Descriptions of the Most Common Spinal Surgeries
Lumbar Discectomy
Discectomy surgery for the removal of a herniated lumbar disc is one of the most commonly performed procedures in the United States. The disc is a soft gel-like material between the vertebrae that can herniate or protrude into the spinal canal and compress nerves causing pain and loss of function.
An incision is made vertically along the midline of the back, usually about 2 inches long. Paraspinous muscle is stripped off the spinous process and the lamina. A small window is created in the lamina overlying the disc herniation. The nerve root is identified and gently retracted to expose the offending disc herniation. The protruding disc material is then removed while the support structure of the disc remains intact. This returns the disc to a more normal shape and relieves the pressure on the nearby spinal nerve. The wound is closed usually with sutures. Most discectomy procedures take anywhere from 45 to 60 minutes to perform.
Post operative recovery is relatively fast. Relief from nerve root compression is often immediate, but back pain associated with the surgery can be intense. Patients are up walking the same night or the next morning after the surgery, and usually discharged home in 1 to 2 days. The vast majority of patients experience significant pain relief.
Foraminotomy
Foraminotomy surgery is performed to treat pinched or compressed nerves. This procedure removes the foramina (the area where the nerve roots exit the spinal canal) to increase the size of the nerve pathway. This surgery can be done alone or with a laminotomy.
Laminotomy
A laminotomy procedure is one in which only a small portion of the lamina (a part of the vertebra) is removed to relieve pressure on the nerve roots.
Lumbar Laminectomy (Open Decompression)
A lumbar laminectomy is a surgical procedure that is performed to alleviate pain caused by nerve impingement by relieving pressure on the spinal cord. This surgery is designed to remove a small portion of the bone over the nerve root and/or disc material from under the root to give the nerve root more space.
A laminectomy effectively decreases pain and improves function for patients with disorders such as spinal stenosis, spondylolisthesis and spinal tumors. Spinal stenosis primarily afflicts elderly patients, and is caused by degenerative changes that result in enlargement of the facet joints. The enlarged joints then place pressure on the nerves causing pain and loss of function. Degenerative changes and/or deficient development of a portion of the vertebra can result in a spondylolisthesis. The outcome of this disorder is forward slippage of the lower lumbar vertebrae causing pain and loss of function.
- Typically a two inch to three inch incision is made in the midline of the back and the left and right back muscles (erector spinae) are dissected off the lamina on both sides and at multiple levels.
- The lamina is then removed (laminectomy) allowing the surgeon to see the nerve roots.
- The facet joints, which are directly over the nerve roots, may then be trimmed to give the nerve roots more room.
Patients are in the hospital for one to two days and the patient’s return to normal activity is largely dependant on the preoperative condition and age of the patient. It is recommended that patients avoid excessive bending, lifting, or twisting for six weeks. Daily walking is strongly encouraged.
The success rate of this surgery is favorable. Approximately 70% to 80% of patients will have significant improvement in their function and markedly reduced level of pain and discomfort
Anterior Cervical Discectomy Fusion
The cervical spine or neck consists of 7 vertebrae. The spinal cord runs from the brain down through the cervical spine, controlling the function of the body’s organs and limbs. In between each of the 7 vertebrae of the cervical spine are soft pads or discs which act as shock absorbers and allow for bending and movement of the head.
Millions of people suffer from pain in their necks or arms. A common cause of neck pain is a rupture or herniation of one or more of the cervical discs. This happens when the annulus (tough outer layer) of the disc tears and the soft center (nucleus) of the disc squeezes out. As a result, pressure is placed on the nerve root and causes pain in the neck, shoulders, arms, and sometimes the hands. These herniations can happen as a result of aging, wear and tear, or sudden stress or trauma like from a fall or car accident.
An anterior cervical discectomy fusion (ACDF) is the most common surgical procedure to treat damaged cervical discs. It is called “anterior” because the cervical spine is reached through a small incision in the front of the neck. During the surgery, the soft tissues of the neck are separated and the disc is removed. In order to maintain the normal height of the disc space, the surgeon will fill the space between the vertebrae with a small plug of bone or other graft substitute, and in time, that will fuse the vertebrae. This is called fusion.
A small titanium plate with screws is placed over the site of the bone graft between two vertebrae to assist in the fusion process and add stability to the spine. The plate also serves to keep the graft in place and prevent the graft from “backing out”. The ACDF usually takes about 90 minutes to perform. Patients are typically discharged the day after surgery. Patients will feel some pain after surgery especially at the incision site. Pain medication will help control the pain. Most patients are up and moving around within a few hours after surgery. This is encouraged to keep circulation normal and avoid blood clots.
After discharge from the hospital, walking and a daily low-impact exercise program is best after this type of surgery.
Signs of infection like swelling, redness, or draining at the incision site, and fever should be reported to the surgeon immediately.
Maintaining a healthy attitude, a well-balanced diet, and getting plenty of rest are great ways to speed up recovery.
Lumbar Fusion Surgery
At each level in the spine, there is a disc space in the front and paired facet joints in the back. A spinal fusion is designed to stop the motion at a painful vertebral segment which should then decrease pain generated from the joint. Bone graft is added to an area of the spine and ideally grows between the two vertebral bodies, fusing them together into one long bone thereby stopping the motion at that one segment.
Bone graft and titanium instrumentation or “implants” such as screws, rods, and plates are usually used in this procedure. Bone graft can be taken from the patient’s hip (autograft bone) during the surgery, or harvested from cadaver bone (allograft bone). Synthetic bone graft substitutes are also available.
Conditions that may be treated by spinal fusion surgery include:
Degenerative disc disease
Spondylolisthesis
Weak and unstable spine (caused by infection/tumors or by trauma such as a car accident or severe fall)
Fractures
Scoliosis or deformity
There are several types of spinal fusion surgery options:
Posterior Lumbar Interbody Fusion (PLIF)
The surgery is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies. Titanium instrumentation such as screws, rods, and cages may be used.
Anterior Lumbar Interbody Fusion (ALIF)
The surgery is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies. Titanium instrumentation such as plates, screws, and cages may be used.
Anterior/Posterior Fusion
The surgery is done from the front and the back
A one-level spinal fusion, on average, takes approximately three hours to perform. Additional vertebral levels typically add 1-1.5 hours to the surgical procedure. Patients typically spend 3-5 days in the hospital before they are discharged.
Signs of infection like swelling, redness, or draining at the incision site, and fever should be reported to the surgeon immediately.
Maintaining a healthy attitude, a well-balanced diet, and getting plenty of rest are great ways to speed up recovery.
Vertebroplasty/Kyphoplasty
Vertebral fractures are quite common. Up to 250,000 vertebral fractures are diagnosed each year. Most of the fractures occur in older people who have fragile bones and suffer from a condition called osteoporosis. Normal activities or minor incidents can cause these fractures. The majority of these fractures, even if they’re painful to start with, heal on their own with little or no lasting pain or disability. Even so, the risk of new fractures remains high.
Standard treatment for a vertebral fracture includes pain medication and the use of a brace for support. If a vertebral fracture does not improve over a number of weeks with pain medication and a brace, there are two types of minimally invasive procedures available to provide almost immediate relief: vertebroplasty and kyphoplasty.
Both vertebroplasty and kyphoplasty procedures involve the placement of bone cement into the fractured vertebra through small, minimally invasive incisions in the back under x-ray guidance.
Vertebroplasty
This procedure is done in the operating room with the patient sedated but awake. General anesthesia is not used during this procedure.
Bone cement or glue is injected under pressure into the fractured vertebra through a very small incision made in the back.
The cement/glue hardens in a few minutes, congealing the fragments of the fractured vertebra together and providing immediate stability.
The entire procedure takes about 15 minutes to perform. This surgery is almost always done on an out-patient basis, although specific insurance contracts may require a patient spend one night in the hospital.
Kyphoplasty
This procedure is done in the operating room with the patient sedated but awake. General anesthesia is usually not used during this procedure.
- A balloon catheter is guided into the vertebra and inflated with a liquid under pressure.
- As the balloon inflates, it helps to restore the height of a collapsed vertebra due to the fracture.
- Once the balloon is fully inflated, it is deflated and removed, and the large cavity created is filled with bone cement/glue.
- The cement/glue hardens in place.
© 2012 SouthEastern Spine Specialists
