A microdiscectomy surgery can be performed under spinal or general anesthesia as an outpatient procedure (go home same day) and involves removing or shaving down the disc to free the nerve and alleviate pain.
A treatment for lumbar spinal stenosis is to open the nerve canal by laminectomy. This may be performed under spinal or general anesthesia as an outpatient procedure (go home same day) or overnight stay depending on how many levels need to be decompressed.
There are many approaches and reasons to perform a spinal fusion. The techniques vary from direction – posterior or from the back called PLIF or TLIF , lateral or from the flank side called XLIF, anterior or through the abdomen called ALIF, and combinations of these approaches as well as minimal invasive techniques.
This is a procedure that may be recommended for problems due to degeneration of the disc, a herniated disc or spinal canal narrowing. ACDF involves removing the disc, placing a bone graft and titanium plate and screws for fixation.
A potential side effect of cervical fusion is wearing out of other discs in the neck when a fusion is performed. By maintaining motion this problem may be less likely with an artificial disc replacement.
The field of spine surgery continues to evolve. There is a better understanding of what works and what does not today than years ago. A few areas of innovative approaches to spinal problems include:
The treatment of chronic low back pain has traditionally been with spinal fusion although outcomes continue to be variable. A new theory of back pain includes signals from nerve endings that supply the vertebral bodies surrounding the disc called the basivertebral nerve and causing “vertebrogenic “pain. A minimally invasive technique to treat this problem involves radiofrequency ablation of the nerve. Here is a video to learn more.
Spine surgeries are performed under general anesthesia mostly because of anticipated long duration of the procedure. With newer, less invasive techniques and shorter time in the prone position, in some cases we are able to avoid the side effects of general anesthesia (nausea, vomiting, constipation) by offering spinal anesthesia. In combination with other pain management techniques including local anesthesia and sedation, patients are able to recover faster. Ask your surgeon if you may be a candidate for this approach.
Sciatica down the leg or what we refer to as radiculopathy is often treated with rest, anti-inflammatories, exercise and physical therapy and sometimes injections of steroids into the spinal canal. The leg pain can be excruciating and may have numerous causes but most commonly is due to a herniated disc compressing the nerve root.
Patients who have difficulty standing or walking due combinations of leg pain, numbness and /or weakness may have a degenerative condition called spinal stenosis or narrowing of the spinal canal with compression of the nerves. The exit zone of the spinal canal is called the foramen and when narrowed may also cause nerve root pressure and pain down the leg.
Chronic low back pain has several causes related to degeneration of the lumbar spine and is often referred to as spondylosis. The common structures where degeneration occurs and can lead to symptoms include the intervertebral disc and facet joints.
Neck pain can develop over time and present along the neck, shoulders, base of the skull, and between the shoulder blades.
Pain, numbness or tingling sensations down the arm is referred to as cervical radiculopathy. The symptoms are often positional meaning that that may be worsened or relieved by flexing or extending the neck or placing the arm overhead or at the side. Radiculopathy is often treated with rest, anti-inflammatories, exercise and physical therapy and sometimes injections of steroids into the spinal canal.
Spinal canal narrowing of the cervical spine may lead to compression of the spinal cord with symptoms referred to as myelopathy. This is often a slow onset and manifests as sometimes pain in the arms, numbness or tingling sensations, or simply clumsiness of the hands and loss of dexterity. Another not uncommon patient description of myelopathy is weakness of the legs or feelings of loss of balance.
Slippage of the vertebral bodies in the lumbar or cervical is referred to as spondylolisthesis. There are many causes of spondylolisthesis but the most common is due to degeneration of the disc and often leads to symptoms of spinal stenosis.
When a spinal fusion is performed its main task is to stop movement between the stabilized segments. While stopping abnormal movement between degenerated segments relieves pain symptoms, in theory, this may lead to increased stress and movement at adjacent segments. This is referred to as adjacent segment degeneration and may lead to a recurrence of pain months or years after a spinal fusion is performed.
How to prepare for surgery? You have made the decision to proceed with a surgical procedure. This informational booklet was made to support you, your family members and other caregivers to promote additional education, safety and enhance the best possible outcome with surgery. There are many types of surgeries for numerous spinal conditions, but some basics are presented here which should be helpful. Your surgical team will provide additional detail along your journey.