Northwest Spine Surgery

Anterior cervical discectomy and fusion is a combined surgical procedure to decompress spinal nerves and stabilize the cervical spine. This surgery is performed to relieve pain, numbness and weakness in the neck and upper back and to provide stability in this portion of the spine. As the name indicates, this procedure is performed through an incision at the front, or anterior, of one side of the neck. With this surgical approach, the disc can be accessed without disturbing the spinal cord, the neck muscles and uninvolved spinal nerves. The operation is performed under general anesthesia. The cervical spine begins at the base of the skull and consists of seven vertebrae with discs between them. One of the most important parts of the body, the neck is also the most articulate portion of the spine, moving more freely and in more directions than the other sections. Beyond that, the cervical spine is also responsible for protecting the spinal cord and providing support to the skull, which in turn protects the brain. Because of the neck's vital functions, injury or disease of the cervical spine is a very serious condition. Reasons for an Anterior Cervical Discectomy and Fusion An anterior cervical discectomy and fusion is considered when there has been severe damage to the upper spine following a fracture or when a congenital abnormality or degenerative disease has weakened the area badly. This may occur as a result of osteoarthritis or a herniated disc. An anterior cervical discectomy and fusion is usually performed when a patient is experiencing debilitating pain because cervical nerves are being compressed or when there is excessive motion between the vertebrae of the cervical spine. The Anterior Cervical Discectomy and Fusion Procedure During the cervical discectomy, a disc that has been herniated or ruptured is surgically removed. The discectomy eliminates pressure on the compressed nerve and so relieves the pain and other symptoms such compression causes. During the cervical fusion portion of the surgery, two or more damaged vertebrae are joined through the use of a bone graft so that they will eventually grow together. The bone graft is used as a spacer to keep the bones from rubbing against each other during the process. The bone graft is either taken from another part of the patient's body, usually the hip, or is harvested from a donor bank. While a material known as morphogenetic protein may be used to replace a bone graft in other spinal fusion surgery, it is not used in the anterior cervical procedure since it can sometimes cause swelling and interfere with swallowing. The fusion increases spinal stability and decreases the pain associated with misaligned cervical movement. Typically, a metal plate and screws are used to increase stability as the bones fuse. This process usually takes from 3 to 6 months. Immediately following the surgical procedure, the patient is fitted with a cervical collar for extra support of the neck region. Risks of an Anterior Cervical Discectomy and Fusion Procedure Although this procedure is considered a safe one, there are risks associated with any spinal surgery. These may include: danger of infection, excessive bleeding, blood clots, injury to the spinal cord, nerves or arteries, and the possibility of adverse reactions to anesthesia. Recovery from a Posterior Cervical Fusion Typically, after surgery is complete, the patient remains in the hospital overnight, although some patients may be permitted to leave the same day and some may have to remain in the hospital for a day or two longer. Full recovery usually takes from 4 to 6 weeks and during this time the patient's activities are restricted. The patient has to refrain from driving, bending, lifting, pushing, pulling or reaching. In most cases, sexual activity is also restricted. A program of physical therapy is normally recommended to promote a more successful recovery and to achieve maximum postsurgical mobility.

Cervical fusion is a surgical procedure performed to join at least two of the vertebrae of the neck. This surgery is performed to alleviate pain in patients with disorders of the cervical spine, such as stenosis and degenerative disc disease. The cervical spine is made up of seven vertebrae stacked on top of one other, each two separated by a cushion known as an intervertebral disc. In patients with certain spine conditions, some bones of the cervical spine may rub against one other, causing pain, numbness and other troubling symptoms. While there are several nonsurgical methods available to treat these conditions, some patients may benefit from cervical fusion to avoid future complications and achieve long-term relief. Reasons for Cervical Fusion Cervical fusion is performed to stop painful movement in the targeted area. It is often performed in conjunction with a cervical discectomy to relieve compression of spinal nerves. Patients may require a cervical fusion for various reasons, including: Anatomical abnormality or traumatic injury Spinal stenosis or osteoarthritis Disc herniation Spondylolisthesis Rheumatoid arthritis Infection Tumor In addition to relieving pain, a cervical fusion may be performed to realign the spine correctly or to prevent destabilization, further deterioration, fracture or paralysis. The Cervical Fusion Procedure Spine fusion surgery can be performed through an incision in the front, back or side of the body, depending on the location of the affected vertebrae and the patient's individual condition. During the procedure, either a vertebra or a disc between two affected vertebrae may be removed. In either case, the resulting empty space will be filled with a bone graft harvested either from another part of the patient's body or from a donor bank. While artificially created protein substances called bone morphogenetic proteins (BMPs) are sometimes substituted for bone grafts in other spinal fusions, they are not used in cervical procedures. This is because there is a risk of adverse reactions to the BMPs that may result in difficulty swallowing or breathing. Titanium metal screws or a titanium metal cage are most often used to stabilize the region until the bones grow together. Fusion surgery is performed under general anesthesia in a hospital setting. Movement of the spine in the treated area will not be possible after surgery, so the operation is usually only performed on one small section of the cervical spine. New technology allows spinal fusion to be performed with magnification and illumination of the damaged area. Instead of stripping away the muscle, the surgeon can insert an endoscope through a much smaller incision, effectively creating a tunnel directly to the affected vertebrae. This modern procedure is much less invasive than previous operations and results in less scarring, less bleeding and a more rapid recovery. Risks of Cervical Fusion Although considered a safe procedure, cervical fusion carries some risks as do all surgeries. These include the possibilities of infection, excessive bleeding, nerve damage, grafting problems, breathing difficulties and adverse reactions to medications or anesthesia. Recovery from Cervical Fusion After the cervical fusion procedure, patients stay in the hospital for up to a week, but are encouraged to get up and walk around as soon as they are able. A rigid neck brace may need to be worn for several months after surgery, depending on whether or not metal hardware has been used during the operation. Patients will require physical therapy after surgery in order to restore strength and mobility to the area. Physical therapy is designed to control pain and inflammation throughout the often lengthy recovery process, and may include massage, electrical stimulation and ice, as well as physical exercise. Throughout the rehabilitation process, patients gradually increase activity levels and learn new methods of movement to keep themselves as flexible as possible. Heavy lifting and other types of strenuous activities are restricted until healing is completed, usually a period of several months. Patients will be individually advised about when they may resume normal daily activities, depending on the nature of their particular surgical surgery, their medical condition, and the speed at which they are healing.

A cervical laminectomy is a surgical procedure that can effectively relieve compression of the spinal nerves and so reduce the pain of spinal stenosis. Cervical spinal stenosis is a condition that involves a narrowing of the spinal column in the neck area. It often produces pain, cramping, weakness or numbness in the neck, shoulders or arms. This condition can develop as a result of injury to, or deterioration of, the discs, joints or bones within the spinal canal. Because the vertebrae of the neck are more capable of movement than any other area of the spine and because they are not only responsible for protecting the spinal cord, but for supporting the skull, surgical repairs in this area are a delicate matter. While many cases of spinal stenosis can be successfully treated through conservative methods such as rest, wearing a back brace, engaging in physical therapy, or taking nonsteroidal anti-inflammatory drugs, some patients do not respond to these measures. If the symptoms of spinal stenosis become progressively worse, a cervical laminectomy may become necessary. The Cervical Laminectomy Procedure In a cervical laminectomy procedure, a small section of bone that covers the back of the spinal cord, called the lamina, is removed. The removal of this portion of the bone and any nearby bone spurs relieves the pressure on the spinal cord. A laminectomy of the cervical spine is performed through the upper back and neck while the patient is under general anesthesia. The surgeon makes an incision and carefully retracts the muscles and ligaments to obtain access to the spine. An imaging device such as an X-ray is typically used during the surgery to view the vertebral structures more precisely and pinpoint the problem area. Depending on the extent of the damage, the lamina may be removed in portions or in its entirety on both sides of the spine. The surgeon will then assess the region, removing any calcified cartilage as well as the spinous processes, the sharp protrusions at the back of each vertebrae, if necessary. By removing the lamina, bone spurs and other debris, the compression of the spinal cord and spinal nerves is alleviated and symptoms improve. If the bones within the cervical spine have been moving against each other, a spinal fusion procedure may be necessary to promote stability. This procedure can be performed at the same time the patient is undergoing the cervical laminectomy. The fusion involves inserting a bone graft into the space between the affected vertebrae in order to join them. The bone graft is harvested from another part of the patient's body or is received from a donor bank The surgeon will also attach titanium metal rods, plates and screws to the vertebrae to prevent movement of the bones during the fusion process. Recovery from Cervical Laminectomy A cervical laminectomy should relieve much or all of the pain and numbness in the arms and neck that stenosis sufferers experience. After the procedure, the patient typically remains in the hospital for a short stay and may be fitted with a neck brace for temporary support. Soon afterward, most patients begin a physical therapy regimen to build up muscle strength and increase flexibility. Patients are advised to refrain from reaching, lifting, pushing or pulling for several weeks after the procedure. Usually, they can return to work in approximately 3 months. When a cervical laminectomy is accompanied by spinal fusion, recovery time may be somewhat longer. Risks of Cervical Laminectomy Cervical laminectomy is a spinal surgery procedure and as such, carries some risk. These risks include postsurgical infection, excessive bleeding, blood clot formation, nerve damage and adverse reaction to anesthesia.

Cervical radiculopathy refers to pain that radiates into the shoulder and arm as a result of injury to a nerve root in the cervical spine (neck). An injured nerve can send pain signals throughout the area into which it extends. Sometimes known as a "pinched nerve," cervical radiculopathy can be the result of a herniated disc, a bone spur, an injury to the spine, or osteoarthritis. Causes of Cervical Radiculopathy Cervical radiculopathy often results from pressure placed on spinal nerves by either a herniated disc or bone spur. A herniated disc can develop when too much force is exerted on an otherwise healthy intervertebral disc; bone spurs develop when cartilage deteriorates and bones begin rubbing against each other. Bone spurs can cause a narrowing of the spinal canal, which can place pressure on a nearby nerve. Additional causes of cervical radiculopathy include the following: Aging Degenerative diseases such as arthritis Conditions that cause changes in bones Traumatic injury Although aging can cause disc changes that result in cervical radiculopathy, not everyone with aged, worn discs is affected. Symptoms of Cervical Radiculopathy Cervical radiculopathy can result in pain that radiates down one or both arms, or into the shoulders. Certain movements, such as extending the neck or turning the head, pull on the affected area, and can worsen the pain. Additional symptoms of cervical radiculopathy include the following: Muscle weakness in the arm, neck, chest, upper back or shoulders Tingling sensations down to the hands Numbness A lack of coordination, particularly in the hands, can also be a symptom of cervical radiculopathy. Diagnosis of Cervical Radiculopathy In order to diagnose cervical radiculopathy, a complete medical history is taken and a physical examination conducted. The exam typically includes an evaluation of the patient's strength, reflexes and sensation of feeling. To ensure the most accurate diagnosis, several diagnostic tests may also be performed. These tests may include X-rays to view spinal alignment and discs; a CT scan to obtain detailed views of the spinal bones; and an electromyogram to examine electrical activity along the nerve. MRI scans are the most commonly performed tests used to evaluate spinal conditions, because they offer clear visualization of the abnormal areas of soft tissue around the spine. In many cases, MRI scans are the only test needed to determine the cause of neck pain. Unlike other imaging tests, MRI scans use magnetic fields and radio waves to view the structures of the neck. MRI scans also enable a thorough examination of the nerves and discs without using any dyes or needles. Treatment of Cervical Radiculopathy Cervical radiculopathy is generally first treated with conservative measures. Treatment plans may include a combination of medications, including anti-inflammatory drugs and oral corticosteroids, to help reduce pain and swelling. Steroid injections in the spine can be very effective for decreasing swelling, allowing for healing to take place. In severe cases, stronger prescription pain medications may be necessary. Physical therapy can help strengthen the muscles in the problem area, maximize flexibility with stretching exercises and take some pressure off the injured nerve roots. Cervical radiculopathy patients may also need to wear a soft collar around the neck to limit the range of motion in the neck and rest the muscles. If conservative measures fail to provide a patient with relief, or symptoms are worsening, surgery is often required. There are several types of procedures used to correct cervical radiculopathy. Anterior cervical discectomy and fusion (ACDF) is the most common surgery to treat cervical radiculopathy; it restores alignment of the spine and reduces compression on the nerves. Posterior cervical laminoforaminotomy is another procedure used to alleviate symptoms; it removes portions of the spinal bones that are compressing the nerve roots. Artificial disc replacement (ADR) is performed to remove the worn disc, relieve pressure on the nerves and restore height between the vertebrae.

A laminectomy is a surgical procedure to relieve the spinal nerve compression that results from spinal stenosis or a herniated disc. Spinal stenosis is a narrowing of one or more areas of the spinal canal. A herniated disc results when a disc, the gelatinous tissue between two vertebrae, protrudes outside the parameters of the spine. Both spinal stenosis and disc herniation result in excessive pressure on adjacent spinal nerves, causing pain, cramping, numbness, tingling or weakness in the neck, shoulders, arms, lower back or legs, depending on where on the spine the problem occurs. Both conditions may result from aging, injury, or arthritic deterioration. While many cases of spinal stenosis or disc herniation can be successfully treated through one or more conservative methods, such as rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, or the support of a back brace, in some instances these treatments are insufficient. If the symptoms of spinal stenosis or disc herniation become progressively worse, a laminectomy may become necessary. This minimally invasive surgical procedure can provide effective relief from the pain, numbness or weakness many patients experience. The Laminectomy Procedure A laminectomy is performed through the affected area of the back while the patient is under general anesthesia. The surgeon makes an incision and retracts the muscles and ligaments to obtain access to the spine. An imaging device, such as an X-ray, is typically used during the surgery so that the structures of the vertebrae can be precisely visualized and the problem area pinpointed. Depending on the extent of the damage, the lamina may be removed in portions or in its entirety on both sides of the spine. The surgeon will then assess the region, removing any necessary calcified cartilage or spinous processes, the sharp protrusions at the back of each vertebra. By removing the lamina, bone spurs and other debris, the compression of the spinal cord and spinal nerves is alleviated and symptoms improve. The laminectomy procedure typically lasts from 1 to 3 hours. Recovery from a Laminectomy A laminectomy usually relieves much or all of the pain and numbness in the arms or legs that patients have suffered as a result of stenosis or disc herniation. After the procedure, patients typically remain in the hospital for several nights. Soon afterward, a physical therapy regimen is begun to build up muscle strength and flexibility. For several weeks following the procedure, activities that require reaching, bending and lifting will be restricted. Most people will be able to return to work in approximately 3 months. Risks of a Laminectomy A laminectomy is a spinal surgery procedure and as such, it carries some risk. The complications that may be associated with this procedure include postsurgical infection, blood clot formation, breathing problems, nerve damage and adverse reaction to medication or anesthesia. The great majority of laminectomy procedures are successful and uneventful.

Posterior lumbar fusion, also known as arthrodesis, is a surgical procedure performed to join two or more of the lumbar vertebrae (the small bones of the lower back) into one solid bone. This operation is designed to stop mechanical pain, the pain associated with the movement of the affected bones that results in inflammation of the discs and joints. During this surgery, a bone graft is inserted along the side of the vertebrae which will eventually help the bones grow together. The procedure is called a posterior fusion because the surgeon works on the back of the spine. Reasons for Posterior Lumbar Fusion Posterior lumbar fusion is commonly performed to treat a variety of spinal conditions affecting the lower back, including: Spondylolisthesis Spinal fractures Tumors Infections Scoliosis Degenerative disc disease Radicular pain (down the buttock and thigh) Other surgical procedures are frequently performed along with lumbar fusion, such as removing bone spurs or repairing herniated discs. The Posterior Lumbar Fusion Procedure During the procedure, performed under general anesthesia, the patient is usually face down on a special operating table. This position not only provides the surgeon with room to operate and increases comfort for the patient, but also lessens the patient's blood loss. An incision is made in the middle of the lower back to expose the spinal column, and part of the lamina, the bony covering of the spinal canal, is removed. The surgeon also removes any disc fragments or bone spurs impinging on the nerves, and prepares the patient for the fusion by shaving off a layer of bone from the back of the affected vertebrae. This resulting cut surface is receptive to the bone graft that will be attached. Because the primary goal of a posterior lumbar fusion is to eliminate the mechanical pain and inflammation associated with vertebral movement, the operation basically consists of a type of welding, in which the bone graft, taken either from the patient's own hip (autograft), harvested from a cadaver (allograft) or manufactured (synthetic), is used to stimulate bone growth. Most often, the graft is fixed in place using a combination of screws, rods and plates to keep the vertebrae from moving. Held in place this way, the tissues have a higher success rate of growing together completely and permanently. Recovery from Posterior Lumber Fusion Recovery from this surgery takes from 1 to 3 months during which the patient normally undergoes physical rehabilitation and must avoid heavy lifting, bending and twisting.