posterior cervical fusion surgery is a spinal fusion surgery in the neck, or cervical, spine. The surgeon makes an incision in the back of the neck. The neck muscles are retracted, providing access to the spine. Often, cervical fusion surgery is performed combined with decompression surgery. Bone graft is placed, and often screws or surgical wire is used at the fusion level to provide stability.

What Conditions Are Treated With Posterior Cervical Fusion?

• Cervical Myelopathy
• Cervical Kyphosis
• Cervical Spondylolisthesis
• Cervical Stenosis
• Failed Anterior Surgery
• Pseudoarthrosis of Anterior Fusion Attempt
• Ankylosing Spondylitis Deformity
• Cervical Deformity

What Is Cervical Total Disc Replacement (TDR)?

Total disc replacement surgery is one of the latest advancements in spine surgery. Replacing the disc removes the cause of pain while preserving natural motion.

The surgeon makes an incision in the front of the neck. The contents of the neck are gently retracted, enabling the front part of the spine to be seen. Fluoroscopy is used to determine the correct levels before the disc material is removed and the artificial disc is inserted.

Cervical disc replacement is performed for the treatment of herniated disc, painful disc, radicular syndrome, and other cervical spine problems.

What Conditions Are Treated With Cervical Disc Replacement?

First, in the cervical spine, it is used to treat herniations that are pinching the nerves, giving the patient neck, shoulder, and arm pain. Sometimes bones spurs can pinch the nerve passage and these too, depending on the size of the bone spur, are treatable by disc replacement. The patient may experience in addition to pain, numbness, and tingling, as well as weakness in a certain nerve distribution.

Posterior Thoracic Fusion is the process of joining bones with bone graft, adding bone graft or bone graft substitute to an area of the spine to set up a biological response that causes the bone to grow between the two vertebral elements that thereby stop the motion at the segment. The fusion process essentially “tricks” the body into thinking it has a fracture.

Posterior cervical fusion is performed on the back of the mid-back region for reasons such as instability of the spine, fracture, degenerative, or stabilization for tumors. The goal with fusion is to stabilize the spine so that pain or deformity is reduced.

What Is Thoracic Decompression?

Thoracic decompression is the removal of part or all of the bone that covers the back of the spinal column called the lamina, as well as removal of a portion of the rib on the affected side. The purpose of this surgery is to access the disc or bone that is causing pressure around the spinal cord or nerve(s).

In a fusion surgery, a bone graft and/or instruments are used to encourage bone growth over the sacroiliac joint and create one immobile unit. Joint fusion can effectively reduce pain and instability caused by sacroiliac joint dysfunction or inflammation.

Our surgeons are trained in minimally invasive techniques for sacroiliac joint fusion for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. The procedure is done by inserting small titanium implants across the sacroiliac joint to maximize post-surgical stability and weight-bearing capacity. The procedure is done through a small incision and takes about an hour.