Spine Surgery at Spine Colorado

What You Need to Know
The overall goal of spine surgery is to get to the root of the problem, while at the same time causing the least amount of disruption to the patient’s lifestyle. Spine surgery is typically a choice of last resort, after all non-surgical methods have been exhausted, or when problems like severely herniated discs or damaged vertebrae simply will not respond to non-surgical treatments. While studies show that more than half of back surgeries are unnecessary, there are times when surgery is the answer.

When surgery is the right course of action, it is essential for you to play an active role in selecting the best spine surgeon for you. You should look for a surgeon that specializes in spine problems rather than one that spends time treating patients with other needs, such as head, knee and shoulder injuries. As with anything else, practice makes perfect. The more a person does something, the better they get at it. The ideal spine surgeon is one who is fellowship-trained, spine-specialized and proficient in minimally invasive techniques.

Lumbar Discectomy
Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary to popular belief, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae.

An injury or damage from a lifting incident may cause the jelly center to break through the wall of the disc. When the disc herniates, the jelly center can press on nearby nerves. This causes back or leg pain when the herniation is in the low back, and arm pain if the disc is in the neck area.

In a lumbar discectomy, the surgeon typically only removes the portion of the disc that is causing a problem, not the entire disc. If you have a herniated disc, keep in mind that a disc has a purpose. When you remove a disc, it may cause instability in the joint, and a surgeon may recommend a fusion to re-stabilize the area.

The surgeon can remove the damaged piece of disc through a traditional incision in the back or neck or with a surgical probe, such as in percutaneous discectomy.

Depending on the nature of your disc problem, your surgeon will recommend the most appropriate type of surgery for you.
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Cervical Discectomy
Cervical is the medical term for ‘neck.’ Just as in a lumbar discectomy, the surgeon will remove a piece of damaged disc tissue in the neck area to relieve pressure on the spinal cord or nerve roots. In some cases, by removing a piece of the shock-absorbing disc that separates the two vertebrae, the structures may become less stable. Consequently, when the disc is removed, a surgeon may recommend "fusing" the vertebrae to prevent instability. This fusion surgery may require a second incision in the front of the neck to gain access to the disc area. A cervical discectomy is best left to surgeons who specialize in spine.
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Fusion
Bone is often taken from the hip of a patient during traditional fusion procedures. This process, however, can cause just as much pain and discomfort as the actual surgery itself. An alternate method is the use of Infuse Bone Graft, a bone-growth substance that eliminates the need for harvesting bone from a person’s hip.

Bones contain traces of protein extracts that are required for the bone to heal or regenerate. This substance is called bone morphogenetic protein, or BMP. Scientists have produced a usable form of BMP that is now being used in place of bone harvested from a patient’s hip. Studies have shown that the positive results achieved from surgery using Infuse Bone Graft match that when bone is taken from the hip.

During a fusion surgery, the disc is removed, and the surgeon inserts a small wedge of bone in between the two vertebrae to restore the disc space. Over time, the two vertebrae "fuse" together into a solid structure. While this limits movement and flexibility, it can also help to ease pain.

The decision to fuse or not to fuse can be a complex one. It will probably be based on the surgeon's assessment of two factors: the amount of instability that a discectomy will cause and the amount of disc space that is necessary to restore. If the surgeon opts not to do a fusion, a different follow-up surgery may be recommended.
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Laminectomy
A laminectomy involves the removal of part or all of the bone covering the spinal canal. The purpose of this procedure can be to free nerve roots, remove a tumor, bone spur or to perform certain types of fusion procedures.

Click on image to enlarge.

Removing the lamina (laminectomy) is much like removing the cover on a fuse box to access the wiring. By removing the lamina, the surgeon gains access to the disc area and frees more space for the nerves inside.

During the surgery, a one to two-inch incision is made in the low back. The spine surgeon then chips away the lamina of one or more vertebrae to gain access to the disc area. The surgeon will then remove any fragments that may have broken away from the disc, as well as the area of disc that is herniated and pressuring a nerve root. The entire disc is not removed. If it was, you would lose the shock-absorbing function of the disc between the vertebrae. Instead, the surgeon typically removes the part of the disc that has ruptured outward, along with another 10 or 20 % of the disc, in order to prevent future problems from arising.

A laminectomy is often used to treat recurrent disc herniations or wherever scar tissue is involved. Laminectomy may also be used in cases of spinal stenosis in which the entire canal is narrowed like a ring on a swollen finger.
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Rhizotomy
Rhizotomy is a procedure in which the physician may use heat or cold to intentionally damage the ability of a problematic nerve to telegraph pain signals to the brain. While pain signals serve to warn us about danger or injury, sometimes a nerve can end up in a "stuck" position, sending a continuous pain signal to the brain.

"Neuroablation" is another word used to describe the surgical procedure to purposely inhibit the nerve's ability to transmit a pain signal. During the procedure, the spine surgeon can destroy the problematic nerve by cutting it or by using extreme heat or cold. This intentional "short circuit" can be temporary or permanent, depending upon the procedure.

Trying to mask this signal with drugs can have damaging long-term implications. Drugs can have dangerous side effects to internal organs. By using rhizotomy, the pain signal is turned off at the source.
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Scoliosis Surgery
Through the placement of hooks, rods and screws, a spinal curve can be corrected and stabilized. A fusion often follows scoliosis surgery, in order to maintain the correction permanently.

Scoliosis is not the result of an injury and usually appears without cause. It can be inherited, and it usually affects more women than men. In the case of most spinal curves, the spine is not only bent but twisted like a corkscrew.

Some cases of scoliosis are not serious. Over time, if a curve worsens, surgery may be required to correct it. In extreme cases in which the curve is not corrected, spinal deformity can place pressure on internal organs and shorten a person's life expectancy. (Learn more about scoliosis)

During scoliosis surgery, the surgeon may use special instruments that hook onto various vertebra segments. These surgical rods are the adjusted to "de-rotate" the twisted and bent corkscrew.

Decades ago, Harrington Rods were used to surgically straighten the spine. However, this technique did not untwist or correct the spine. Current state-of-the-art instrumentation achieves much better spine correction than older rods did.

Generally speaking, the younger the patient, the more flexible the spine and the better the result from scoliosis surgery. As the patient becomes older, say over 40 years old, the spine is less flexible, and there may be a greater risk involved in attempting to correct the curve. Because the spinal cord is involved, only spine surgeons who specialize in scoliosis should perform scoliosis surgery.
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Dorsal Column Stimulation
Dorsal column stimulation, also known as spinal cord stimulation, is used in complex cases of back pain that cannot be resolved non-surgically or with another surgery. In most cases, it is used when leg pain is worse than back pain. The intent of dorsal column stimulation is to use an electrical signal instead of drugs to mask pain that cannot be removed any other way.

During this procedure, the patient is awake, and the surgeon delicately places tiny electrodes under the skin in the back. At that point, a tiny electrical current is transmitted through the wires to the desired location in the back. This sensation feels like a tiny tickle, as the electrical current interrupts the pain signal that may be sent to the brain from the damaged nerve. The patient helps instruct the surgeon as to which electrical setting and placement of wires produces the most pain relief. It is important to note that this technique is only used in the most extreme cases of back and leg pain.
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