Microdiscectomy is a surgical procedure employed to relieve the pressure over the spinal cord and/or nerve roots, caused by a ruptured (herniated) intervertebral disc. A herniated disc, common in the lower back (lumbar spine) occurs when the inner gelatinous substance of the disc escapes through a tear in the outer, fibrous ring (annulus fibrosis). This may compress the spinal cord or the surrounding nerves, resulting in pain, sensory changes, or weakness in the lower extremities.

It is usually indicated in patients with herniated lumbar disc, who have not found adequate pain relief with conservative treatment. This procedure involves the use of microsurgical techniques to gain access to the lumbar spine. Only a small portion of the herniated disc that compresses the spinal nerve is removed.

Procedure

A microdiscectomy is performed under general anesthesia. Your surgeon will make a small incision in the midline over your lower back. Through this incision, a series of progressively larger tubes are placed and positioned over the herniated disc. The affected nerve root is then identified. Your surgeon removes a small portion of the bony structure or disc material that is pressing on the spinal nerve using microsurgical techniques. The incisions are closed with absorbable sutures and covered with a dressing.

Postoperative Care

Following the surgery, patients will be discharged home on the same day or the next day. Post-operatively, patients are advised to gradually increase their activity levels. If required, physical therapy is started after four to six weeks of the surgery to improve strength and range of motion.
Benefits of microdiscectomy include:

• Less muscle and soft tissue disruption
• Shorter recovery time
• Minimal postoperative pain and discomfort
• Fewer risks of complications

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Lumbar laminectomy is a surgical procedure to relieve the pressure over the spinal nerves which results in pain and numbness in the legs. The narrowing of the spinal canal can occur either due to wear and tear or degenerative changes of the different parts of the spine. This results in a condition known as spinal stenosis. Laminectomy involves the complete removal of the lamina, a small bony plate covering the spinal canal. Laminectomy is another spinal decompression surgical procedure in addition to foraminotomy and facetectomy.

The spinal nerves may be compressed due to following reasons:

• Age related wear and tear of the spine
• Excessive stress and strain causing weakening of the spinal disc
• Abnormal bulging or even rupture of the intervertebral disc into the spinal canal
• Degenerative changes such as bone spur formation around the facet joints or along the edges of the vertebrae

The symptoms of spinal stenosis and nerve compression include back pain, leg pain, leg numbness and difficulty in walking.

Procedure

Lumbar laminectomy involves the following steps:

• The procedure is conducted under general anesthesia.
• The patient is placed, facing downward, in a special frame.
• This frame is designed to relax the abdomen to prevent blood loss as well as provide more space for surgery.
• Fluoroscopy is used to identify the positioning of the incision.
• An incision is made through the skin, over the back, to approach the spine.
• The muscles are retracted with the help of a retractor.
• The bony projections present on each side of the vertebra and the lamina are removed by cutting along the inner edge of the facet joint until the pedicle bones are reached.
• A small portion of the ligamentum flavum, present between the lamina bones and the spinal cord, is also removed.
• Removal of this ligament exposes the nerves present in the spinal canal.
• Soft tissues present around the spinal nerves are carefully removed with small cutting instruments.
• Any bone spurs or intervertebral disc fragments present near the nerves, are also removed.
• All of these surgical interventions help in relieving the pressure over the spinal nerves, present in the spinal canal
• Finally the muscles and soft tissues are repositioned and the wound is sutured.

Post-operative care

Generally, patients are discharged home on the same day of the surgery. Patients are instructed to move their back carefully and avoid strain for the next few days. Other post-operative instructions include:

• Avoid driving for at least 2-3 weeks
• Patient can perform light work after 4 weeks
• Avoid heavy work for at least 2-3 months
• Physical therapy should be started after 3-4 weeks

Risk and complications

There are always some complications associated with any major surgery. Some of the common complications associated with lumbar laminectomy include:

• Complications related to anesthesia
• Conditions such as thrombophlebitis
• Infection
• Damage to the spinal nerves
• Persistent pain
• Spinal segments instability

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Artificial cervical disc replacement surgery is an alternative to spinal fusion surgery, where the damaged intervertebral disc in the neck is removed and replaced with a disc implant. This surgery relieves neck pain as well as restores the normal range of motion of the neck.

A cervical spine fusion surgery involves permanent fusion of two vertebral bodies and eliminates movement between them while an artificial disc is similar to the normal intervertebral disc and assists in movement.

Advantages

The advantages of the artificial cervical disc replacement include:

• Preservation of mobility
• Restoration of disc height
• Stabilization of the cervical spine
• Decreased stress during movement
• Supports the weight of the head, during rest and movement

Artificial discs are usually made up of a stainless steel and polyethylene combination. Some designs possess spike-like irregularities into the surface to enhance the hold over the upper and lower surfaces of the respective vertebral bodies. Bone screws are used to secure the artificial disc in place.

Indications and Contraindications

Artificial cervical disc replacement is usually indicated in the following circumstances:

• Progressive deterioration of your symptoms

• Neck pain associated with pain, weakness or numbness of the arm and leg
• Symptomatic cervical disc disease does not respond to conservative treatment
• Difficulty walking

Artificial cervical disc replacement is contraindicated in the presence of arthritis, significant osteoporosis or an active infection, and if the patient has allergy to stainless steel.

Procedure

Before the surgery your doctor will explain the benefits and risks of the device and the procedure to you. Your doctor may also order a few blood tests, X-rays, or other imaging tests to determine your medical condition. You may also need to obtain a health clearance from your physician for the surgery.

The patient is put under general anesthesia. The surgery is performed under X-ray guidance (fluoroscopy). You will lie face up on the operating table. Your surgeon approaches the cervical spine from the front of your neck. A small incision is made in the front of the neck and the soft tissues are gently retracted to access the cervical spine. The damaged disc along with any loose disc fragments or bone spurs are then identified and removed. After the disc is removed, the disc space is cleared and the artificial disc device is placed in the prepared disc space, restoring its normal height and relieving any pressure over the spinal nerves. The incisions are closed and covered with a dressing.

It is a minimally invasive procedure as the muscles and soft tissues are not excised during the surgery.

After the surgery

After your surgery, you will be transferred to a recovery room and the medical staff will closely monitor the vital signs. A cervical brace is recommended to offer stability and support during the healing process. You may experience mild discomfort, pain at the incision site, neck muscle spasms, or other related symptoms following the surgery.

Post-operative care

You will need to keep the incision area clean and dry. Refrain from hot tubs, swimming, heavy lifting, driving, and smoking. You can initiate physical therapy as directed by your surgeon. Take medications as recommended by your doctor. Arrange for a follow-up appointment with your doctor.

Risks

The potential risks associated with artificial disc replacement surgery may include infection, bleeding, nerve injury, and problems due to anesthesia.

Call your doctor if the incision site shows signs of infection such as pain, redness, swelling, or alteration in the quantity of smell of the drainage, or if you develop fever over 101° F. Also inform your doctor if you develop bowel and bladder dysfunction or numbness over the genital area.

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The cervical spine is present in the neck region and supports the weight of the head. Soft pads or intervertebral discs, present between the adjoining vertebrae, act as shock-absorbers and assist in movements of the head. Each disc is composed of a soft inner core called the nucleus pulposus and the fibrous outer band called the annulus fibrosus.

Anterior cervical discectomy (ACD) is a surgical procedure employed in the management of various disorders affecting the cervical spine which include disc herniation, disc degenerative disease and cervical radiculopathy. In ACD, the neurosurgeon approaches the affected disc from the front (anterior) of the neck.

Procedure

The basic steps of anterior cervical discectomy include:

• The patient is taken to the operation room and administered general anesthesia.
• The patient is made to lie on the operation table, face up with the head bent slightly to the right.
• A small incision is made, usually above the left collar bone; avoiding injury to the nerves supplying the voice box.
• The muscles and the soft tissues are then retracted to approach the spine.
• X-ray imaging is employed to identify the affected intervertebral disc.
• The front portion of the disc is then removed with forceps while the back portion is removed with a small rotary cutting tool called a burr.
• A special microscope is employed for visualizing the disc and assists in accurate removal of the disc material and bone spur around the spinal cord.
• The adjoining surfaces of the vertebrae are prepared, which causes bleeding and aids in the healing process.
• The dimensions of the space between the vertebrae is measured and a suitable bone graft, taken from the pelvis, is fitted in to the disc space.
• Confirmatory X-ray may be taken to confirm the proper placement of the bone graft.
• Finally, a drainage tube is placed in the wound, the retraction over the muscles and soft tissues is removed, and the wound is sutured.

In case of spinal instability, after removal of the disc, the vertebrae adjacent to the disc are fixed with screws and a metallic plate and this is known as arthrodesis.

Postoperative care

Patients may be discharged on the same day of the surgery or may be advised a couple of days of hospital stay. A neck brace is recommended, for a few months. Patients are initiated on a liquid diet which is gradually changed to normal food, depending on their recovery. Rest is advised as it helps in healing of the bone graft.

Risk and complications

Every major surgery is associated with complications. Some of the complications associated with anterior cervical discectomy include:

• Complications related to anesthesia
• Conditions such as thrombophlebitis
• Nonunion or pseudarthrosis
• Infection
• Damage to the spinal nerves
• Problem related to bone graft
• Persistent pain

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An interbody fusion is a method of fusing the lumbar spine that involves removing the intervertebral disk. When the disk space has been cleared out, a metal, plastic, or bone spacer is implanted between the two adjoining vertebrae.

These spacers, or "cages," usually contain bone graft material. This promotes bone healing and facilitates the fusion. After the cage is inserted, surgeons often use metal screws, plates, and rods to further stabilize the spine.

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Anterior lumbar interbody fusion (ALIF) is a surgery performed to correct the spinal problems in the lower back. The surgery can be implemented either as an open surgery or minimally invasive technique.

Indications

The common indications of ALIF are:

• Severe lumbar (low back) or leg pain that is unresponsive to non-surgical treatment.
• Degenerative disc disorder of lumbar spine (pain due to damaged disc)
• Spondylolisthesis (slippage of one vertebra on another)
• Scoliosis (S-shaped curve of spine)
• Fractures of spine
• Tumors
• Spinal instability

Surgical procedure

The ALIF surgery is usually performed under general anesthesia. The patient is positioned supine lying on the back. The surgeon makes an incision in the abdomen and retracts the muscles and various structures to enhance the clarity and accessibility to the anterior aspect of the vertebrae. The surgical approach is from the front of the vertebral body in the low back region. Your surgeon removes whole or a part of the damaged disc between two adjacent vertebrae followed by fusion of the same with or without the use of bone grafts. External implant materials such as rods, screws, plates, and wires may be fixed to the treated vertebrae to deliver extra support and stability during the healing process. At the end of the procedure, the structures are re-approximated and the skin is closed with sutures.

The success of surgery depends on various factors such as age, spinal condition, overall health status, and activity level of the individual.

Recovery

The recovery period after ALIF surgery depends on the body’s healing capacity. The post-surgical hospitalization includes the rehabilitation program. If required, your surgeon may prescribe pain medications or a brace and follow-up physical therapy upon discharge.

The period of your rest or inactivity depends on a few factors such as the type of surgical procedure and the approach used to access your spine, the size of the incision and presence of any complications. Return to work or normal activity depends on the type of work or activity you plan to perform. Usually 3 to 6 weeks is the ideal time of healing. With the advanced and innovative techniques, it is now possible to achieve improved fusion rates, short hospital stay with an active and rapid recovery period.

Strictly adhere to the post-operative instructions suggested by your spine surgeon to promote healing and reduce the possibility of post-operative complications.

Risks or complications of ALIF surgery

The complications of the ALIF surgery include infection, nerve damage, blood clots or blood loss or bowel and bladder problem and any problem associated with anesthesia. The underlying risk of spinal fusion surgery is failure of fusion of vertebral bone and bone graft which usually requires an additional surgery.

Talk to your spine surgeon if you have any concerns or queries regarding ALIF.

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Posterior Cervical Fusions

Posterior cervical fusion (PCF), a surgical procedure performed through the back of the neck, involves joining or fusing two or more damaged cervical vertebrae. The fusion of vertebrae is also known as arthrodesis. Sometimes metallic plates may be used for fixing the vertebrae, this is also known as instrumentation.

PCF may be employed for the management of cervical fractures, bone dislocations, and deformities due to abnormal curvature of the cervical vertebrae.

Procedure

The basic steps of posterior cervical fusion include:

• The procedure is conducted in an operating room with the patient under general anesthesia.
• The patient lies face down, on the operation table.
• A small incision is made over the middle of the neck, at the back.
• The muscles and the soft tissues are then retracted to approach the spine.
• X-ray imaging is employed to identify the affected intervertebral disc.
• The surfaces of the lamina of the each vertebra to be fused are trimmed. This results in bleeding which aids in rapid healing of the fused bones.
• In addition, small strips of bone graft taken from the pelvis are placed over the spinal column, which aid in fusion of the bones.
• Confirmatory X-rays may be taken to confirm the proper placement of the bone graft.
• Finally, the retracted muscles and soft tissues are placed in their normal positions and the wound is sutured.

Postoperative care

Patients may be discharged from the hospital within a week of the surgery. A neck brace is recommended for several months; however, this restriction may not be required if the vertebrae are fixed with a metal plate during the PCF surgery. Patients are initiated on a liquid diet which is gradually changed to solid food, depending on their recovery.

Physical therapy is recommended after 4-6 weeks of the surgery. Physical therapists help patients perform their routine activities without exerting any extra stress on the neck. Rest is advised as it helps in healing of the bone graft.

Risk and complications

Every major surgery is associated with complications. Some of the complications associated with posterior cervical fusion include:

• Complications related to anesthesia
• Conditions such as thrombophlebitis
• Nonunion or pseudarthrosis
• Infection
• Damage to the spinal nerves
• Problem related to bone graft
• Persistent pain

Laminoplasty

Laminoplasty is a surgical procedure performed to release pressure over the spinal cord and nerve roots. The lamina is a thin plate of bone located between the facet joints of the cervical (neck), thoracic (mid-back), and lumbar (low back) regions of the spine. The lamina protects the spinal canal that contains the spinal cord and its nerve roots.

Laminoplasty can be beneficial in treating cervical spinal stenosis, cervical herniated disc, cervical radiculopathy, degenerative disc disease, lumbar herniated disc, lumbar spinal stenosis, spondylosis, spondylolisthesis, tumor, and infection.

Before surgery

Your doctor will explain the procedure, its risks and benefits, and resolve all your other queries before the surgery. You may require a general health clearance certificate, from a physician, for the surgery. You may also be ordered a few blood tests, X-rays, or other imaging tests to evaluate your medical condition.

Procedure

The procedure is performed under general anesthesia and X-ray or fluoroscopic guidance. The lamina is completely cut on one side and partially cut on the other which creates a hinge on one side of the lamina, and a small opening on the other. The tips of the spinous processes, projections of bone which can be felt as you rub your fingers along the back of your spine, are removed to create room for removal of the lamina. This releases the pressure over the spinal cord and the nerves. A wedge, made out of bone or metal, is used to hold the lamina in position during the healing process. An intraoperative X-ray is taken to check the positioning of the wedge.

After surgery

Following the surgery, you will be shifted to a recovery room and the vital signs are closely monitored by the medical staff. You may experience slight discomfort, pain at the incision site, neck or back muscle spasms, or other related symptoms after the surgery. Depending on the type of surgery, a cervical or lumbar brace is recommended to offer stability and support during the healing process.

Post-operative care

The incision area should be kept clean and dry. You should refrain from hot tubs, swimming, heavy lifting, driving, and smoking. You can begin doing physical therapy as directed by your doctor. Take medications as prescribed by your doctor. Also arrange a follow-up appointment with your doctor.

Risks

The possible risks associated with laminoplasty surgery may include infection, bleeding, problems with anesthesia, and nerve injury.

You must inform your doctor if the incision site shows signs of infection such as pain, redness, swelling, or alteration in the quantity or smell of the drainage, or if you develop fever over 101° F. Also inform your doctor if you develop bowel and bladder dysfunction or numbness over the genital area.

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