If a patient's diagnosis determines a need for surgical intervention, The Neuroscience Institute Spine Surgery Team provides multiple surgical options to address these specific conditions. When appropriate, minimally invasive options can be considered to address some conditions.
Depending on the procedure, our surgeons use computer-assisted navigation and MRI imaging during surgery for the highest level of precisions, while reducing possible complications and the likelihood of needing a revision.
Surgeons can relieve the pain through "decompression surgery", in which the piece of the disc or bone is removed; and/or through "fusion surgery", in which portions of the bony spine are fused together to decrease or eliminate excessive movement of the disc, and eliminating the source of pain.
Minimally invasive surgical techniques that are available may be discussed with your physician. Some common conditions that may require surgical intervention are:
Intervertebral disc with posterior herniation.
Herniated Disc: The disc degenerates and the inner core leaks out and places pressure on the nerve root. Discs can herniate in any area of the spine and protrude into the spinal canal where they press on the nerves. This can cause pain to radiate down the patient's arm or leg, with the possibility of accompanying numbness or weakness.
Surgical Treatment: Surgeons can perform a laminectomy, a procedure where a small portion of the outer bone covering, or lamina, over the nerve root is removed. This can be done with or without discectomy, in which the portion of the disc that is restricting the nerve root is extracted. These two procedures provide more room for the nerve to heal, thereby alleviating pain.
Degenerative Disc Disease: Over time, discs in the spine naturally degenerate, but do not necessarily cause back pain. However, a patient can injure weakened discs, many times as a result of sports or repetitive activities that involve bending or twisting of the spine. Because the disc is weakened, there is excessive movement around the disc, causing inflammation and irritation that can cause chronic back pain.
Treatment Options: Many people with degenerative disc disease can be treated with medications, physical therapy and exercise.
If surgery is indicated, spinal fusion can stabilize the area. First, bone is obtained from a bone graft. The bone graft provides "scaffolding" to promote new bone growth.
The surgeon can fuse the disc area together by placing replacement bone either in front of the spine (anterior interbody fusion) in the disc space, or along the back of the spine (posterior interbody fusion), or both in front and in back, depending on the area of the spine that is affected. The fusion of the spinal segment limits the motion around the affected area, thereby decreasing or eliminating the pain.
In some cases, the surgeon may insert screws and rods into the pedicle region of the spine around the affected disc. These pedicle screws and rods help to stabilize the area and restrict movement so that the bone graft can heal. In the cervical area, surgeons may apply a small plate to add stability to the area.
Lateral radiograph showing spondylolysis; dotted line shows anterior displacement of vertebra L5 (spondylolisthesis).
Isthmic or Degenerative Spondylolisthesis: Spondylolisthesis occurs when a vertebrae slips forward and presses onto, or dislocates over another vertebrae. This can be caused by a congenital defect or stress fracture. Pain can result from disc degeneration as the disc tries to stabilize itself, or from a fracture.
Treatment Options: Treatments may include medication to relieve pain and reduce inflammation, physical therapy and exercise. Surgeons may treat spondylolisthesis by performing a spinal fusion using different approaches.
Lumbar Spinal Stenosis: Over time, the facet joints (located in the back of the spine) may enlarge as they degenerate. Facet joints may press on the nerves as they exit the spine and create pain.
Surgical Treatment: Surgeons may treat lumbar spinal stenosis by performing decompression surgery. The bone is removed to give the nerves more room and often requires fusion to stabilize the spine.
Cervical Foraminal Stenosis: The facet joints in the spine enlarge and put pressure on the nerve root or spinal cord. The cervical disc space may narrow over time, even without disc herniation, as a result of enlargement of a joint into the spinal canal.
Surgical Treatment: For cervical stenosis, the disc may be removed to allow for more room for the nerve. The open space is then preserved through fusion of a bone graft into the area.
Osteoarthritis: The facet joints on the back of the spine are made up of two bony processes with cartilage between them, surrounded by a capsule filled with fluid. The cartilage and fluid normally permit the joints to move without much friction. In a patient with osteoarthritis, cartilage within the joints breaks down, resulting in greater friction within the joint. This leads to increased stiffness and back pain.
Surgical Treatment: Fusion surgery may be performed for osteoarthritis to restrict movement in the painful joint. However, surgery is generally not recommended since several vertebrae are usually affected and fusion of multiple levels of the spine would be required.
Osteoporotic Compression Fracture: Osteoporosis is the weakening of the bone and may cause a fracture in the vertebral body in the spine.
Treatment: Kyphoplasty/Vertebroplasty - Physicians will expand some of the compressed bone in the spine with bone cement to re-align the spine, which will alleviate pain. This procedure has a very good success rate.