Cervical Discectomy and Fusion
What is a Cervical Discectomy and Fusion?
A cervical discectomy and fusion is a surgical procedure performed on the cervical (neck) region of the spine to help relieve pressure on nerves, and perhaps even the spinal cord itself. Over time, wear and tear, arthritis or an injury can damage the structures of the cervical spine resulting in pressure and irritation to nerves and nerve roots. This pressure can cause severe pain, discomfort, and numbness not only to the neck, but down the arms as well. During the operation, a small incision is made, usually in the front of the neck, and the surgeon removes the bony material or disc that is causing the problem. In most cases, the surgeon then fuses or joins together the affected vertebrae using bone graft or bone graft and a metal plate
Who is a Candidate for Cervical Discectomy and Fusion?
Frequent pain and/or numbness in the neck or down the arms will usually result in a visit to the doctor. A diseased or damaged disc in the neck is a common cause of this pain or numbness, and can happen for a number of reasons. Over time, a disc can wear and “flat-ten,” resulting in the vertebrae above and below the flattened disc to slide back and forth, or even touch. This can pinch or irritate the nerves causing pain and numbness. Another cause may be a sudden injury, resulting in a bulging out or herniating disc, causing pressure on the nerves and nerve roots. Bony growths (spurs) can also form, and further narrow the pathways through which the nerves must travel.
What is Disc Replacement?
Disc replacement is the surgical procedure in which a worn or damaged intervertebral disc is replaced by an artificial disc designed to allow continued motion of that part of the spine. The artificial disc is made of two metal components, with or without a plastic spacer in between. The metal plates are attached to the vertebrae that sit above and below the damaged disc. Your spine surgeon, often in conjunction with a vascular surgeon, performs the surgery through an incision made into your abdomen. Lumbar disc replacement is an operation which may be effective in relieving lower back pain due to a worn or damaged intervertebral disc.
Who is a Candidate for Disc Replacement?
You may be a candidate for disc replacement if your discomfort is primarily due to back pain which has not been alleviated by more conservative treatment measures, and if you do not have spinal instability or nerve compression. If there is evidence of nerve compression, disc replacement surgery along may not be an effective surgical procedure for you. Disc replacement surgery is designed to replace the damaged disc while preserving the natural movement of the spine (unlike lumbar fusion in which the natural movement of the vertebrae is eliminated). The bone quality must be good with minimal effects of osteoporosis; therefore candidates for disc replacement are generally younger than 65 years old. Not every condition involving painful damaged discs can be treated with disc replacement. Your spine surgeon will carefully evaluate your condition and discuss any options with you
What is a Kyphoplasty?
Kyphoplasty is a minimally invasive surgical procedure for people suffering with compression fractures of the spine. The procedure involves the insertion of a balloon into the collapsed vertebra followed by injection of a special material. The material hardens and stabilizes the vertebra, preventing further movement, and may reduce the pain caused by bone rubbing against bone. Patients can resume their activities almost immediately. Previously, the only treatment available to most people with this problem was weeks of bed rest and pain medications.
Why would someone need a Kyphoplasty?
As mentioned, the most common reason for kyphoplasty is to stabilize a compression fracture of one or more vertebrae. Compression fractures can occur from an accident or trauma, but the underlying cause is likely to be osteoporosis. The National Osteoporosis Foundation estimates that ten million Americans have osteoporosis, and the disease causes 700,000 vertebral fractures annually. The majority of these fractures occur in women. Younger people can also suffer these fractures as the result of weakened bones from the long-term use of steroids use to treat diseases such as asthma, lupus, and rheumatoid arthritis. Sometimes the bone becomes so weak and brittle that a fracture may occur by simply coughing or rolling out of bed. Regardless of the cause, a compression fracture of the spine may result in greatly limited activity, severe pain, and a tremendous reduction in the quality of life.
What is Lumbar Fusion?
The lumbar area of the spine is better known as the lower back. A lumbar fusion is an operation to stabilize the lower back by creating bony bridges between at least two vertebrae and eliminating motion between them. It can be done by fusing the vertebral bodies in front (anterior) or by fusing the facet joints and lamina in the back (posterior). Bone or bone substitutes can be placed on and between the lamina and the facet joints. Metal screws and rods or plates may be attached to the bones to secure the fixation while the bony bridge heals.
During the operation, a four to five inch incision is made in your lower back and the muscles supporting the spine are divided. A small window is made in the sheet of bone (lamina) covering the spinal cord. Next, the surgeon removes any ruptured disc material or bone spurs that are pinching the nerves or spinal cord. The site is then prepared for fusion by obtaining bone graft and/or bone substitute and laying it on the bone. Metal screws and rods or plates may be attached to the bones to secure fixation while the bone heals.
The operation typically takes two to three hours; however it may be longer, depending on the complexity of the problem and the number of vertebrae needing to be fused.
Who is a Candidate for Lumbar Fusion?
Lumbar Fusion may be recommended to treat a number of spine problems. However, the majority of people with these conditions will be successfully treated with conservative measures- that is, without surgery. Only after conservative measures have failed to relieve symptoms will surgery be considered. Problems that may be treated with lumbar fusion include:
Sciatica – Sciatica is one of the most common reasons for lumbar fusion. It is the irritation of a spinal nerve or nerves, usually by a herniated or bulging disc.
Spondylolisthesis – This term describes a particular type of abnormal movement of the vertebrae. With spondylolisthesis, one vertebra has slipped forward over another. If the vertebra continues to slip back and forth, the spinal nerves may be affected, causing leg pain, numbness, tingling and/or weakness.
Degenerative Disc Disease – Age and wear and tear can cause the discs that act as cushions between each vertebrae to shrink, allowing abnormal movement. This abnormal movement can again result in an unstable area in the spine, and compress the nerves, causing leg pain and numbness.
Arthritis – Arthritis of the spine can lead to spinal stenosis, a narrowing of the spinal canal caused by bony spurs forming on the vertebrae, narrowing the openings through which the nerves and nerve roots must travel. This narrowing can cause pressure on the nerves, resulting in pain, numbness, tingling or weakness down the legs.
What is a Lumbar Laminectomy?
The lumbar area of the spine is better known as the lower back. The lamina is a part of each vertebra. A lumbar laminectomy is the surgical removal of the lamina or part of the lamina on one or more of the vertebrae in the lower back. This is usually done to relieve pressure on nerves that may become inflamed from pressure caused by a narrowed spinal canal, bone spurs, or a herniated disc. Once the lamina is removed, the surgeon can then access the spinal canal and remove the source of irritation or pressure.
Who is a Candidate for a Lumbar Laminectomy?
Those who suffer from frequent lower back pain and perhaps leg pain and numbness may have a condition known as spinal stenosis. Spinal stenosis describes the narrowing of the spinal canal in the area where the nerves and nerve roots exit the spinal column. This narrowing can occur as a result of arthritis in the spine, by calcium deposits, or by simply the wear and tear that occurs from repetitive stress on the lower spine. In addition, some people are born with a narrow spinal canal that becomes symptomatic as they age.
The narrowing of the spinal canal may eventually cause pressure on the nerves and nerve roots that emerge from the spinal column. This irritation can result in pain and numbness, particularly after sitting or standing for extended lengths of time. Lumbar laminectomy may be recommended in order to make more room for the nerves or nerve roots.
Another condition that is often treated with a lumbar laminectomy is a herniated disc. The discs act as cushions or “shock absorbers” between the vertebrae. Part of the disc may herniate or bulge into the canal, again putting pressure on the nerves. Once the laminectomy is performed, the surgeon may trim or remove whatever material is causing the irritation.
What is a Lumbar Microdiscectomy?
The low back area is also called the lumbar spine. The discs are the shock absorbing cushions in between each of lumbar vertebrae. The disc can become injured or worn resulting in a herniation. Sometimes people refer to this as a slipped or ruptured disc. When this happens, it can become a cause of back and/or leg pain.
During a lumbar microdiscectomy the surgeon makes a 1-2 inch incision and uses a microscope or loupes along with micro-surgical techniques to remove the part of the disc that is putting pressure on the spinal nerve. This minimally invasive technique spares the bones, muscles, ligaments and surrounding soft tissue from trauma making recovery easier and faster.
Who is a Candidate for Microdiscectomy?
Less than 10% of patients with disc herniations require surgery. Most of these conditions will resolve with basic care measures. However, in some cases, the back and leg symptoms become unmanageable. This occurs when the damaged disc puts pressure on the spinal nerve producing pain that goes to your leg. Pressure on the nerve may cause pain, numbness and/or weakness in the leg. This is sometimes called “sciatica.” Sciatica is usually felt as a sharp, shooting pain through the buttock, down the back of the leg and may go into the foot. When leg pain does not resolve with basic care measures, and the ability to perform daily activities is severely restricted, the patient may be a good candidate for a microdiscectomy.