Surgical and Non-surgical Procedures Offered

Discectomy:

The Microendoscopic Discectomy (MED) is a minimally invasive surgical technique used to remove a herniated nucleus pulposus (disc). A disc ruptures when there is a tear in the outer lining (annulus) of the disc. When a tear in the annulus occurs, a fragment of disc material may protrude and pinch surrounding nerves. When a nerve is compressed it can cause symptoms such as extremity pain, numbness, weakness, electrical sensations, and bowel and bladder incontinence. If symptoms are not relieved with conservative treatments, a patient may be a candidate for surgical removal of the herniated disc fragment.

Microendoscopic Discectomy differs from the open microdiscectomy. The incision using the microendoscopic technique is smaller (approximately 1cm), causing less trauma to the surrounding tissue. A smaller incision allows for decreased post-operative pain and a faster recovery. A patient is considered a potential candidate for a microendoscopic discectomy if he or she has a large herniated disc fragment extruded to the side of the spinal canal.

Microendoscopic Discectomy is performed by making a small incision in the patient's back and inserting a small endoscopic probe between the vertebrae and into the herniated disc space. A small camera is placed through the probe enabling the surgeon to view the operation on a TV screen in the operating room. Small surgical devices are placed through the probe to remove bone and herniated disc fragments.

The procedure usually takes about one hour; the patient is often able to return home on the same day. It is normal for a patient to experience postoperative pain, such as back pain, spasms, and lower extremity symptoms. These symptoms will usually improve as the nerve heals and inflammation of the nerve decreases. Patients are given pain medications during the healing process.

Kyphoplasty:

Kyphoplasty is a new, minimally invasive treatment for compression fractures of the spine. The most common cause of compression fractures is osteoporosis. The traditional treatment for fractures within a vertebral body (one of bones of the spine) caused by osteoporosis has included pain reduction medication, bed rest, and bracing. Kyphoplasty offers immediate pain relief and stabilization of the vertebral body. It is also effective in treating pathologic compression fractures.

Compression fractures of a vertebral body not only cause pain but also cause the spine to shorten and fall forward. Many people develop a 'hump back' posture deformity after a compression fracture.

The kyphoplasty procedure uses a balloon to straighten the fractured area of the vertebral body. Once this is achieved, bone cement is injected into this newly formed space to obtain immediate stabilization and maintenance of the upright posture. At the conclusion of the procedure, the spine is better aligned and stabilized and pain is dramatically relieved. Kyphoplasty is done through a quarter-inch incision. Small tubes are placed into the fracture with x-ray guidance. The procedure takes about 45 minutes per fractured vertebra. Blood loss is minimal and patients usually leave the hospital the following day.

Laminaplasty:

This procedure is used to relieve spinal cord compression in the cervical spine. Its most common use is in severe cases in which the spinal cord is compressed at multiple levels. This procedure is very similar to a laminectomy. However instead of completely removing the lamina (bony roof), the lamina is hinged on one side and rotated away from the spinal cord - a procedure similar to cracking open a door. This procedure allows marked expansion of the spinal canal and relieves compression of the spinal cord. It also is a good alternative to an anterior cervical decompression and fusion. The laminaplasty is performed posteriorly and does not involve fusion of the spine. It allows for decompression of the spinal canal while maintaining good stability.

 

Laminectomy:

A laminectomy can be performed on all regions (lumbar, thoracic, cervical) of the spinal column to relieve pressure on the spinal cord or the nerve roots. The lamina is the bony roof of the spinal canal. Laminectomy is the term used to refer to the process of removing the lamina (usually both sides). Removing the lamina increases the size of the spinal canal, giving more room for the spinal cord or nerve roots.

This procedure is also called a spinal decompression. Pressure on the nerve roots or the spinal cord can be caused by bony spurs or by a herniated or bulging disc. This pressure is often referred to as spinal stenosis and can cause pain and weakness. The pressure is relieved by removing the lamina as well as any other source of compression such as bone spurs, a herniated disc, or disc bulges. Decompression of the nerve roots and the spinal cord relieves pain and other symptoms.

Spinal Fusion:

Abnormalities or degeneration ("wearing") of the discs between vertebrae may lead to abnormal motions causing back and or leg pain. If this pain continues following attempts at rehabilitation, surgery may be recommended. Surgical treatments for this pain commonly involve eliminating motion between affected vertebrae by initiating new bone growth, ultimately joining the two vertebrae together. The surgical procedure is generally referred to as a 'spinal fusion procedure'. Generally the procedure is completed to induce new bone growth into the space between the transverse processes (posterolateral fusion) or the vertebral bodies (anterior interbody fusion). The spinal column may be surgically approached via an incision from the back or through the abdomen. A fusion may be attempted either on the front or back side of the spine.

There are different types of spinal fusion:

Anterior Interbody Spinal Fusion
This procedure is performed via an incision in a patient's abdomen. The vertebral bodies are approached from the front and a femoral ring (cadaver bone), or cylindrical cage is placed between the two vertebral bodies. The femoral ring or cage instrumentation is filled with bone graft usually obtained from the patient's hip (iliac crest). If fusion is successful, motion between the vertebrae will stop and any pain caused by abnormal motion between those vertebrae will no longer exist.

Posterior Spinal Fusion
sometimes referred to as a posterolateral spinal fusion, is performed from an incision made in the back. The procedure entails roughening the surfaces of the transverse processes and inserting bone graft between the transverse processes. The bone is usually obtained from a patient's hip (iliac crest). If fusion is successful, motion between the vertebrae will stop and any pain caused by abnormal motion between those vertebrae will no longer exist.

 

Injections:

Epidural
The epidural space is within the spinal canal and surrounds the spinal cord. Steroid injections into this space can help to decrease inflammation of nerves and other soft tissues in the problematic area. These injections are usually given in a set of three for a cumulative effect. They are used for problems such as: Herniated discs, Sciatica, Radiculopathy, Narrowing of the Spinal Canal (Spinal Stenosis), and occasionally for Discogenic Low Back Pain. They can be given in the neck (cervical spine), upper back (thoracic spine), lower back (lumbar spine), and from the level of the tailbone (caudal approach).

Facet Injections
Facet joints are the joints in the posterior portion of the spine. There is one set of two facet joints between each vertebra in the spine. These joints can commonly be affected by arthritis and can cause back pain. Injections of local anesthetic and steroid can be used to relieve this pain.

Selective Nerve Root Blocks/Transforaminal Epidural Injection
Nerve root blocks use medications such as local anesthetics or steroids to disable a specific nerve root that is causing pain. Nerve root injury can often be localized by electrodiagnostic testing, and can be caused by herniated discs, stenosis, facet cysts, whiplash, or hyperextension injuries.

Medications:

Medications for treating back pain include:

STEROIDS
Cortisone, Prednisone, Methylprednisilone (Medrol Dose Pack), Triamcinilone (Kenalog), Celestone, Depomedrol.

NSAIDS (Non-steroidal Anti-inflammatory)
Celebrex, Vioxx, Aspirin, Ibuprofen(Advil, Motrin), Naproxen (Alleve), Diclofenac, Salsalate, Voltaren, Daypro, Indomethicin(Indocin)

OPIATES
Vicodin, Tylenol#3, #4, Percocet (Oxycodone and Tylenol), Percodan, Norco, Lorcet (Hydrocodone and Tylenol), Lortab, Darvocet (Propoxyphene and Tylenol), Darvon, MS Contin (Morphine SO4), Oxycontin (Morphine S04 sustained release), Duragesic Patch (Fentanyl)

MUSCLE RELAXANTS
Robaxin, Soma, Flexaril, Zanaflex, Baclofen, Parafon Forte, Skelaxin

OTHER Elavil (Amytriptlilline), Neurontin, Paxil, Prozac, Zoloft, Remeron Sinequan, Deseryl

Physical Rehabilitation:

The rehab team performs a complete and thorough physical evaluation to assess your level of conditioning as well as nerve, muscle and joint function. The therapist will also evaluate posture, strength, flexibility and endurance. From this evaluation, an individualized treatment plan will be developed, working toward mutually agreed upon goals.

Treatments utilized by the rehab team may include McKenzie-based movements, modalities, electrical stimulation, and traction. The therapist may also perform some hands-on treatment such as soft tissue work, joint mobilization, and manipulation. Exercise also has a major role in therapy at the Spine and Rehab Center. The therapist will instruct you in stretching, strengthening, and self-management strategies and will provide an individualized home program so you can learn to manage your problems by yourself. This will help prevent further injury.

All of the therapists are committed to developing a concise, individualized program for long-term success.