Treatment Options

HOW WE CAN TREAT YOU

Artificial Disc Replacement - Total Disc Replacement

Total disc replacement (TDR) is a procedure designed to help maintain segmental spinal motion, alleviate pain, restore discs back to their proper height, and return the spine back to its correct curvature. In TDR, an incision is made, and the affected discs are removed and replaced with artificial ones.

Adult Stem Cell Implantation

Using an FDA-patented technique of harvesting patients’ own stem cells, Dr. Spencer has experience in the world of treating both spinal cord injury and degenerative disc disease of the lumbar spine. Candidates for this treatment have severe neurological deficits, and not all patients will pass our strict screening process to receive this treatment.

During adult stem cell implantation, we take around 100 cc of tissue from the patient to be processed in order to abstract the stem cells. These will then be injected above and below the site of the injury. We will continue to monitor progress after this procedure has been administered.

Anterior Cervical Discectomy & Fusion

Description: Cervical Fusion

Anterior cervical fusion (ACF) is a spinal fusion surgery in the neck, or cervical, spine. The surgeon makes an incision in the front of the neck. The contents of the neck are gently retracted, enabling the front part of the spine to be seen. Fluoroscopy is used to determine the correct level(s) before the disc material is removed and the fusion graft is inserted. A surgical plate is then screwed in place over the fusion level.

Conditions Treated with Cervical Fusion

Anterior Cervical Fusion is performed for the treatment of herniated, cervical spondylosis, kyphosis, cervical stenosis and myelopathy.

What to Expect During Cervical Fusion:

• The surgeon makes an incision in the front part of the neck.

• Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated.

• The contents of the neck are gently retracted to the side so that the spine can be seen.

• Disc tissue is removed.

• A fusion cage is placed in the disc space.

• Often, a plate is screwed over the operated segment to hold the graft in place and stabilize the area.

• Surgery takes approximately 1-2 hours.

Why might I need an anterior cervical discectomy (decompression) and fusion?

Cervical spine surgery may be needed for a variety of problems. Generally, surgery may be performed for degenerative disorders, trauma or instability.

An ACDF is usually performed for one or more of the following reasons:

1. To treat pressure on the spinal cord (caused by cervical canal stenosis/spondylosis or an intervertebral disc prolapse).

2. To treat pressure on one or more spinal nerves in the neck (caused by foraminal stenosis, cervical spondylosis, or an intervertebral disc prolapse)

3. To treat instability of the cervical spine (this may occur due to degenerative changes, arthritis, or trauma).

Surgery is usually recommended when all reasonable conservative measures (pain medications, nerve sheath injections, physical therapies, neck collars etc.) have failed. In cases of significant instability or neurological problems, surgery may be the most appropriate first treatment option.

Anterior Lumbar Interbody Fusion

ALIF is used to treat discogenic lower back pain or spondylolisthesis. This treatment involves removing at least one intervertebral disc and fusing together spinal bones through a cage and screws. Essentially, this keeps the spine from moving in that area and alleviates pain that was associated with that movement.

Cervical Foraminotomy

During cervical foraminotomy, an incision is made in the middle of the back of the neck so that bone spurs, thickened ligaments, and herniated disc segments can be removed, thus widening the foramen. By removing these bones and tissue, compression is released from the nerve roots and pain is soothed.

Cervical Laminotomy / Posterior Cervical Fusion

Cervical laminotomy is similar to cervical foraminotomy. The procedure begins in the same way, with an incision made at the middle of the back of the neck. In cervical laminotomy, the lamina is partially cut to form a hinge, thus relieving pressure over the spinal cord. Then, bone spurs, herniated disc tissue, and other fragments are removed to widen the spinal canal.

Posterior Cervical Fusion

Posterior cervical fusion (PCF) is a spinal fusion surgery in the neck, or cervical, spine. The surgeon makes an incision in the back of the neck. The contents of the neck are gently retracted, enabling the back part of the spine to be seen. Fluoroscopy is used to determine the correct level(s) before the disc material is removed and the fusion graft is inserted. A surgical plate is then screwed in place over the fusion level.

Conditions Treated with Cervical Fusion

Posterior Cervical Fusion is performed for the treatment of herniated, cervical spondylosis, kyphosis, cervical stenosis and myelopathy.

What to Expect During Cervical Fusion:

• The surgeon makes an incision in the back part of the neck.

• Fluoroscopy (live X-ray) is used to determine the correct level(s) to be operated.

• The contents of the neck are gently retracted to the side so that the spine can be seen.

• Disc tissue is removed.

• A fusion cage is placed in the disc space.

• Often, a plate is screwed over the operated segment to hold the graft in place and stabilize the area.

• Surgery takes approximately 1-2 hours.

What is a posterior cervical fusion?

An posterior cervical fusion (PCF) is an operation through the back of the neck to relieve pressure on the spinal cord and/or nerves, as well as to stabilise the spine.

It is abbreviated to ‘PCF’, with each letter standing for:

P= Posterior This means the operation is done from the back of the neck, rather than from the front.

C= Cervical This refers to the neck.

F= Fusion This refers to the joining of two or more neck bones together at the end of the operation, in order to ensure stability.

Craniotomy

Craniotomy is a base term to describe a brain operation to treat a number of different conditions, including brain tumors, head injuries, cerebral aneurysms, pain, epilepsy, or infection. During a craniotomy, an incision is made in the scalp and a small section of the skull is cut and removed so that the surgeon can access the brain (the piece is then securely fashioned back in place upon completion).

Craniotomy for Brain Tumor

During a craniotomy, the tumor will either be biopsied and sent to a pathologist for further testing or removed entirely. We use stereotaxis (computerized navigation techniques) in order to perform the most accurate and safe procedure currently available.

Kyphoplasty/Vertebroplasty

Kyphoplasty/vertebroplasty is used to treat vertebral compression fractures that were caused by spinal tumors, a severe injury, or osteoporosis. During this minimally invasive surgery, bone cement is injected into the fractured vertebrae, allowing the vertebrae to return to their normal height. By restoring the affected area, the spine’s curvature is improved, and pain is relieved.

The spine is made up of strong bones called vertebrae, but they can break just like any other bone in the body. When they do, the result is called a vertebral compression fracture, because the main section of each vertebra collapses in height. Today doctors may recommend minimally invasive procedure specifically designed to treat spinal compression fractures.

The first is called “vertebroplasty.” during a vertebroplasty the doctor injects specially designed bone cement directly into the fractured vertebra through a small profile needle, to prevent it from collapsing any further and eliminate the motion within the bone due to fracture. This stops the severe pain. The vertebroplasty strengthens or casts the fractured bone.

The other minimally invasive procedure doctors may use today is called kyphoplasty. During a kyphoplasty, the procedure is essentially the same as vertebroplasty with the only difference being the placement of a balloon inside the fractured bone prior to cement injection. When the balloon is inflated, it creates a void or cavity within the vertebrae to aid in cement placement to fill the void and hold the fracture in place. Typically, patients will experience markedly reduced pain immediately following the procedure. These procedures are often per-¬ formed on an outpatient basis.

Procedure: The basic steps involved in Kyphoplasty/vertebroplasty include:

• The patient is placed on the operation table and sedated

• The affected segment of the spine is sterilized

• X-ray images are used to identify the placement of the incision

• A small incision is made and two large needles are inserted, at different angles, into the vertebral body through the pedicle; under fluoroscopic guidance

• An inflatable balloon is inserted, through one of the needles, into the compressed vertebrae and inflated to restore the normal height of the vertebrae

• Once the normal height of the vertebrae has been achieved, the balloon is deflated and withdrawn

• This procedure is called kyphoplasty, as it reduces abnormal curvature of the spine i.e. kyphosis, before stabilizing it

• The bone cement is filled into the prepared space

• The pressure and the quantity of the cement to be injected is monitored to prevent any leakage

• The needles are removed and the incision is closed and sutured

Post-operative care

After the procedure most patients are observed for a day and discharged the next day. The basic post-operative instructions for the patients who undergo kyphoplasty/vertebroplasty include:

• Post-operative pain is managed by medications such as painkiller and narcotics

• Avoid any strain or stressful movement for the first 24 hours, then gradually resume your routine activities

• Maintain proper posture while sitting, standing, sleeping and lifting; in consultation with your physiotherapist

• Start physical therapy as and when recommended by your neurosurgeon

• Keep the incision clean and dry

Risks and complications

As there are few complications associated with every surgery. The complications associated with kyphoplasty/vertebroplasty include:

• The leakage of the bone cement that may cause compression or blockage of neural foramen and result in nerve pain

• Bleeding

• Damage of the spinal nerves that may cause numbness or paralysis

• Infection

Lateral Lumbar Interbody Fusion - Anterior/Posterior Fusion

Lateral lumbar interbody fusion involves joining two or more vertebrae together so that bone can grow in between the space. This is an option for those who have experienced vertebral damage or disc degeneration. During LLIF, you will be operated on laterally (through the side). The affected discs will be removed and replaced with a spacer, allowing the spine to return to normal curvature while bone growth is promoted where the discs were.

Why might a doctor recommend spine surgery?

There are a number of reasons why a doctor might recommend spine surgery. In general, surgery is performed to eliminate instability or nerve compression in the back due to degenerated discs and/or facet joints. Disc degeneration results in a lack of proper spacing between the discs, which can cause severe and debilitating pain. Other conditions that might require surgery are the slippage of one vertebra over another or a change in the normal curvature of the spine – including scoliosis and other extreme curvatures of the spine.

Anterior/posterior Lumbar Interbody Fusion:

Anterior/posterior lumbar interbody fusion involves the removal of one or more intervertebral discs and the joining of two or more spinal bones (vertebrae) together using screws and a cage.

What is Anterior/posterior lumbar interbody fusion?

A spinal fusion is a surgical procedure which results in two or more bones being joined together in a solid and stable fashion by bridges of bone between them. The aim is to stop movement across that particular segment of the spine.

In an anterior/posterior procedure, your surgeon will operate from the side of your body (lateral approach) and go through the lateral muscles (psoas) to reach your spine.

He will remove the diseased disc(s) (discectomy) and replace it with an implant called a spacer to restore the disc height and allow bone to grow between your vertebrae.

In addition, your surgeon may make a second incision and insert screws and rods through the back (posterior approach).

What are the key advantages to the Anterior/Posterior technique?

The anterior/posterior approach does not require dissection or retraction of the sensitive back muscles, bones, ligaments, or nerves and allows for more complete disc removal and implant insertion as compared with traditional posterior procedures. Nor does lateral access require the delicate abdominal exposure or present the same risk of vascular injury as traditional anterior approaches. As a result, operating time is often reduced, patient blood loss is minimized, and recovery time is significantly shorter.

Lumbar Laminectomy

Lumbar laminectomy deals with removing portions of laminae from the spine. These laminae are often called “shingles” for your spine, as they are bony segments that help muscles attach to the spine in addition to protecting nerve roots.

During this surgery, some of these laminae are removed in order to treat compression in the lower part of the spine. This compression can be caused by degenerative spine disorders or prolapsed discs.

What is a lumbar laminectomy and rhizolysis?

A lumbar laminectomy and rhizolysis is an operation on the spine in the lower back. Its purpose is to relieve pressure on the nerve roots that leave the spine and run down to form the nerves in your legs. The back of the spine has a bony ‘shingle’ on either side of the midline. These angled segments of bone are known as the laminae, and their purpose is to permit muscles to attach to the spine and also to protect the nerve roots. Removal of portions of these laminae is known as a ‘laminectomy’, ‘hemilaminectomy’, or ‘partial hemilaminectomy’.

By simply removing portions of the laminae, the underlying nerve roots may remain somewhat compressed. To adequately decompress the nerve root, it is often necessary to remove part of the facet joint (‘mesial facetectomy’), as well as any thickened ligament. Decompression of a nerve root is known in surgical terms as a ‘rhizolysis’.

The bony structures of your spine are carefully defined, and using microsurgical techniques, a fine high-speed drill is used to shave some bone away over the top of the nerves. The ligament is then detached and removed and the underlying nerve root is identified. The nerve root is decompressed (this is known as a ‘rhizolysis’) and the disc is visualised. If there is a significant disc prolapse, a microdiscectomy is performed; otherwise the disc is left alone.

If the disc is to be removed (microdiscectomy), this is done by first cutting the outer annulus fibrosis (fibrous ring around the disc) and removing the nucleus pulposus (the soft inner core of the disc). Disc removal is performed using a combination of special instruments.

The wound is closed with dissolving sutures. Followed by glue then steri strips.

Lumbar Microdiscectomy

Lumbar microdiscectomy includes removing prolapsed discs in order to relieve compression on the nerve roots in the spinal canal. It is this pressure that causes pain to run through your lower back or legs, so depressurizing this area is essential for treatment.

What is a lumbar laminectomy and rhizolysis?

The wound is closed with dissolving sutures. Followed by glue then steri strips.

Minimally Invasive Spine Surgery

Many patients are apprehensive of traditional open spine surgery, as there are some risks associated. MIS may be an option for those who are not ready to undergo such a serious surgery. MIS uses computer-assisted technology and instrumentation to help treat your condition with a reduced recovery period, less scarring and pain after surgery, and improved functionality.

The most common type of MIS treatments are MIS tubular microdiscectomy, MIS lumbar laminectomy, cervical laminoforaminotomy, endoscopic discectomy, MIS transforaminal lumbar interbody fusion, MIS lateral, percutaneous pedicle screw instrumentation, and pre-sacral interbody arthrodesis.

Posterior Lumbar Fusion - TLIF

TLIF is an alternative procedure to spinal fusion surgery. During this treatment, intervertebral discs are removed in order to fuse two or more vertebrae together with screws and a cage. This is an option for patients with herniated discs, lumbar canal and/or recess stenosis, foraminal stenosis, discogenic lower back pain, facet join pain, or spondylolisthesis.

What is fusion?

A spinal fusion is a surgery designed to join two or more vertebrae by encouraging bone to grow between them.

Why is fusion done?

There are a variety of conditions that can be treated with a fusion. These conditions include vetebral damage or intervertebral disc degeneration due to age, injury, or trauma.

These conditions can lead to:

-Loss of disc height

-Disc herniation

-Slippage of one vertebra over another

-Neural compression

When these event lead to pain or numbness, a fusion can be performed to restore the height of the disc space, decompress the nerves, and immobilize two or more adjacent vertebrae. The goal is to reduce or eliminate pain.

What is a psterior fusion procedure?

In a posterior fusion procedure, Dr. Spencer will operate from the back of your body (posterior approach) and go through the back muscles to reach your spine.

He will remove the diseased disc(s) (discectomy) and replace it with an implant called a spacer to restore the disc height and allow bone to grow between your vertebrae.

In addition, Dr. Spencer may make a second incision and insert screws and rods through the back (posterior approach).

Regenerative Medicine

Regenerative medicine is a safe, natural alternative treatment that relies on anti-inflammatories, growth factors, and cellular components to help heal muscles, ligaments, and cartilage damage. It can also be used to soothe chronic pain.

Sacroiliac Joint Fusion - SI Joint Fusion

Sacroiliac (SI) joint fusion is a surgical procedure performed in an operating room, with either general or spinal anesthesia. It is a minimally invasive surgical (MIS) procedure, it requires a small incision (about one to two inches long), along the side of the buttock.

Dr. Spencer will use a specially designed system to guide the instruments that prepare the bone and facilitate placement of the titanium implants across the sacroiliac joint. Fluoroscopy, an imaging technique commonly used by physicians, provides Dr. Spencer real-time moving images of internal structures during the procedure. Typically, three implants are used in a procedure.

Both the surgical technique and the implant are designed to pretect the tissues surrounding the surgical site.

The whole minimally invasive surgical SI Joint procedure takes about an hour. Recovery time is significantly less than open surgery.

Spinal Cord Stimulator

This is a device that is implanted into the spine and uses electrical pulses to interfere with pain signals in spinal nerves. Instead of pain signals being sent through, the message comes across as a tingling sensation. Spinal cord stimulators are only used in cases when conservative treatments or surgeries are ineffective.