One Mercado Street, Suite 200 Durango, CO 81301
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.
Microdiscectomy / Minimally invasive discectomy
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. This causes back or leg pain when the hernation is in the low back, and arm pain if the disc is in the neck area (see "cervical spine/neck").
In a lumbar discectomy, the surgeon typically only removes the portion of the disc that is causing a problem, not the entire disc. If you have a herniated disc, keep in mind that a disc has a purpose. When you remove a disc, it may cause instability in the joint, and a surgeon may recommend a fusion to re-stabilize the area.
The surgeon can remove the damaged piece of disc through a traditional incision in the back. However, at Spine Colorado, the surgeons typically use a microscope to minimize incision size, tissue trauma and recovery time. In addition, in some cases, minimally invasive discectomy can provide an even less invasive approach.
Depending on the nature of your disc problem, your surgeon will recommend the most appropriate type of surgery for you.
Anterior lumbar interbody fusion (ALIF)
In this type of spinal fusion surgery, back muscles and nerves remain undisturbed. The space between discs is fused by approaching the spine through the abdomen. This procedure is used when the spine is relatively stable, when there's a significant amount of disc space collapse, and in cases of one or two level degenerative disc disease. The surgeon will approach the abdomen through an incision (minilaparotomy) or by using an endoscope.
Posterior lumbar interbody fusion (PLIF)
This spinal fusion surgery is very similar to the anterior lumbar interbody fusion, except that the surgeon approaches the spine through the low back. This method is used when there is a greater amount of instability in the patient's spine. An advantage to this surgery is that it can also provide anterior fusion of the disc space without having a second incision.
A laminectomy involves the removal of part or all of the bone covering the spinal canal. The purpose of this procedure can be to free nerve roots, remove a tumor, bone spur or to perform certain types of fusion procedures. Removing the lamina (laminectomy) is much like removing the cover on a fuse box to access the wiring. By removing the lamina, the surgeon gains access to the disc area and frees more space for the nerves inside.
A laminectomy in the lumbar spine is often used to treat
recurrent disc herniations or where scar tissue is involved. Laminectomy
may also be used in cases of spinal stenosis in which the entire canal
is narrowed like a ring on a swollen finger, squeezing all of the nerve
roots at that level of the spinal canal.
Through the placement of hooks, rods and screws, a spinal curve can be corrected and stabilized. A fusion often follows scoliosis surgery, in order to maintain the correction permanently.
Scoliosis is not the result of an injury and usually appears without cause. It can be inherited, and it usually affects more women than men. In the case of most spinal curves, the spine is not only bent but also twisted like a bent corkscrew. Some cases of scoliosis are not serious. Over time, if a curve worsens, surgery may be required to correct the curve and prevent pain and worsening deformity. In extreme cases, if the curve is not corrected, the spinal deformity can place pressure on internal organs, which can shorten a person's life expectancy.
During scoliosis surgery, the surgeon may use special
instruments that attach onto various vertebra segments. These surgical
rods are the adjusted to "de-rotate" the twisted and bent
corkscrew spine. Decades ago, Harrington Rods (the “first-generation” of
instrumentation) were used to surgically straighten the spine. However,
this technique did not untwist or correct the spine. Today, there are “fourth-generation” techniques
to improve corrections, minimize levels fused and minimize the need
for post-operative bracing.
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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