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NeuroCare Brain & Spine Center™ - Surgical Treatment Options of the Spine
Microdiscectomy
A microdiscectomy is an operation done to treat a herniated lumbar disc. In a microdiscectomy, a small window is made in the bone over the nerve and disc and
the portion of the disc that is compressing the nerve is removed.
A microdiscectomy is performed through a small (1 to 1 1/2 inch) incision in the
back. Muscles are moved aside to allow the surgeon to see the bone to be removed
and then see the nerve and disc. The surgeon positions a surgical microscope or
uses magnifying loupes to illuminate and magnify the nerve and surrounding
structures so they can be seen clearly. This procedure is often done on an
outpatient basis.
Anterior Cervical Discectomy and Fusion
Anterior cervical discectomy and fusion (ACDF) is a surgical treatment for
patients with cervical disc disease causing arm and/or neck pain.
In an ACDF, an incision is made on the front of and to one side of the neck. An
assistant gently protects the trachea (windpipe) and esophagus (the connection
between the mouth and stomach) so that the surgeon can remove the disc. Removing
the disc relieves pressure from the nerve roots and/or spinal cord. To maintain
the space between the vertebrae, a graft is placed where the disc had been. The
body will then fuse this area growing new bone to join the two spinal vertebrae
together. The fusion also helps to maintain adequate space for the decompressed
spinal cord and/or nerve roots.
Anterior cervical fusions are also performed to treat cervical instability due
to trauma (fractures or dislocations), tumors, infection or kyphosis – a
deformity of the spine.
Depending on the condition being treated, this is also an outpatient procedure.
Laminectomy
A laminectomy involves removing the bone that forms the back part of the spinal
column. It can be done to remove pressure from the nerves or spinal cord. A
laminectomy can involve a single level of the spine or multiple level in some
cases.
The procedure may be the only surgical treatment need or may be a part of a
spinal fusion or other operation. It is a common surgical treatment for spinal
stenosis.
Lumbar Spinal Fusion
A lumbar spinal fusion is done to eliminate motion at a vertebral segment, which
in turn should decrease pain. This procedure is often used to treat low back
pain from degenerative disc disease. It is also done to treat pain from an
unstable spine as a result of a tumor, fracture, scoliosis or other deformity.
In a lumbar spinal fusion surgery, a degenerated disc may be replaced with a
graft. The graft causes the two vertebrae segments to grow together into one
bone, thereby eliminating the motion and the pain.
In many cases, lumbar spinal fusions are supported by implanting spinal hardware
in the form of screws and rods to hold the spine still while the body "fuses" a
bone graft.
Minimally invasive lumbar fusion
Some patients can be treated effectively with a minimally invasive lumbar
fusion. In this procedure, the surgeon uses different devices, which require a
much smaller incision than a traditional spinal fusion, causing less trauma to
the surrounding tissues. This typically results in a faster recovery for the
patient.
Vertebroplasty and Kyphoplasty for spinal compression fractures
 Vertebroplasty
and kyphoplasty are procedures to reduce the pain of vertebral compression
fractures associated with osteoporosis, tumors, and trauma.
Both vertebroplasty and kyphoplasty involve the injection of acrylic cement into
a fractured vertebra to control pain and prevent the vertebrae from further
collapse. For some patients, the techniques can be performed as outpatient
procedures.
Kyphoplasty differs from vertebroplasty in that it also is designed to restore
the height of a compressed vertebrae by inflating a balloon in the vertebrae before the acrylic
is injected. Both procedures provide pain relief from vertebral compression
fractures.
Disc Replacement/Artificial Discs
Disc replacement (Artificial discs) offers a non-fusion surgical option for
people with degenerative disc disease. A surgeon replaces the degenerative disc
with an artificial disc in order reduce pain and maintain mobility.
The advantage to disc replacement is that, unlike a spinal fusion, it preserves
normal motion of the spine. Using an artificial disc to replace a degenerated
disc avoids placing the stresses of a spinal fusion on the spine. When a spinal
fusion is performed, the stresses cannot be absorbed by the "fused" level and
are borne by the levels above and below the fusion.
Intradiscal Electrothermal Therapy (IDET)
Intradiscal Electrothermal Annuloplasty (IDET) is a minimally invasive,
outpatient treatment option for chronic low back pain due to degenerative disc
disease or contained disc herniation. IDET provides some patients with pain
relief.
IDET involves inserting a catheter into the disc and heating it up. This
procedure helps some people reduce their pain without undergoing spine surgery.
Resection of spinal tumors and other lesions
Tumors of the spine can be either benign or malignant. Benign tumors include
schwannomas, neurofibromas and meningiomas. Malignant tumors in the spine are
relatively rare. When they do develop, they are usually from the spread of
cancer from another body area.
The purpose of surgical resection (partial or complete removal) of the spinal
tumor or lesion – regardless of whether it’s benign or malignant – is to reduce
pain and maintain spinal mobility and stability. In some cases, spinal tumors
may require non-surgical treatment such as radiation or chemotherapy.
Treatment of congenital abnormalities of the spine
Treatment options are available for congenital abnormalities of the spine
including neural tube defects such as spina bifida. Congenital abnormalities are
conditions that are present from birth.
In many cases, when congenital abnormalities of the spine need surgical
treatment, it is useful for a multi-disciplinary team of doctors to evaluate and
treat the patient.
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