Procedures

NON-OPERATIVE SPINE PROCEDURES

The covering over the nerve roots in the spine is called the dura. The sleeve-like space surrounding the dura is called the epidural space. Nerves travel through the epidural space before they travel into your legs. The nerves leave the spine from small nerve holes. These nerves may become inflamed due to irritation from a damaged disc or from contact with a bone spur. Inflammation of these nerves may cause pain in your low back, hip, buttock and legs.

An epidural injection places anti-inflammatory medicine (cortisone) into the epidural space to reduce nerve inflammation, and hopefully reduce your symptoms. By stopping or limiting nerve inflammation we may promote healing, and speed up “mother nature”, thereby reducing your pain. Although not always helpful, epidural injections reduce pain and improve symptoms in most people within 3-7 days. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.

Your doctor may order up to three epidural injections spaced approximately 2-4 weeks apart. Performing a repeat injection depends on your response to the prior injection. If you obtain excellent relief from an epidural, you do not need to have it repeated. If you have partial sustained benefit (>35% relief) the epidural can be repeated for possible additive benefit. If an epidural injection provides minimal benefit (<35 % relief), the physician may choose another injection be performed with a change in technique and/or cortisone used.


A celiac plexus block is used for pain control. This procedure blocks the nerves which come from the pancreas, liver, gall bladder, stomach and intestine. A celiac plexus block consists of injections of a local anesthetic, steroid or ethy-alcohol (phenol). The use of alcohol, called a neurolytic block, destroys the nerves. A trial block is done, using a local anesthetic, before a neurolytic block is performed. If you get short term pain relief from the local anesthetic then a neurolytic block is done.


The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract with the bony structure of the spine in some way.

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the neck, shoulders and arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

The discs are soft, cushion-like pads, which separate the hard vertebral bones of your spine. A disc may be painful when it bulges, herniates, tears or degenerates and may cause pain in your neck, mid-back, low back and/or arms, chest wall, abdomen and legs. Other structures in your spine may also cause similar pain such as the muscles, joints and nerves. Often, we will have first determined that these other structures are not your sole pain source (through history and physical examination, review of x-rays, CT/MRI, and/or other diagnostic injection procedures such as facet, sacroiliac joint injections, and nerve root blocks) before performing discography.

Discography confirms or denies the disc(s) as a source of your pain. It is a relatively simple procedure that uses a small needle to inject contrast dye into your disc. MRI and CT scans only demonstrate anatomy and cannot absolutely prove your pain source. In many instances, discs are abnormal on MRI or CT scans but are not a source of pain. Only discography, which is a functional test, can tell if the disc itself is a source of your pain. Discography is usually done only if you think your pain is significant enough for you to consider more advanced treatment options, directed at the disc itself, such as surgery.

Lumbar facet joints are small joints located in pairs in your lower back. These joints provide stability and guide motion in your spine.

If the joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The lumbar facet joints can cause pain in your lower back, hip, buttock, or leg.

A facet joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the facet joints are numb, then these joints are likely your pain source. Furthermore, time-release cortisone will be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.

The Fascia Iliaca Compartment Block (FICB) is a simple block for post-operative pain relief for procedures and injuries involving the hip, anterior thigh, and knee.  This block is useful, pre and post-operatively, for fractures of the hip and proximal femur, as well as total hip arthroplasties.

The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.

An IV is started so that relaxation medication can be given. The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance. The skin on the back is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.


A lumbar sympathetic block typically involves a series of injections to relieve leg pain (sciatica) caused by complex regional pain syndromes, usually after injury to a joint or limb.

Using live x-ray (fluoroscopy) a needle will be guided into the opening where the nerve root is being compressed. A dye solution that can be seen on our x-ray monitor is injected so that we can determine the extent to which the nerve is being compressed. Local anesthetic is then injected around the nerve root to relieve your pain. A steroid medication is also injected around the nerve root which acts as an anti-inflammatory medication to decrease the inflammation and swelling of the nerve root.

Medial branch nerves are small nerves that feed out from the facet joints in the spine, and therefore carry pain signals from those joints. A medial branch nerve block temporarily interrupts the pain signal being carried from a specific facet joint.

RACZ Caudal Neurolysis is a non-surgical injection treatment for managing low back and leg pain oftentimes caused by scarring from a previous back surgery.

Pulsed Radiofrequency Neurotomy (PRFN) is a minimally invasive procedure that disables and prevents a specific spinal nerve from transmitting pain signals. PRFN is a modified version of a procedure termed Radiofrequency Therapy (RT), a procedure developed more than 30 years ago. PRFN is still fairly new, but more and more pain management specialists are performing this procedure to treat painful facet joints.

Like its predecessor, PRFN applies a precisely targeted electrical field to change the function of nerves – in this case, a specific branch of a spinal nerve rendering it incapable of transmitting pain signals. However, PRFN is different. A primary difference between the original technique (RT) and PRFN is that ‘pulsed’ radiofrequency applies an electrical field to the target nerve for short intervals at a lower temperature, which does not destroy nerve tissue, but rather “stuns” the nerve.


The sacroiliac joint is a large joint in your lower back and buttocks region. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, abdomen, hip, buttock or leg. A sacroiliac joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the joint is numb it means this joint is more likely than not your pain source. Furthermore, time-release cortisone will be injected into the joint to reduce any presumed inflammation, which on many occasions can provide long-term pain relief.

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the mid back or around the rib cage. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

A selective epidural injection places anti-inflammatory medicine (cortisone) over the spinal nerve in the epidural space to reduce inflammation, and hopefully reduce your pain. By stopping or limiting nerve inflammation, the epidural injectionmay promote healing and speed up “mother nature”. Although not always helpful, epidural injections reduce pain and improve function in most people within 3-7 days. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.

A selective epidural injection also provides diagnostic information. If the nerve injected becomes numb after the procedure, and that nerve is the reason for your pain, you will feel immediately better. This helps to prove that the nerve we injected is the source of your pain. This helps in guiding future treatment options including any future surgical interventions


Myofascial trigger points are felt to be hyperirritable foci in muscles and fascia associated with taut muscle bands. Trigger points are diagnosed by palpation and produce a local twitch response and a referred pain pattern distal to the site of muscle irritability. Trigger points cannot be properly diagnosed in the acute stages of low back pain when muscle spasm and inflammation are present. Initially, trigger points generally respond to a program of stretching and correction of poor postural mechanics with or without other modalities, such as superficial heat or cold. Trigger point injections should be reserved for patients who have not responded in the first four to six weeks to a properly directed program and appropriate pharmacologic intervention.

The trigger point injection should be carried out under antiseptic technique informing the patient of potential adverse effects. There is little evidence to support any beneficial effect of adding corticosteroid to the injection. In fact, a saline injection can as effective as a local anesthetic. However, for patient comfort and to assist in deciding upon therapeutic efficacy, injecting a local anesthetic such as lidocaine and/or mepivacaine is acceptable.

Injection of multiple trigger points should be avoided. Some trigger points may require more than one injection, but generally more than three injection of the same trigger point is not indicated. Repeated trigger point injections may cause local muscle damage and scarring, which may potentially lead to a poor functional outcome. They should not be performed in isolation, but rather, in conjunction with a directed exercise program. Proper follow-up after injections is necessary in order to assess the patient’s response to the injection and to progress the rehabilitation program.

OPERATIVE SPINE PROCEDURES


This procedure is used to implant antibiotic-impregnated beads of calcium sulfate or calcium phosphate into infected bone. The beads deliver medication directly to the source of the infection. This is important, because infected bone often has a poor blood supply, and oral antibiotics may not be able to reach the infection through the bloodstream.


Spinal fusion for the management of lumbar degenerative disc disease has been available for several decades. The results of this procedure remain under constant scrutiny and progressive development. Anterior lumbar fusion was initially introduced in the early 1920s. Fibula and iliac struts, femoral rings and dowel, as well as synthetic metallic devices have been applied as fixation implements to aid in lumbar interbody fusion. Approaches to the spine have experienced similar evolutionary changes. Prior to the 1950s most anterior lumbar approaches were extensive transperitoneal exposures (i.e. through the membrane lining the walls of the abdominal and pelvic cavities). In 1957, Southwick and Robinson introduced the retroperitoneal approach (i.e., behind the peritoneum). Transperitoneal exposures (i.e., through the peritoneum) require incision of both the anterior and posterior peritoneum. In contrast, retroperitoneal expoures maintain the integrity of the peritoneum and approach the spinal column laterally behind the bowel and peritoneal contents. This has the advantage of less post-operative bowel problems.

Additional changes in technique have seen the advent of minimally invasive approaches, including endoscopic and laparoscopic methods. Minimally invasive approaches are generally directed at one or two-level disease processes. Anterior lumbar interbody fusion (ALIF) may be useful in the treatment of unyielding low-back pain. The cause of this pain is often difficult to diagnose. Broad categories of pathology that may be associated with persistent low-back pain include degenerative disc disease, spondylolysis, spondylolisthesis or iatrogenic segmental instability.


ALIF is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material.

ALIF is generally used to treat back or leg pain caused by degenerative disc disease. The surgeon will stabilize the spine by fusing vertebrae together with bone graft material.

When the cervical disease encompasses more than just the disc space, the spine surgeon may recommend removal of the vertebral body as well as the disc spaces at either end, to completely decompress the cervical canal. This procedure, a cervical corpectomy, is often done for multi-level cervical stenosis with spinal cord compression caused by bone spur (osteophytes)growth.

Anterior cervical discectomy and fusion (ACDF) with anterior plate fixation is an established surgical treatment for patients with cervical disc disease.Pain in the neck and extremities, among other symptoms, may occur when an intervertebral disc herniates – when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft, jelly-like center) squeezes out and places pressure on neural structures, such as nerve roots or the spinal cord. Bony outgrowths, called bone spurs or osteophytes, which form when the joints of the spine calcify, may also cause these symptoms.

Anterior cervical discectomy with fusion is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs – a condition referred to as nerve root compression.


Laminaplasty is a procedure intended to relieve pressure on the spinal cord while maintaining the stabilizing effects of the posterior elements of the vertebrae. The laminaplasty procedure involves “hinging” one side of the posterior elements of the spine and cutting the other side to form a “door”. The door is then opened and held in place with wedges. By relieving pressure on the spinal cord it is the goal of laminaplasty to stop the progression of damage to the spinal cord and allow for as much recovery of function as possible.

A posterior cervical foraminotomy is a minimally-invasive procedure designed to enlarge to space through which the nerve root exits from the spinal cord (the so-called neural foramen) and at the same time try to remove any piece of disk which is pushing on the nerve. Interestingly, sometimes the foraminotomy alone can alleviate symptoms without a diskectomy being needed. The whole disk is not removed, just the fragment pressing the nerve root. A fusion is not performed and most patients typically do not require a neck collar after the surgery.

This minimally-invasive procedure, performed through a rube called a cannula, is designed to relieve the pain caused by herniated disc tissue pressing against nerve roots in the spine. The surgery is performed under general anesthesia, and the patient is allowed to leave the hospital the same day.

This technique is used during complex surgical procedures, especially those that involve manipulation of the spinal cord. IOM allows a neurotechnologist to monitor the health of the nervous system in real time during surgery. This greatly reduces the risk of surgery-related nerve damage.

This minimally-invasive procedure treats spine fractures caused by osteoporosis. It is designed to provide rapid back pain relief and help straighten the spine.

Lumbar laminectomy is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions.Stenosis occurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs or osteophytes form.Spondylolisthesis (the slipping of one vertebra onto another) also can lead to compression.

The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.


This procedure removes a section of bone from the rear of one or more vertebrae to relieve the painful and disabling pressure of stenosis. The spine is then stabilized with rods and screws.

A lumbar corpectomy is performed to relive pain caused when diseased or damaged bone blocks and pinches the spinal cord. It can also be performed to correct spinal deformities.

Lumbar microsurgery is a way of doing low-back surgery through a small incision. There are two types of lumbar microsurgery. Microdecompression is removal of bone from the spine. Microdiskectomy is removal of disk. This removal takes pressure off nerves and reduces symptoms.

Since pedicle screws traverse all three columns of the vertebrae, they can rigidly stabilize both the ventral and dorsal aspects of the spine. The pedicle also represents the strongest point of attachment of the spine and thus significant forces can be applied to the spine without failure of the bone-metal junction. The rigidity of pedicle fixation allows for the incorporation of fewer normal motion segments in order to achieve stabilization of an abnormal level.

A lumbar micro endoscopic discectomy is a minimally invasive procedure performed through a tubular device and designed to relieve pain caused by herniated discs pressing on nerve roots.

Microendoscopic discectomy has been hailed as one of the newest and best methods for disc removal as minimally invasive techniques have gained popularity across surgical specialties.

This surgery removes bone and/or portions of a herniated or diseased disc to relieve neck and radiating arm pain caused by parts of the disc pressing on nerve roots.

This surgery removes bone and/or portions of a herniated or diseased disc to relieve neck and radiating arm pain caused by parts of the disc pressing on nerve roots.

Percutaneous procedures are minimally invasive and offer decreased morbidity, require no bone graft and promise shorter recuperation time. Candidates for a percutaneous procedure must complain of symptoms related to contained herniated disc or focal protrusion. It does not substitute conventional open procedures required for extruded discs.

This minimally-invasive procedure uses a small needle and advanced laser technology to reduce a herniated disc, quickly relieving pain in most patients. The procedure may be performed on an outpatient basis using a gentle, relaxing medicine and local anesthetic.

Selective Endoscopic Discectomy™ (SED™) is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain.

Spinal cord stimulation (also called neurostimulation) uses electrical impulses to relieve chronic pain of the back and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. Neurostimulation candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

When conservative efforts fail, spinal surgery is sometimes necessary. Stem cells are being investigated in many different forms for application in spinal surgery and orthopaedic surgery amongst many other possible applications. Traditionally, obtaining stem cells for spinal fusions required the harvesting of bone from the pelvis to place over the spine to improve the likelihood of a successful fusion. Recently, researchers and surgeons have sought other means of obtaining a successful fusion without the need to obtain this pelvic bone and the donor site morbidity associated with its harvest (pain, additional surgical time, increased risk of infection, delayed recovery etc). The success of a fusion is dependent on many factors, one of which is the environment created to encourage bony union. Without the proper matrix of cells, obtaining a fusion is exceedingly difficult. Osteoprogenitor cells (cells which help make new bone) are responsible for ensuring bone formation and subsequent fusion at the site of bone graft deposition.

Techniques to enhance the appropriate types of cells deposited to the bone graft site are showing extreme promise in obtaining a successful union of the bone. Stem cells can be obtained by aspirating them from the bone marrow of the pelvis with a large needle without a surgical incision instead of removing them along with a substantial amount of the bone from the pelvis. These cells are then concentrated in a centrifuge and injected over the bone graft site to enhance the cellular matrix’s ability to consolidate, or heal, the bone together. Other techniques to obtain pluripotent stem cells (cells that can differentiate into many types of tissue depending on the surrounding environment-including bone) can be harvested from placental membranes and amniotic fluid known to be rich in these factors. Additionally, these tissues and cells derived from amniotic fluid have been shown to produce high-density bone (Atala et al). There are products available that have shown promise in increasing bone formation and enhancing the body’s regenerative process after surgery without having to harvest tissue or cells from the pelvis or local bone.

Currently, many centers are conducting detailed research on the potential applications of stem cells in the treatment of a multitude of disorders. There appears to be promise in using stem cells for spinal fusions, treatment of tendonitis, cartilage and meniscal tears, in pain management via stem cell spinal injections, in urology for incontinence and inflammation as well as prostate disease, and as a dermal filler and to repair collagen in plastic surgery. Mesenchymal stem cells are known to be responsible for growth and regeneration of tissue. Unfortunately, their numbers decrease dramatically with age. By harvesting them from a rich source such as the placenta and amniotic fluid after childbirth, surgeons may be able to provide patients with an improved chance of successful fusion and tissue repair after surgery. At the Orthopaedic & Spine Institute, our surgeons are versed in all forms of treatment for orthopaedic and spinal disorders. They are adept at performing techniques to enhance the possibility of successful operative and non-operative treatment alike. Using state of the art techniques and science to guide them, they can offer the most effective treatments available to their patients. By keeping current with the literature, continuing to stay abreast of the improvments in science and technology, and subsequently implementing those scientific advances, such as stem cell application, they are helping to usher in a new era of enhanced surgical outcomes.

Damos la bienvenida a pacientes de hablar español. Muchos miembros de nuestro personal son bilingües. Por favor no vacile en solicitar la ayuda bilingüe cuando usted telefonea a nuestra oficina.


The following opinion has been written to help explain to our patients the science or lack of science behind the use of amniotic multipotential stem cell products in orthopaedic practice. First, it must be recognized that, as orthopaedic surgeons, we are constantly searching for novel techniques and technologies that can help our patients improve their lives. Specifically, we are far more interested in truly regenerative healing processes that can return patients to full function than we are in just palliative or pain relieving processes that don’t really “fix” the problem. Second, stem cell therapy and the field of biologic regeneration is literally the “holy grail” of restorative surgery. For this reason,the physicians at the Orthopaedic and Spine Institute(OSI) continue to watch with great anticipation some of the recent advances in biologic regeneration.

In animals, stem cell use has been extensive with many promising technologies not yet approved for human use. These include the use of bio engineered materials that form scaffolds and are imbued with growth factors that allow both cartilage and bone to grow when injected or are surgically placed into bone and cartilage defects. Also, small molecules are being identified that specifically regulate stem cells already present in the local tissue to grow into the appropriate replacement tissues. However, the process for these therapies and substances to be approved through the FDA can be agonizingly slow. Alternatively, capturing stem cells from bone marrow aspiration is painful and highly technique dependent and frequently yields inadequate amounts of stem cell mass for appropriate tissue treatment. For these reasons, the physicians at the Orthopaedic and Spine Institute have been very interested in amniotic derived multipotential stem cells.

The advantages of amniotic derived stem cells are many. First, they are multipotential. This means that they can, depending on the location and conditions, turn into different tissues depending on where they are injected. Second, they do not require the sacrifice of human embryos for their isolation, thus avoiding the current controversies associated with the use of human embryonic stem cells. Third, they have low immunogenicity and consistent anti-inflammatory function so are not identified by the hosts immune system as foreign. Fourth, complicated and painful harvesting techniques are not required.Until non-allograft sources are able to match these advantages, the amniotic derived stem cells appear best.

Finally, although there are solid basic science articles being published every week in support of the use of stem cells, solid clinical trials in humans are lacking. This is always concerning for us as clinicians because of the possibility that we may employ an expensive therapy based on non-human trials only to find out as time goes by that our initial enthusiasm was misplaced. However, the anecdotal human evidence along with the strong animal studies leads us to believe that amniotic stem cell treatments are worth the cost and are very low risk. Please talk to one of the OSI clinicians about options regarding stem cell injections or the use of stem cells for your surgery.

Bibliography:

M. B. Goldring and S. R. Goldring. Articular cartilage and subchondral bone in thepathogenesis of osteoarthritis. Annals of the New York Academy of Sciences. Vol. 1192,April 2010, p. 230.

J. Gorman. New gel could lead to cartilage repair. Science News, Vol. 162, August 10,2002, p. 93

J. Hunter. Pharmacologic therapy for osteoarthritis—the era of disease modification.Nature Reviews Rheumatology.

K. Johnson et al. A stem cell–based approach to cartilage repair. Science.

S. KIM, S. K. SOHN, K. Y. LEE, M. J. LEE, M. S. ROH and C. H. KIM. Use of HumanAmniotic Membrane Wrap in Reducing Perineural Adhesions in a Rabbit Model of UlnarNerve Neurorrhaphy.The Journal of Hand Surgery (European Volume, 2010) 35E: 3:214–219.

Ayaka Toda, Motonori Okabe, Toshiko Yoshida and Toshio Nikaido. Potential of AmnioticMembrane/Amnion-Derived Cells for Regeneration of Various Tissues.Department ofRegenerative Medicine, University of Toyama Graduate School of Medicine andPharmaceutical Sciences, Japan.


A physician may recommend a lumbar fusion in circumstances where the predominant source of back pain is thought to be a severely degenerated disc between two vertebral bones or to a “slippage” of the spine bones (which is referred to as “spondylolisthesis”). Slippage of the bones results in misalignment of the spine and possible entrapment of the spinal nerves.

Other circumstances exist in which a fusion may best treat the source of back and leg pain. A lumbar fusion may be recommended for diagnoses such as a recurrent disc herniation, scoliosis or curvature of the spine, or for a traumatic injury of the spine such as a fracture. All of these different conditions can cause back and leg pain.


Traditionally, TLIF has been performed as an “open” technique, which requires making a larger incision along the middle of the back. Through this incision, the surgeon then cuts away, or retracts, spinal muscles and tissue to access the vertebrae and disc space. The cutting and retracting of muscle and tissue is part of the reason that after the operation, patients are faced with a long recovery period of several weeks or months.

Today there is a minimally invasive TLIF technique that is proving to be an effective alternative to “open” fusion surgery. In a minimally invasive TLIF, the surgeon inserts a small tube through the skin until it “rests” on the spine. Using special surgical instruments the surgeon then does the entire TLIF procedure through the tube. Working through the small tube, instead of a larger “open” incision, greatly reduces the amount of muscle and tissue that is cut or retracted. Blood loss is dramatically reduced. These minimally invasive benefits also lead to shorter hospital stays and quicker patient recovery times.


This surgical procedure replaces a damaged or diseased disc in the cervical spine with an artificial disc that restores the natural alignment of the spine. Unlike fusion surgery, which causes the vertebrae above and below the problem disc to grow together into a single bone, the artificial disc preserves spine motion at that leve

This surgical procedure replaces a severely diseased or damaged vertebra with a device designed to restore the spine’s proper height and alignment. The patient’s pain is relieved by eliminating pressure on the spinal cord or nerve roots in the thoracic or lumbar spine.

MINIMALLY INVASIVE SPINE PROCEDURES


This minimally-invasive procedure, performed through a rube called a cannula, is designed to relieve the pain caused by herniated disc tissue pressing against nerve roots in the spine. The surgery is performed under general anesthesia, and the patient is allowed to leave the hospital the same day.


A lumbar micro endoscopic discectomy is a minimally invasive procedure performed through a tubular device and designed to relieve pain caused by herniated discs pressing on nerve roots.


Microendoscopic discectomy has been hailed as one of the newest and best methods for disc removal as minimally invasive techniques have gained popularity across surgical specialties.


Percutaneous procedures are minimally invasive and offer decreased morbidity, require no bone graft and promise shorter recuperation time. Candidates for a percutaneous procedure must complain of symptoms related to contained herniated disc or focal protrusion. It does not substitute conventional open procedures required for extruded discs.

Percutaneous procedures are minimally invasive and offer decreased morbidity, require no bone graft and promise shorter recuperation time. Candidates for a percutaneous procedure must complain of symptoms related to contained herniated disc or focal protrusion. It does not substitute conventional open procedures required for extruded discs.


Lumbar microsurgery is a way of doing low-back surgery through a small incision. There are two types of lumbar microsurgery. Microdecompression is removal of bone from the spine. Microdiskectomy is removal of disk. This removal takes pressure off nerves and reduces symptoms.


Since pedicle screws traverse all three columns of the vertebrae, they can rigidly stabilize both the ventral and dorsal aspects of the spine. The pedicle also represents the strongest point of attachment of the spine and thus significant forces can be applied to the spine without failure of the bone-metal junction. The rigidity of pedicle fixation allows for the incorporation of fewer normal motion segments in order to achieve stabilization of an abnormal level.


A new, minimally disruptive procedure is being performed to provide relief to those who suffer from back pain. The minimally disruptive procedure, called XLIF (Extreme Lateral Interbody Infusion).

The XLIF procedure offers patients a safe and effective, less invasive alternative to spine surgery. Unlike traditional back surgery, the XLIF surgery accesses the spine through the patient’s side, which avoids disrupting major muscles and tissue in the back. Patients are often walking within a few days, with a typical 4-6 week recovery rather than the traditional 6+ months of recovery following a typical open back surgery.” The XLIF procedure utilizes a nerve monitoring system that has sensors to alert the surgeon when his probe is approaching one of the nerves running through the muscle, so he can steer around it. Additionally, with the XLIF procedure, the incisions are much smaller than those in traditional back surgeries. The surgeon accesses the spine through two one-inch incisions compared to the five-inch incisions necessary with traditional open back surgery. This results in minimal tissue disruption and shorter hospital stays and recovery time. Patients spend one night in the hospital compared to the five nights typical of traditional surgery patients.

The XLIF procedure is part of NuVasive’s Maximum Access Surgery (MAS) system, a proprietary suite of instruments and technology, which includes the MaXcess System for minimally disruptive spine surgery and the NeuroVision JJB System (nerve avoidance technology). When performing surgery using MaXcess and NeuroVision together, surgeons can gain novel access to the spine with better direct visualization, avoidance of critical nerves and stabilization of the spine, while still using traditional techniques. This technology allows surgeons to perform a wide range of conventional spine procedures through a minimally invasive approach that leaves less tissue trauma and scarring. Additionally, the doctors can perform surgical procedures using instruments that are similar to those used in open procedures, but through significantly smaller incisions.


Selective Endoscopic Discectomy™ (SED™) is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus that is contributing to the patients’ leg and back pain.


Balloon Kyphoplasty
The spine is made up of 33 vertebrae, small bone segments that help you stand up straight. When one of these bone segments cracks or fall apart, it results in a spinal fracture. This can be very painful and can cause swelling and discomfort when bending or twisting and can also cause breathing problems.

Spinal fractures are common in patients with osteoporosis, a disease which causes bones to weaken. Fractures are also extremely common in cancer patients due to weakened immune system and bone loss.

A balloon kyphoplasty can greatly help reduce the pain and fix the fracture. It’s a minimally invasive procedure that takes from a half hour to hour per level. During the procedure, the surgeon creates a path into the cracked or fractured vertebrae using a small instrument. Once the appropriate position is identified, the balloon is inflated to lift the bone fragments into the correct position. Once the fragment is where it’s supposed to be, the balloon is deflated and removed, leaving behind a small cavity. To keep the bone from falling apart again, the cavity is filled with a special cement to hold it in place. This reinforces and stabilizes the bone.

Balloon kyphoplasty can be very beneficial for cancer patients who experience spinal fractures, resulting in greater functionality and pain reduction than results from non-surgical treatments.

The relatively simple procedure produces a greater quality of life and increased mobility in most patients. Like all procedures, there are some risks of side effects or complications, such as infection or cement leakage. Potential patients should consult their doctors for a full list of indications, benefits, and potential risks before deciding on a treatment plan.