Cervical & Lumbar Artificial Disc Replacement (ADR)
Disc replacement involves taking out a damaged or herniated intervertebral disc and substituting an artificial one.
Artificial disc replacement is an option for symptomatic disc problems that are unrelieved by conservative management (medications, therapy, activity modifications, and injections). Conditions like degenerative disc disease, herniated discs, and spinal stenosis can all cause pinched nerves that lead to disabling pain, paresthesias, and/or weakness.
Patients may have troublesome symptoms like weakness and numbness, or even loss of function. This affects the arms if one has cervical disc disease and the legs if one has lumbar disc disease. Artificial disc replacement can resolve these symptoms and relieve pain, allowing the patient to have an improved quality of life.
This procedure involves a incision on the front/anterior part of the neck for the cervical spine or on the front/anterior part of the abdomen for the lumbar spine. Using imaging guidance, the disc that needs to be removed is localized and extracted (complete discectomy). The artificial disc fits into the gap between the vertebrae. Artificial discs are becoming increasingly sophisticated and closely mimic the function of natural discs. This motion preservation solution (non-fusion) is a key advantage of having artificial disc replacement as opposed to fusion surgery.
Anterior Lumbar Interbody Fusion (ALIF)
ALIF stands for Anterior Lumbar Interbody Fusion. This procedure is done from the front (anterior) of the lower abdomen below the umbilicus (belly button).
At our practice, a mini-open ALIF approach is available that preserves the muscles and allows access to the front of the spine through a small incision. This technique is a muscle splitting (as opposed to a muscle cutting) approach and is frequently used to fuse the L5-S1 disc space. This approach can also readily address the L3-L4 and L4-L5 levels via the same incision.
With the help of a general surgeon or vascular surgeon, the anterior lumbar spine vertebrae are accessed after making an incision and mobilizing the abdominal contents. The spine surgeon then performs the discectomy to provide room for the nerves. After adequate discectomy, the surgeon inserts an anterior interbody cage with bone graft (with or without plates/screws) to stabilize the spine and facilitate fusion.
Corpectomy
Corpectomy Fusion is a surgical procedure performed to alleviate the pain caused by damaged vertebrae or disc material that pinches and blocks the nerve roots. This procedure can be performed on either the Cervical or Lumbar Spine. Moreover, it involves the removal of diseased bone or damaged discs, followed by the fusion of affected vertebrae to restore spinal stability. The surgeon will place either a static or expandable Vertebral Body Replacement (VBR) device in place of the removed vertebrae. In addition, they may use either a plating solution to augment the VBR device.
Direct Lateral Interbody Fusion (DLIF)
Direct Lateral Interbody Fusion (DLIF), is a minimally invasive surgical procedure for treating leg or back pain caused by degenerative disc disease. Unlike traditional anterior or posterior approaches to back surgery, DLIF approaches the lumbar spine through the patient’s side, allowing the surgeon to avoid major muscles of the back.
Once the incision is made and the vertebrae are accessed using minimally invasive techniques, the disc material is removed. Following this, an interbody and lateral plate is inserted in the place of the removed disc to provide stability to the spine and facilitate fusion.
Kyphoplasty or Vertebroplasty
Vertebroplasty and kyphoplasty are procedures used to treat painful vertebral compression fractures in the spinal column, which are common results of osteoporosis. Your doctor may use imaging guidance to inject a cement mixture into the fractured bone (vertebroplasty) or to insert a balloon into the fractured bone to create a space that is subsequently filled with cement (kyphoplasty).
Cervical, Thoracic, or Lumbar Laminectomy (Decompression)
Laminectomy is surgery that creates space by removing bone (spinous process and lamina) and soft tissues (ligaments) associated with arthritis of the spine. Laminectomy enlarges the spinal canal to relieve pressure on the spinal cord and/or nerves. Laminectomy is often done as part of decompression surgery.
Cervical Laminoplasty
Laminoplasty is a surgical procedure in which the lamina is repositioned to relieve the symptoms caused by spinal cord compression. The lamina is a bony structure the represents the posterior or backside of the vertebrae. Each vertebra includes two laminae (left and right side) that form the roof over the spinal canal to protect the back of the spinal cord.
Decompression is achieved by opening and elevating the lamina to alleviate pressure on the spinal cord. The surgeon lifts one side of the lamina to widen the spinal canal and relieve pressure. To hold the lamina open, the surgeon may insert an implant, such as a laminoplasty plate.
Microdiscectomy (Lumbar Decompression)
Microdiscectomy is a surgical procedure to relieve pain and other symptoms that occur when a herniated disc in the spine presses on an adjacent nerve root. During the operation, the surgeon frees the nerve by removing small fragments of disc, bone, and ligament.
Posterior Cervical Decompression & Fusion (PCDF)
The primary goal of a posterior cervical procedure is to relieve pressure on the nerve roots or spinal cord in the cervical spine using a surgical approach through the back of the neck.
Screws or hooks and rods may be used to hold the spinal column in place while fusion occurs or to provide stability. The screws are inserted into the left and right sides of the vertebrae to be fused. A rod connects the screws to stabilize the spine on each side. Each screw is secured to the rod by a cap.
Transforaminal Interbody Lumbar Fusion (TLIF)
TLIF stands for Transforaminal Lumbar Interbody Fusion. The TLIF technique involves approaching the spine from a posterior approach but more from the side of the spinal canal through a midline incision in the patient’s back. This approach greatly reduces the amount of surgical muscle dissection and minimizes the nerve manipulation required to access the vertebrae, discs, and nerves. Our practice prefers the TLIF approach for interbody fusion because it is typically less traumatic to the spine, safer for the nerves, and allows minimal access and endoscopic techniques for spinal fusion.
As with DLIF and ALIF, the disc material is removed from the spine and replaced with a bone graft (along with cages, screws, or rods if necessary) inserted into the disc space. The instrumentation facilitates fusion while enhancing the spine’s strength and stability. We currently use many state-of-the-art cage technologies, including those made of bone, titanium, polymer, and even bioresorbable materials.
Spinal Cord Stimulation (SCS)
Spinal Cord Stimulation (SCS) alters the experience of pain by sending impulses to the spinal cord that compete with pain signals. As a result, the pain messages that your body sends to the brain are blocked or modified.
Spinal cord stimulation is most commonly used for leg, back and arm pain that has not responded to spinal surgery. It can also be used to treat back pain that is not suitable for spinal surgery. Other conditions that may also respond to SCS include complex regional pain syndrome (CRPS), pain following nerve injury, refractory gain, post-herpetic neuralgia, peripheral vascular disease, and diabetes.
If your spine specialist decides that this treatment is suitable for your condition, a comprehensive trial is undertaken to determine if SCS will be helpful to you. There are many different spinal cord stimulator devices available for the management of chronic pain. Your spine specialist will determine the appropriate spinal cord stimulator for you, by assessing you independently and using up-to-date clinical research and current best practice.
A spinal cord stimulator system is made of four parts:
Impulse Generator (IPG): this is a computer that is roughly the size of a matchbox that controls the impulses delivered to the spinal cord. It is implanted under the skin and has an inbuilt battery.
An electrode: this sits in the epidural space and delivers very small and precise currents to the spinal cord.
A hand-held controller: this is used to turn the system on and off, adjust the type of stimulation, location of stimulation and level of stimulation.
A hand-held charger: some IPGs are rechargeable and require regular charging to maintain stimulation.