Spine Procedures

Spinal Procedures

Select A Procedure Below

Overview

Anterior cervical discectomy and fusion (ACDF) is a minimally invasive procedure that stabilizes the spine, corrects cervical disease, and relieves symptoms. The procedure provides relief by removing damaged intervertebral discs and by preventing motion around spinal vertebrae that are involved in spinal stenosis, disc degeneration, pinched nerves, and disc herniations. The procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of cervical spine disease can manifest as localized and/or radiating symptoms. Localized symptoms include neck pain, neck stiffness, decreased range of motion, and cracking sounds in the neck with motion. Headaches are also common; they usually start in the neck and radiate up to the back of the head, but can radiate to the front of the head as well.  Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the neck, branching into the shoulders, arms, and hands. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Cervical Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Cervical Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Cervical Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Cervical Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone grinding. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Conservative Alternatives

Most cervical spine disease is initially treated with conservative options. Common treatments include, rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications and steroid injections. Treatments may be used in any number or combination, but surgical options, such as ACDF surgery, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the neck, such as lifting weights or maintain poor posture at a desk. This is generally prescribed for a duration ranging from a shorter duration of several days up to several weeks. It is important to support the neck with certain pillows, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a cervical spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to pinched nerves. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of cervical spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to cervical spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of cervical spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from cervical spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of cervical spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

The ACDF is performed with the patient in a laying on his or her back. An intraoperative x-ray machine is used throughout the procedure to confirm that the correct vertebra/vertebrae are being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made and the muscles on the front of the neck are gently parted. While working to part through the muscles, the vessels of the neck, including the carotid artery and jugular veins are carefully moved out of the surgical field. 

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate. The anterior longitudinal ligament, a large ligament that runs along the spinal vertebrae, is removed to reveal the disc space between the affected vertebrae. The intervertebral disc is removed from this space via a series of biting instruments, until nothing occupies the disc space. After the disc is removed, the spinal cord and nerve roots are visible; compressing disc herniations or bone spurs can be removed to relieve pressure on the nerves and/or spinal cord.

To prepare the disc space for the implant and the fusion hardware, the disc space is drilled to provide a smoother surface and then measured to select an implant that will fit in the space. Once the correct size implant has been chosen, it is filled with bone graft either from the patient or a cadaver, and placed into the empty disc space to create a fusion; the implant is secured into the bone using screws in order to prevent further motion at the spinal level. The implant fit and spinal alignment are confirmed with intraoperative imaging. After placing the hardware, the retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure.        

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the six weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Elevate head of bed: For at least the first week, sleep with the head of bed elevated to a minimum of 30 degrees or sleep in a recliner. The elevation may reduce swelling in the neck due to the natural inflammation process triggered by surgery, easing post-operative pain and making it easier to swallow.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the neck for at least the first six weeks after surgery. This may include driving because checking the blind spot requires turning the head.

Cervical Collar: Some patients may be placed in a soft, foam collar or in a rigid collar at the surgeon’s discretion. Generally, the collar is worn at all times, even during the night, for the first six weeks.  A cervical collar should not be worn while driving as it prevents motion in the neck and would not allow for checking the blind spot before switching lanes or turning.  

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the placement of hardware and the recovery of the incision site for routine healing. If a cervical collar was required, it no longer needs to be worn except if needed for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. High impact activities, such as running, bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (chin to chest) and extension (head tilted back) views of the cervical spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back to work and performing a normal routine. The incision is well healed. 

Overview

Cervical disc replacement is a minimally invasive surgical option that uses implants and other hardware to create a stable spine structure. This surgery provides relief by removing damaged intervertebral discs in patients with diseases of the cervical spine, such as disc degeneration and spinal stenosis. The procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of cervical spine disease can manifest as localized and/or radiating symptoms. Localized symptoms include neck pain, neck stiffness, decreased range of motion, and cracking sounds in the neck with motion. Headaches are also common; they usually start in the neck and radiate up to the back of the head, but can radiate to the front of the head as well.  Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the neck, branching into the shoulders, arms, and hands. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Cervical Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Cervical Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Cervical Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Cervical Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone grinding. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Conservative Alternatives

Most cervical spine disease is initially treated with conservative options. Common treatments include, rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications and steroid injections. Treatments may be used in any number or combination, but surgical options, such as cervical disc replacement surgery, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the neck, such as lifting weights or maintain poor posture at a desk. This is generally prescribed for a duration ranging from a shorter duration of several days up to several weeks. It is important to support the neck with certain pillows, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a cervical spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to pinched nerves. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of cervical spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to cervical spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of cervical spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from cervical spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of cervical spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, physical exam, and imaging to confirm the spinal disease diagnosis, to determine the affected level, and to decide on the type of surgery. Cervical disc replacement is a minimally invasive stabilization procedure used to treat refractory spine disease symptoms in the cervical region.

The cervical disc replacement is performed with the patient laying on his or her back. An intraoperative x-ray machine is used throughout the procedure to confirm that the correct vertebra/vertebrae are being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made and the muscles on the front of the neck are gently parted. While working to part through the muscles, the vessels of the neck, including the carotid artery and jugular veins are carefully moved out of the surgical field. 

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate. The anterior longitudinal ligament, a large ligament that runs along the spinal vertebrae, is removed to reveal the disc space between the affected vertebrae. The intervertebral disc is removed from this space via a series of biting instruments, until nothing occupies the disc space. After the disc is removed, the spinal cord and nerve roots are visible; compressing disc herniation or bone spurs can be removed to relieve pressure on the nerves and/or spinal cord.

The disc space is drilled to provide a smoother surface, measured to select an implant that will fit in the space, and then the correct size implant is placed into the empty disc space. The implant fit and spinal alignment are confirmed with intraoperative imaging. After placing the hardware, the retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure. 

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the six weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Elevate head of bed: For at least the first week, sleep with the head of bed elevated to a minimum of 30 degrees or sleep in a recliner. The elevation may reduce swelling in the neck due to the natural inflammation process triggered by surgery, easing post-operative pain and making it easier to swallow.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the neck for at least the first three weeks after surgery. This may include driving because checking the blind spot requires turning the head.

Cervical Collar: Some patients may be placed in a soft, foam collar or in a rigid collar at the surgeon’s discretion. Generally, the collar is worn, except for at night over the first three weeks.  A cervical collar should not be worn while driving as it prevents motion in the neck and would not allow for checking the blind spot before switching lanes or turning.  

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the placement of hardware and the recovery of the incision site for routine healing. If a cervical collar was required, it no longer needs to be worn except if needed for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. High impact activities, such as running, bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (chin to chest) and extension (head tilted back) views of the cervical spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back to work and performing a normal routine. The incision is well healed. 

Overview

Cervical foraminotomy is a minimally invasive decompression procedure performed to create space around compressed nerves without removing the intervertebral disc, adding an implant, or fusing the spine. This surgery is used to relieve nerve compression caused by foramina narrowing by disc degeneration, disc herniations, or spinal stenosis. The procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of cervical spine disease can manifest as localized and/or radiating symptoms. Localized symptoms include neck pain, neck stiffness, decreased range of motion, and cracking sounds in the neck with motion. Headaches are also common; they usually start in the neck and radiate up to the back of the head, but can radiate to the front of the head as well.  Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the neck, branching into the shoulders, arms, and hands. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Cervical Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Cervical Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Cervical Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Cervical Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone grinding. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Conservative Alternatives

Most cervical spine disease is initially treated with conservative options. Common treatments include, rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications and steroid injections. Treatments may be used in any number or combination, but surgical options, such as a cervical foramintomy surgery, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the neck, such as lifting weights or maintain poor posture at a desk. This is generally prescribed for a duration ranging from a shorter duration of several days up to several weeks. It is important to support the neck with certain pillows, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a cervical spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to pinched nerves. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of cervical spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to cervical spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of cervical spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from cervical spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of cervical spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease diagnosis, to determine the affected level, and to decide on the type of surgery.  A cervical foraminotomy is a minimally invasive decompressive procedure used to treat refractory spine disease symptoms in the cervical region.

The cervical foraminotomy is performed with the patient lying face down. An intraoperative x-ray machine is used throughout the procedure to confirm that the correct vertebra/vertebrae are being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made on the midline of the neck and the muscles on the back of the neck are gently dissected.

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate.  A small portion of the laminae, the backside of the vertebrae, is removed to reach the foramen, vertebral spaces through which nerves branch off of the spinal cord and into the body. The surgeons removes any pieces of disc material or bone spurs that may be compressing nerves using specialized biting instruments and then begins the closing process. The retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin may be closed with either sutures or staples, which are strong enough to hold together the thick muscles in the neck.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure.

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the first six weeks after surgery to protect the spine to ensure a full recovery.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the neck for at least the first six weeks after surgery. This may include driving because checking the blind spot requires turning the head.

Cervical Collar: Some patients may be placed in a soft, foam collar or in a rigid collar at the surgeon’s discretion. Generally, the collar is worn for comfort only.  A cervical collar should not be worn while driving as it prevents motion in the neck and would not allow for checking the blind spot before switching lanes or turning.  

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the alignment of the spine and for routine healing of the incision site. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. High impact activities, such as running, bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (chin to chest) and extension (head tilted back) views of the cervical spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back to work and performing a normal routine. The incision is well healed. CDR

Overview

Endoscopic Discectomy is a minimally invasive decompression procedure performed to create space around compressed nerves without removing the disc, adding an implant, or fusing the spine. This surgery provides relief by removing damaged intervertebral discs in patients with diseases of the lumbar spine such as herniated discs. The procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of lumbar spine disease can manifest as either local or radiating symptoms. Localized symptoms include lower back pain, lower back stiffness, and decreased range of motion. Radiating symptoms are typical on only one side of the body or the other, but can occur on both sides simultaneously. Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the lower back, branching into the buttocks, hips, legs, and feet. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Lumbar Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Lumbar Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Lumbar Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Lumbar Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone rubbing. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Spondylolisthesis: Spondylolisthesis is the shift or slip of a vertebra either forwards or backwards relative to the vertebra above and below. This disrupts the structure and stability of the spine, affecting its ability to stabilize the body. Spondylolisthesis can be caused by a variety of condition, but all of them can cause compression on the nerve roots because an abnormally positioned vertebrae can change the size of the spinal canal, the space that the spinal cord runs through, or of the foramen, the vertebral space through which nerves branch off of the spinal cord and into the body.

Scoliosis: Scoliosis is a sideways curvature of the spine, which can place uneven amount of stress, such as weight or pressure, on other joints (e.g. hips, shoulders) and certain vertebra, leading to unevenness in these joints. Scoliosis can lend to more progressive degenerative changes as there is more pressure on the vertebrae in the curve, as well as more stress on the intervertebral discs.

Conservative Alternatives

Most lumbar spine disease is initially treated with conservative options. Common treatments include rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications, and injections. Treatments may be used in any number or combination, but surgical options, such as endoscopic discectomy, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the lower back, such as lifting weights, poor posture, repetitive bending or lifting.  This is generally prescribed for a short duration ranging from a shorter duration of several days up to several weeks. It is important to support the lower back with certain lumbar supports, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a lumbar spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to lumbar spine disease. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of lumbar spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to lumbar spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of a lumbar spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from lumbar spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of lumbar spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery.  Endoscopic discectomy is a minimally invasive decompressive procedure used to treat spine disease symptoms in the lumbar region.

An endoscopic discectomy is performed with the patient lying on their stomach with the lower back pointed upward.  A specialized intraoperative x-ray machine, a fluoroscope, is available and used throughout the spinal surgery to ensure that the correct vertebra/vertebrae is being operated on.  After locating the proper vertebra, the skin is marked, cleaned, and draped for sterilely.  A small, less than one inch, incision is made on the midline of the lower back.  A guidewire, a long thin metal wire, is place with the guidance of the fluoroscope.  Once the guidewire is at the appropriate position and touching the lamina of the target vertebral body, a series of cylindrical dilators are placed over the wire to gently move the tissue from the surgical field.  When the appropriate dilation is met, a specialized retractor is placed over the dilators and the dilators are removed. The retractor keeps the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back.  Specialized Instruments are placed through the retractor to remove the disc herniation compressing the nerve.  Once the nerve on the target side of the body is decompressed, the retractor is readjusted to evaluate the compression of the spinal nerve on the opposite side.  Any compression on this nerve from disc fragment is also removed.      

Once the nerve roots are decompressed, the procedure is complete and closing may begin.  The retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing. The final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After the procedure is completed, the patient recovers at the surgery center and is typically able to go home within a couple of hours of the procedure.  Prior to discharge home, a patient needs to have pain under control, urinating normally, walking, and tolerating food and beverage.  A friend or family member should be available to drive the patient home and should also be available to monitor the patient for at least 24 hours after the procedure.

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the first three weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the lower back for at least the first three weeks after surgery. This means any tasks that involve bending, lifting, and twisting of the lumbar spine, which includes many house chores.

Back Brace: The surgeon may recommend using a brace though this is not required for all patients and braces can be worn for comfort.  

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the alignment of the spine and for routine healing at the incision site. A brace only needs to be worn for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. Extremely high impact activities, such as bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (bending to touch the toes) and extension (leaning back at the waist) views of the lumbar spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back at work and performing a normal routine. The incision is well healed. 

Overview

Lateral Lumbar Interbody Fusion (XLIF) is a minimally invasive lumbar stabilization surgery performed on the lumbar or thoracic spine to relieve symptoms such as pain or muscle weakness in the lower back and extremities. The procedure treats a span of diseases, including lumbar stenosis, disc herniations, and disc degeneration. This procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of lumbar spine disease can manifest as either local or radiating symptoms. Localized symptoms include lower back pain, lower back stiffness, and decreased range of motion. Radiating symptoms are typical on only one side of the body or the other, but can occur on both sides simultaneously. Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the lower back, branching into the buttocks, hips, legs, and feet. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Lumbar Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Lumbar Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Lumbar Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Lumbar Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone rubbing. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Spondylolisthesis: Spondylolisthesis is the shift or slip of a vertebra either forwards or backwards relative to the vertebra above and below. This disrupts the structure and stability of the spine, affecting its ability to stabilize the body. Spondylolisthesis can be caused by a variety of condition, but all of them can cause compression on the nerve roots because an abnormally positioned vertebrae can change the size of the spinal canal, the space that the spinal cord runs through, or of the foramen, the vertebral space through which nerves branch off of the spinal cord and into the body.

Scoliosis: Scoliosis is a sideways curvature of the spine, which can place uneven amount of stress, such as weight or pressure, on other joints (e.g. hips, shoulders) and certain vertebra, leading to unevenness in these joints. Scoliosis can lend to more progressive degenerative changes as there is more pressure on the vertebrae in the curve, as well as more stress on the intervertebral discs.

Conservative Alternatives

Most lumbar spine disease is initially treated with conservative options. Common treatments include rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications, and injections. Treatments may be used in any number or combination, but surgical options, such as XLIF, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the lower back, such as lifting weights, poor posture, repetitive bending or lifting.  This is generally prescribed for a short duration ranging from a shorter duration of several days up to several weeks. It is important to support the lower back with certain lumbar supports, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a lumbar spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to lumbar spine disease. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of lumbar spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to lumbar spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of a lumbar spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from lumbar spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of lumbar spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery.  XLIF is a minimally invasive stabilization procedure used to treat spine disease symptoms in the lumbar region. Because this procedure is performed between the hip and the ribs, its use is limited to diseases affecting specific lumbar vertebrae unlike a procedure such as Transverse Lumbar Interbody Fusion (TLIF).

The XLIF is performed with the patient lying on their right side with the left side pointed upward. The knees are bent to relax muscles in the spine and special care is taken to position the body to target the affected vertebra. An intraoperative x-ray machine is used throughout the procedure to ensure that the correct vertebra/vertebrae is being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made on the left side of the body and specialized neuromonitoring is used to gently part the psoas muscle in the side until the spine is reached. 

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back. No bone is removed because the vertebrae are approached from the side, but ligament tissue is removed to create access to the affected intervertebral disc, which is then removed with a series of biting instruments.  The empty disc space is measured to select an implant that will fit in the space and intraoperative imaging is used to confirm implant fit and spinal alignment. Once the correct size implant has been chosen, it is filled with bone graft either from the patient or a cadaver, and placed into the empty disc space to create a fusion; the implant is secured into the bone, typically with screws, in order to prevent further motion at the spinal level. Then the retractors are removed from the incision, bleeding is controlled, and a final neuromonitoring check is performed. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure. 

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the six weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the lower back for at least the first six weeks after surgery. This means any tasks that involve bending, lifting, and twisting of the lumbar spine, which includes many house chores.

Back Brace: The surgeon may recommend using a brace though this is not required for all patients. Braces are usually worn for six weeks after the surgery, except while laying down, and are usually made of a soft fabric or a hard plastic. Braces are worn at all times except while laying down for the first six weeks. The back brace serves to protect the hardware (i.e. the implant, screws, and rods) for appropriate healing.

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the placement of hardware and the recovery of the incision site for routine healing. If a brace was required, it no longer needs to be worn except if needed for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. Extremely high impact activities, such as bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (bending to touch the toes) and extension (leaning back at the waist) views of the lumbar spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back at work and performing a normal routine. The incision is well healed.

Overview

Lumbar microdecompression is a minimally invasive decompression procedure performed to relieve pressure from compressed nerves without adding any hardware, implant, or fusing the spine. This surgery provides relief in patients with compressed spinal nerves because of lumbar spine diseases, such as disc herniation or painful bone spur formation. The procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of lumbar spine disease can manifest as either local or radiating symptoms. Localized symptoms include lower back pain, lower back stiffness, and decreased range of motion. Radiating symptoms are typical on only one side of the body or the other, but can occur on both sides simultaneously. Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the lower back, branching into the buttocks, hips, legs, and feet. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Lumbar Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Lumbar Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Lumbar Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Lumbar Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone rubbing. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Spondylolisthesis: Spondylolisthesis is the shift or slip of a vertebra either forwards or backwards relative to the vertebra above and below. This disrupts the structure and stability of the spine, affecting its ability to stabilize the body. Spondylolisthesis can be caused by a variety of condition, but all of them can cause compression on the nerve roots because an abnormally positioned vertebrae can change the size of the spinal canal, the space that the spinal cord runs through, or of the foramen, the vertebral space through which nerves branch off of the spinal cord and into the body.

Scoliosis: Scoliosis is a sideways curvature of the spine, which can place uneven amount of stress, such as weight or pressure, on other joints (e.g. hips, shoulders) and certain vertebra, leading to unevenness in these joints. Scoliosis can lend to more progressive degenerative changes as there is more pressure on the vertebrae in the curve, as well as more stress on the intervertebral discs.

Conservative Alternatives

Most lumbar spine disease is initially treated with conservative options. Common treatments include rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications, and injections. Treatments may be used in any number or combination, but surgical options, such as lumbar microdecompression, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the lower back, such as lifting weights, poor posture, repetitive bending or lifting.  This is generally prescribed for a short duration ranging from a shorter duration of several days up to several weeks. It is important to support the lower back with certain lumbar supports, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a lumbar spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to lumbar spine disease. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of lumbar spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to lumbar spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of a lumbar spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from lumbar spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Exercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of lumbar spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery.  Lumbar microdecompression is a minimally invasive decompressive procedure used to treat spine disease symptoms in the lumbar region.

A lumbar microdecompression is performed with the patient lying on their stomach with the lower back pointed upward.  An intraoperative x-ray machine is used throughout the procedure to ensure that the correct vertebra/vertebrae is being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility.  A small, less than one inch, incision is made on the lower back, either midline, or just off midline to the affected side of the body. The muscles of the back are dissected with as little disruption as possible, until the laminae of the spine is reached, which is the backside of the spine.  Retractors are placed, which keep the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back.  A small amount of the laminae is removed until the appropriate nerve root is exposed.  Specialized biting instruments are then used to remove any element, such as disc fragment or bone spurs, that is placing pressure on the nerve root.

Once the nerve roots are decompressed, the procedure is complete and closing process may begin.  The retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing. The final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After the procedure is completed, the patient recovers at the surgery center and is typically able to go home within a couple of hours of the procedure.  Prior to discharge home, a patient needs to have pain under control, urinating normally, walking, and tolerating food and beverage.  A friend or family member should be available to drive the patient home and should also be available to monitor the patient for at least 24 hours after the procedure.

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the first three weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the lower back for at least the first three weeks after surgery. This means any tasks that involve bending, lifting, and twisting of the lumbar spine, which includes many house chores.

Back Brace: The surgeon may recommend using a brace though this is not required for all patients and braces can be worn for comfort.

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Recovery

Patients are typically evaluated with x-ray imaging to check on the alignment of the spine and for routine healing at the incision site. A brace only needs to be worn for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. Extremely high impact activities, such as bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Recovery

Patients typically undergo x-ray imaging again to get flexion (bending to touch the toes) and extension (leaning back at the waist) views of the lumbar spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back at work and performing a normal routine. The incision is well healed.

Overview

Transforaminal Lumbar Interbody Fusion (TLIF) is a minimally invasive lumbar stabilization surgery performed on the lumbar or thoracic spine to relieve symptoms such as pain or muscle weakness in the lower back and extremities. The procedure treats a span of diseases, including lumbar stenosis, disc herniations, and disc degeneration. This procedure is considered minimally invasive because the surgery is completed through a small incision and by pushing aside muscle tissue rather than by opening the entire back and cutting through muscle tissue as in traditional back surgery.

Related Symptoms

Symptoms of lumbar spine disease can manifest as either local or radiating symptoms. Localized symptoms include lower back pain, lower back stiffness, and decreased range of motion. Radiating symptoms are typical on only one side of the body or the other, but can occur on both sides simultaneously. Radiating symptoms typically occur unilaterally (on one side of the body), but can occur on both sides and will generally follow the nerves in the lower back, branching into the buttocks, hips, legs, and feet. Radiating pain can be described as sharp, shooting, throbbing, electrical, burning, numbness, or tingling and there may be weakness with specific muscle actions.

Related Diseases

Lumbar Disc Herniation: Intervertebral discs provide shock absorption in the spine and are made of a fibrous outer ring, the annulus fibrosis, surrounding a jelly-like inner section, the nucleus pulposus. As repetitive tasks and aging create wear on the annulus fibrosis, small tears create weak spots in the disc and the nucleus pulposus squeezes through, creating a herniated disc and potentially compressing the spinal cord and/or nerve roots.

Lumbar Spinal Stenosis: Spinal stenosis is narrowing of the spine around neural elements, like the spinal cord and nerve roots. Narrowing may occur from a variety of causes, including disc herniation or arthritis. Arthritis and aging can cause intervertebral discs to shrink, narrowing the space through which nerves branch out from the spine; they can initiate bone spur formation, which are bony growths meant to prevent movement at a joint, but can compress a nerve; and they can cause ligaments to grow, which can also compress a nerve.

Lumbar Pinched Nerves: Pinched nerves include the spinal nerve roots that are being compressed because of diseases, such as disc herniation or spinal stenosis.

Lumbar Facet Joint Syndrome: The facet joints connect spinal vertebrae, enabling motion in the spine while also preventing extreme motions. As wear accumulates, the surrounding cartilage begins to thin and the lubricating synovial fluid runs low, allowing bone on bone rubbing. To prevent motion at these areas of friction, the spine starts forming bone spurs, or bony growths, that may press on a nerve directly or cause inflammation of the joint.

Spondylolisthesis: Spondylolisthesis is the shift or slip of a vertebra either forwards or backwards relative to the vertebra above and below. This disrupts the structure and stability of the spine, affecting its ability to stabilize the body. Spondylolisthesis can be caused by a variety of condition, but all of them can cause compression on the nerve roots because an abnormally positioned vertebrae can change the size of the spinal canal, the space that the spinal cord runs through, or of the foramen, the vertebral space through which nerves branch off of the spinal cord and into the body.

Scoliosis: Scoliosis is a sideways curvature of the spine, which can place uneven amount of stress, such as weight or pressure when standing or walking, on other body joints (e.g. hips, shoulders) and certain vertebra, leading to unevenness in these joints. Scoliosis can lend to more progressive degenerative changes as there is more pressure on the vertebrae in the curve, as well as more stress on the intervertebral discs.

Conservative Alternatives

Most lumbar spine disease is initially treated with conservative options. Common treatments include rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications, and injections. Treatments may be used in any number or combination, but surgical options, such as TLIF, are considered if the conservative options do not bring relief.

Rest

Rest in the context of treatment means avoiding activities that put stress on the lower back, such as lifting weights, poor posture, repetitive bending or lifting.  This is generally prescribed for a short duration ranging from a shorter duration of several days up to several weeks. It is important to support the lower back with certain lumbar supports, sitting with support, or laying down. Rest may also include heat therapy with hot showers or heating pads and cold therapy with ice.

Lifestyle Modifications

Certain lifestyle factors may increase the incidence of a lumbar spine disease, such as smoking and increased weight. Smoking decreases blood flow throughout the body which is needed to repair damaged tissues, including those around a compressed nerve. Cessation may restore blood flow, allowing the tissues to access proper nutrition. Added weight may increase the risk for disc herniation which may pinch the nerve, or the acceleration of the aging process, leading to lumbar spine disease. Reducing weight through a low-calorie diet and exercise can reduce pressure on the spine, decreasing the symptoms of lumbar spine disease.

Repetitive leisure or work-related motions such as excessive bending, lifting, and twisting, along with any activity that may be high impact on the spine, such as running or riding ATVs, can also lead to lumbar spine disease. Some of these repetitive task activities may be due to leisure and others due to demands of a job. For people with full labor or heavy-duty jobs, you may need to change jobs or support your work with proper lifting technique, relaxed breaks, and equipment such as a back brace to avoid worsening symptoms. You may also need to alter or avoid high impact activities, such as running to reduce the symptoms of a lumbar spine disease.

Physical Therapy

Physical therapy focuses on changing body mechanics to improve posture and walking as well as to strengthen and retrain muscles, particularly those in the core. The initial step is meeting with a Physical Therapist for a consultation to assess posture, gait, and muscle weakness and to design a personalized exercise program. Other techniques that physical therapists may use are manual treatments such as massage, ultrasound, and electro-stimulation through a TENS (transcutaneous electrical nerve stimulation) unit. A combination of these methods can provide symptom relief.

Alternative Therapy

Alternative therapies include massages, chiropractic care, and acupuncture. These may also be referred to as manual therapies since they address the spine with hands on technique. Massage relieves tension in muscles surrounding the spine and in arm and leg muscles experiencing radiating symptoms. These muscles may be under tension due abnormalities with walking and changes in posture due to pain from lumbar spine disease. Chiropractic care may use specific techniques, such as adjusting the spine or application of traction on the spine. Acupuncture may also provide pain relief as muscles are stimulated electrically.

Home Excercises

A home exercise program may be used in conjunction with or instead of a formal physical therapy regimen. A daily low impact exercise regimen is important for strengthening muscles, especially those in the core. Low impact cardiovascular activities such as walking, swimming, elliptical, and biking are also important for increasing blood flow and strengthening muscles without adding stress on the spine. Home exercise can also lead to weight loss which may reduce pressure on the spine and reduce symptoms. Home exercise routines should be paired with stretches and physician supervision to avoid harm.

Medications

There are multiple types of prescribed and over the counter medications that may be used to treat the symptoms of lumbar spine disease. Some of these medications include Tylenol (acetaminophen), NSAIDs (nonsteroidal anti-inflammatory drugs), muscle relaxants, nerve membrane stabilizers, topical medications, and off label medications.

Epidural Steroid Injections

Epidural steroid injections reduce pain by injecting steroid, or anti-inflammatory, medication at a specific level/levels in the spine. As the herniation places pressure on a nerve, this causes inflammation of the nerve and surrounding tissue which causes pain. A specialized needle is used to deliver medication to the correct area, past the muscles of the back and as close to the spinal nerves as possible. As steroids are a natural anti-inflammatory, this may reduce the inflammation around the nerve, diminishing pain caused by the disc herniation. Steroid injections have the ability to provide pain relief for up to several months, and provide better pain relief for radiating symptoms, such as leg pain, than treatments designed for back pain alone. Steroid injections are only safe to have completed 3 times in one year and must be at least one month apart between sequential injections. This is due to the muscle and tendon breakdown with exposure to the steroid medication too often or too soon. 

Procedure

Preparation for spine surgery begins with a patient history, a physical exam, and imaging to confirm the spinal disease, to determine the affected level, and to decide on the type of surgery.  TLIF is a minimally invasive stabilization procedure used to treat spine disease symptoms in the lumbar and thoracic regions.

The TLIF is performed with the patient lying face down with the lower back pointed upward.  An intraoperative x-ray machine is used throughout the procedure to ensure that the correct vertebra/vertebrae is being operated on. After locating the proper vertebra, the skin is marked, cleaned, and draped for sterility. A small incision, less than one inch, is made on the midline of the lower back.  The muscles of the back are gently dissected until the spine is reached.   

Once the spine is exposed specialized retractors keep the incision open for the duration of the procedure, allowing the surgeon to see and operate without surgically opening the back. A portion of the laminae, the backside of the vertebrae is removed to expose the spinal nerve root and thecal sac (a fluid sac that protects the spinal cord and cauda equina).  The compression from either a disc herniation or bone spurs is removed from the nerves.  After removal of the compression, a specialized instrument, the nerve root retractor, is used to reach the disc space.  A series of biting instruments are used to remove the disc, until the disc space is empty.  

The empty disc space is measured to select an implant that will fit in the space and intraoperative imaging is used to confirm implant fit and spinal alignment. Once the correct size implant has been chosen, it is filled with bone graft either from the patient or a cadaver, and placed into the empty disc space to create a fusion; the implant is secured into the bone, typically with screws, in order to prevent further motion at the spinal level. Then the retractors are removed from the incision and bleeding is controlled. Each layer of tissue is closed with sutures and the final layer of skin is usually closed with a special medical grade glue, which typically leaves less scaring after healing; the final layer may be fully closed with sutures depending on the surgeon’s preference and on the patient’s skin.

After surgery the patient recovers in a post-operative room to make sure that their pain is under control, that they are able to eat and tolerate food and beverage, and that they can walk and urinate properly. They are able to go home within 23 hours of the procedure, but a friend or family member should be available to drive the patient home and to monitor the patient for at least 24 hours after the procedure.

Recovery

Post-Operative Recovery

This procedure is minimally invasive, allowing the patient to get discharged and head home within 24 hours of surgery. There are post-operative instructions to follow the six weeks after surgery to protect the spine and hardware and to ensure a full recovery.

Activity Restriction: Avoid high impact activities, heavy lifting, and repetitive tasks that require range of motion in the lower back for at least the first six weeks after surgery. This means any tasks that involve bending, lifting, and twisting of the lumbar spine, which includes many house chores.

Back Brace: The surgeon may recommend using a brace though this is not required for all patients. Braces are usually worn for six weeks after the surgery, except while laying down, and are usually made of a soft fabric or a hard plastic. Braces are worn at all times except while laying down for the first six weeks. The back brace serves to protect the hardware (i.e. the implant, screws, and rods) for appropriate healing.

Walking: Walking increases blood flow, reduces the likelihood of blood clots, and reduces the likelihood of pneumonia during post-operative recovery.

Proper Nutrition: Proper intake of protein and vitamins (specifically Vitamin A) in the diet is important for healing wounds and tissues after a surgical procedure.

Pain Medication: Take prescribed pain medication only as directed and as long as necessary. Most patients are able to stop taking their prescribed pain medication within one week of surgery. Over the counter medications, such as Acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) may be used as a supplement to or instead of prescribed pain medication.

Six Weeks After Surgery

Patients are typically evaluated with x-ray imaging to check on the placement of hardware and the recovery of the incision site for routine healing. If a brace was required, it no longer needs to be worn except if needed for comfort. The majority of patients will return to work one to two weeks after the procedure, but patients that work physically demanding and labor type jobs should take more time away from work. At six weeks, all patients are able to return to work. Most patients no longer use any prescribed pain medication at six weeks, but may be using over the counter medications as needed. Extremely high impact activities, such as bungee jumping, downhill skiing/snowboarding, or heavy weight lifting, are still discouraged.

Twelve Months After Surgery

Patients typically undergo x-ray imaging again to get flexion (bending to touch the toes) and extension (leaning back at the waist) views of the lumbar spine. These check spinal range of motion and confirm that there is no vertebral sliding because of the implant. All patients are back at work and performing a normal routine. The incision is well healed. 

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If you're living with back or neck pain, it's probably preventing you from spending more time with family and friends, exercising and traveling, or doing the things that you enjoy. Our goal is bring you pain relief with the fastest recovery time and the least invasive treatment so that you can get back to those people and activities sooner.
Fullerton Surgery Center and its team of expert physicians helps people from the Chicagoland community get over their back and neck pain using minimally invasive procedures.