Surgical

Artificial Disc Replacement

A rapidly developing alternative to spinal fusion surgery, artificial disc replacement is a procedure that involves replacing a painful disc that is causing chronic back pain with an artificial disc that provides pain relief without compromising the spine's natural anatomical structure.

Artificial disc replacement surgery may be performed on the lower back (lumbar spine) or the neck (cervical spine). Artificial discs are structurally similar to the damaged discs that are replaced and share similar functions, including acting as shock absorbers in the back or neck.

  • An artificial cervical disc is a device inserted between two cervical vertebrae after an intervertebral disc has been surgically removed
  • Artificial discs are designed to preserve motion at the disc space, offering more motility and faster recovery than fusion
  • Used as an alternative to the use of bone grafts, plates and screws
  • May be recommended in place of anterior cervical discectomy and fusion


Bone Grafts

A bone graft is the process of attaching a new piece of bone to an existing, damaged bone, thus strengthening the site. Most often, bone is removed from the patient in a healthy part of the bodytransplanted from a donor site to a recipient site to facilitate the fusion of vertebrae in lumbar surgery. The grafting tissue is necessary for osteoinduction – the process of building new bone - to occur.

During spinal fusion surgery, the graft is placed into the disc space or in other places between the two vertebrae - and acts as a calcium scaffolding for the patient’s new bone to grow on.

Tissue can either be harvested from the patient’s iliac crest (part of the pelvis), called autograft bone, or from a donor bone (e.g. cadaver bone), called allograft bone, or some type of bone graft substitute (synthetic bone) may be used.

  • There are three types of graft material used in spinal bone grafts: Synthetic bone graft substitutes (man made); Allograft (cadaver bone from a bone bank); Autograft (bone graft taken from the patient’s own body)
  • Bone graft material can be morselized into small pieces or used as larger pieces for structural purposes to help achieve a spinal fusion


Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the discs and facet joints acquired in adult life. As the impairment to spinal cord function (referred to as ""myelopathy"") progresses, both legs weaken and become progressively spastic. Bowel and bladder sphincter control may then be altered. In advanced cases, gait will become progressively more difficult without aid by a cane or a walker.

In the past, cervical laminectomy (removing the posterior aspects of the spinal canal) to decompress (relieve pressure on) the spinal cord has been the procedure of choice.

However, as previously described, the majority of the abnormal anatomy producing spinal cord compression is located anteriorly to (in front of) the spinal cord itself. This is only indirectly addressed by a cervical laminectomy, with a clear subset of patients either failing to benefit or even getting worse after a laminectomy.

Therefore, depending on the patient’s anatomy, many surgeons prefer anterior decompression of the spinal cord and nerve roots. These procedures are referred to as anterior cervical decompression and spine fusion operations. The surgeon may also use instrumentation (plates and screws) to provide immediate internal support for the cervical spine, and to promote bone graft healing.

  • Recommended only after less invasive, non-surgical treatment options have been exhausted
  • Requires careful diagnosis and physical examination to determine the best course of surgical treatment


Lumbar Interbody Fusion

A common form of spinal fusion, Posterior Lumbal Interbody Fusion (PLIF) is surgery to stabilize the affected vertebrae and discs of the spine. Fusion is the process of combining two adjacent vertebrae to create solid bone, thus eliminating any movement. The goal is the surgery is to reduce pain and nerve irritation.

Spinal fusion may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations.

  • Posterior refers to the approach of the surgery, which is from the back part of the spine (rather than the front or side)
  • Lumbar refers to the position on the spine, which is the lower back
  • Interbody refers to the manipulation of the disc space between the vertebrae
  • Fusion is the process of combining two adjacent vertebrae to create solid bone, thus eliminating any movement
  • A bone graft is placed in the interbody space and alongside the back of the verteba to be fused
  • As the bone graft heals, it fuses the vertebra above and below, and forms one long bone


Posterior Lumbar Fusion

A 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 adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

  • Posterior refers to the approach of the surgery, which is from the back of the spine (rather than the front or side)
  • Lumbar refers to the position on the spine, which is the lower back
  • Fusion is the process of combining two adjacent vertebrae to create solid bone, thus eliminating any movement


Spinal Fusion

"Spine fusion surgery involves adding material to existing bone to create one continuous bone. Bones can be fused using medical devises, such as pins, rods and stabilizers, or by using bone grafts from other bones.

Once fused, bones no longer move independently. This is helpful for reducing the pain of vertebrae that have slipped out of alignment (spondylolisthesis), or are increasing pressure on the spinal canal.

Patients with degenerative disc disease or those with isthmic, degenerative, or postlaminectomy spondylolisthesis may experience abnormal and excessive motion at a vertebral segment, resulting in pain. Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis or deformity.

  • Fusion is the process of combining two adjacent vertebrae to create solid bone, thus eliminating any movement
  • In some cases, surgical rods and pins are attached to the back of the vertebra to the spine to help the fusion rate
  • A bone graft is placed in the interbody space and alongside the back of the verteba to be fused
  • As the bone graft heals, it fuses the vertebra above and below, and forms one long bone


Anterior Cervical Corpectomy and Fusion

More extensive than a discetomy, a corpectomy is the process of removing the both the vertebra and the discs from the spine to reduce pressure, restore function and relieve pain. This is recommended when the spinal cord and/or nerve roots are compressed due to stenosis or osteophytes (bone spurs).

In an anterior cervical corpectomy and fusion, the surgeon first removes the discs at either end of the affected vertebral bodies. Next, the surgeon removes ligaments and bone to fully relieve pressure on the spine. Finally, the surgeon fuses surrounding vertebrae, often adding pins and rods for support, to create one continuous bone.

  • An extensive back surgery procedure that includes elevated risks of spinal cord injury
  • Only recommended after other, less invasive treatments have been exhausted
  • Although associated with higher risks than other procedures, ACCF is often carries less risk of damage than the underlying back condition
  • Anterior refers to the approach of the surgery, which is from the front of the neck (rather than the back or side)
  • Cervical refers to the position on the spine, which is the upper or neck region
  • Corpectomy means to remove the vertebral body and disc
  • Fusion is the process of combining two adjacent vertebrae to create solid bone, thus eliminating any movement


Laminectomy

Laminectomy is the surgical removal of the back part of the vertebra that covers the spinal canal. Also known as decompression surgery, laminectomy enlarges your spinal canal to relieve pressure on the spinal cord or nerves.

Laminectomy is most commonly performed to relieve the pressure spinal stenosis places on your spinal cord or nerves. This pressure can cause pain, weakness or numbness that can radiate down your arms or legs. Laminectomy is usually better at relieving these types of radiating symptoms than it is at relieving actual back pain.

  • Typically performed only after all other conservative treatments have failed to relieve symptoms
  • May be recommended if symptoms are severe or worsening dramatically

Procedures
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