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If nonsurgical treatment options have failed, or if there are emergency symptoms, spine surgery may be necessary.The spine surgeons at Spine Colorado each perform a high volume of spine surgery each year—typically well over 200 cases annually. They are also fellowship-trained (the highest level of training possible) and board-certified. They concentrate their practice exclusively on spine surgery. Their expertise includes minimally invasive spine surgery, all common surgical problems in the neck and low back, scoliosis surgery, as well as new innovations including total disc replacement. In addition, the surgeons at Spine Colorado are already referred some of the most complex spine cases across the region and have extensive experience with cervical myelopathy, scoliosis and deformity surgery as well as revision surgery. This experience translates into improved patient care of all spinal problems.
Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary to myths, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae. An injury, damage from a lifting incident or a twist may cause the jelly center to break through the wall of the disc. When a disc herniates, the jelly center can press on nearby nerves. In the neck, this causes arm, shoulder, scapula and, in extreme cases, spinal cord compression.
Posterior Cervical Foraminotomy / Discectomy
For some herniated discs or bone spurs in the neck affecting only the nerve roots, a posterior discectomy and foraminotomy can be performed. This avoids spinal fusion, and with a microscope or a minimally invasive technique, can minimize recovery time and speed a patient back to work or activities.
Anterior Cervical Discectomy
Cervical is the medical term for "neck." Just as in a lumbar discectomy, the surgeon will remove a piece of damaged disc tissue in the neck area to relieve pressure on the spinal cord or nerve roots. In some cases, by removing a piece of the shock-absorbing disc that separates the two vertebrae, the structures may become less stable. Consequently, when the disc is removed, a surgeon may recommend "fusing" the vertebrae to prevent instability. A cervical discectomy is best left to surgeons who specialize in spine.
A corpectomy is often performed for patients suffering from multiple levels of cervical stenosis with cord compression. The goal of a corpectomy is complete decompression of the spinal canal when stenosis encompasses more than just disc space and has moved into vertebral bodies.
Bone spurs forming toward the back of a vertebral body or the ligament behind vertebral bodies can cause the cervical spinal canal to narrow. Therefore, it may be necessary to remove one or more degenerating vertebrae and the discs above and below in order to decompress the spinal cord and nerve roots.
A corpectomy involves a vertical incision in the neck. The middle portion of the vertebra and its adjacent discs are removed to achieve decompression of the cervical spinal cord and nerve roots. A fusion accompanies a corpectomy surgery, using bone harvested from the patient's hip or from a bone bank. This bone graft is used to reconstruct the spine and provide stability.
Anterior Cervical Fusion
A fusion accompanies a anterior cervical discectomy or corpectomy. During fusion surgery, a disc Is removed, and the surgeon inserts a small wedge of bone between two vertebrae to restore disc space. Over time, the two vertebrae "fuse" together into a single solid structure. While this procedure limits movement and flexibility, it also helps relieve neck pain.
Bone graft for the purpose of spinal fusion may be harvested from the patient's hip (autograft bone), from a cadaver bone (allograft bone), or from synthetic bone graft substitutes, which are currently being developed more extensively. Your surgeon will help you decide what is best for you.
A laminoplasty, similar to a laminectomy, is often performed on patients
suffering from spinal stenosis in the neck (narrowing of the cervical
spinal canal). It is also referred to as an "open-door laminoplasty." A
laminoplasty creates more space for the spinal cord and roots. The
actual procedure involves cutting a “hinge” into one
side of the lamina and swinging it open like a door. It relieves
pressure on the spinal cord by increasing the diameter of the spinal
canal and room for the spinal cord. The surgery approach is through
the back of the neck. This procedure creates excellent spinal canal
decompression without the instability that may be created by multiple
level cervical laminectomies.
Unusual movement at a vertebral segment will probably result in pain, especially if the person already has or displays symptoms of degenerative disc disease, fractures, scoliosis or a weak spine. This movement may require a discectomy, and subsequently, a lumbar interbody fusion. Anterior and posterior fusion techniques can be performed in the neck and the low back.
Not all patients who have spinal problems need spine surgery. They can be managed with microscopic decompression or minimally invasive techniques. Spinal fusion is reserved for patients who have spinal instability, spinal deformity or painful degenerative pain. Obviously, this is only after a patient has failed all conservative measures.
In fusion surgery, the goal is to cause bone graft to
grow between two vertebrae and stop the motion at a particular segment
by adding bone graft to it. This results in one long bone rather than
two separate vertebrae. Anterior and posterior lumbar fusions may be
done separately or can be used together for the most severe problems
of the cervical (neck), thoracic (chest level) and lumbar spine (low
back). Your spinal surgeon will help you decide which technique is
right for you.
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