Surgical Interventions for the Spine

Laminectomy/Laminotomy
Spinal surgery usually involves either a laminectomy or laminotomy, or the removal or partial removal of a bony part of the spine called the lamina. During a laminectomey, the bone, or lamina, is removed to allow access to the damaged parts of the spine, such as an injured disc, where surgery is needed. The removal of the bone also often relieves the pressure on the nerve. A laminotomy removes just a protion of the lamina. It is performed when the surgeon needs to have access to only a small part of a slightly damaged disc.

Discectomy
When a disc becomes damaged, it often bulges or herniates,(often called a slipped disc), and no longer remains inside the protective ring of the disc. When this occurs, pressure on the nerves can result. For people with a disc problem, the surgeon forms a window in the torn portion of the outer rings of the disc to allow access to the disc nucleus. The damaged nucleus is then removed, relieving pressure on the nerves. Some surgeons perform what is termed a microdiskectomy, which may require the removal of only a small portion of the bony lamina and the disc.

Spinal Fusion
As the tissues that protect and support the spinal column and nerves become stretched, flattened or otherwise damaged, the vertebra can slip back and forth, creating instability in the spine. For people with instability, a fusion may be necessary to provide protection for the spinal cord and exiting nerves. A fusion involves the joining, or fusing, of two adjacent vertebrae by using bone grafts. Bone-like grafting materials, and metal instruments such as screws, wires, clips, or plates are often used to enhance postoperative stability of the spine.

Cervical Fusion
Fusing vertebrae in the cervical curve may be necessary to stabilize the spine, reducing movements that may cause neck or arm pain. Fusion of the spine occurs when two or more vertebrae are fused, or joined together. Cervical fusion is usually done through an incision in the front of the neck. It may sometimes be done through the back of the neck, or through both the front and back. The surgery generally takes 1 to 4 hours.

The Fusion Procedure
These steps apply to fusion from the front of the neck (anterior cervical fusion):

• The disk is removed from between the vertebrae.
• Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
• To help keep your spine steady and promote fusion, extra support may be used.
• The incision is closed with sutures and/or staples.

If Extra Support is Needed
Metal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Your surgeon may use one or more types of support, which may include plates, screws or hooks.

Anterior Lumbar Fusion
Fusing vertebrae in the lumbar spine may be necessary to stabilize the spine, reducing movements of the vertebrae which may impinge on nerves and cause back or leg pain. Anterior lumbar fusion is done through an incision in your stomach area. Depending on how many vertebrae are fused, the surgery may take 3 to 8 hours.

The Fusion Procedure

• The disc is removed from between the vertebrae to be fused.
• Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
• To help keep your spine steady and promote fusion, extra support may be used.
• The incision is closed with sutures and staples.

If Extra Support Is NeededMetal supports called instrumentation may be used to help steady your spine while it fuses. These supports are not removed. Your surgeon may use one or more types of support, including cages, screws, plates or hooks.

Posterior Lumbar Fusion
Posterior lumbar fusion is done through an incision in your back. Depending on how many vertebrae are fused, the surgery may take 3 to 8 hours.

Fusing the Transverse Processes

• Bone graft is packed between the transverse processes ("wings") on the sides of the vertebrae. Occasionally, other nearby parts of the vertebrae are fused as well.
• To help keep your spine steady and promote fusion, extra support may be used.
• The incision is closed with sutures and staples.

Fusing the Disk Space

• The disc is removed from between the vertebrae to be fused.
• Bone graft is packed into the now-empty space between the vertebrae. In time, the graft and the bone around it will grow into a solid unit.
• To help keep your spine steady and promote fusion, extra support may be used.
• The incision is closed with sutures and staples.

If Extra Support Is Needed

Metal supports called instrumentation may be used to help steady your spine while it fuses. Your surgeon may use one or more types of support. Below are two common types of support used with posterior lumbar fusion:

• A cage may be used when fusing the disc space.
• Screws and rods may be used when fusing the transverse processes. In rare case, these supports may be removed after fusion is complete.

Kyphoplasty
Kyphoplasty is a minimally invasive procedure for osteoporotic patients with one or more vertebral fractures. Kyphoplasty is designed to reduce pain and restore the height of the fractured vertebra, resulting in a reduction of the curvature/deformity of the spine due to osteoporosis. During kyphoplasty, the surgeon inflates a small balloon inside the fractured vertebral body, creating a cavity inside. The balloon is then removed and the cavity is filled with a material which hardens, stabilizing the fracture and allowing almost immediate mobility.

Kyphoplasty is designed to provide

• Significant pain relief
• Stabilization of the fracture
• Deformity correction by re-establishing some or all the lost vertebral body height
• Reduction in lumbar and thoracic spinal deformity (including kyphosis).