Surgical Options
When surgery is necessary, Dr. Chin will ensure that you receive the most thorough and advanced care available. His surgical technique is constantly being refined through his ongoing research and continuing education. If you decide to have surgery, you can help make it a success. Be sure you know what to expect, be prepared, and plan ahead for your surgery. Have realistic expectations about what surgery can do for you and follow Dr. Chin’s instructions.
Microdiskectomy and Diskectomy
In a microdiskectomy spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.
A diskectomy is the removal of a herniated disk in order to relieve pressure on a nerve root. The first step is to remove a portion of the lamina of the vertebra. The lamina is the portion of the vertebra that forms the roof over the spinal nerves. Removing a portion of the lamina creates a window into the spine. The nerves are then pulled to the side so that the herniated disk can be seen. Small instruments are then used to remove the herniated disk material. Most of the nucleus pulposus is removed to prevent the disk from herniating again. Once the disk material is removed, the nerves are free of pressure and irritation.
Laminectomy and Laminotomy
A lumbar laminectomy is a surgical procedure that is performed to alleviate pain caused by neural impingement. The laminectomy surgery is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root to give the nerve root more space and a better healing environment.
To alleviate the pain of a ruptured or herniated intervetebral disc, a Laminotomy may be performed. This surgical procedure is carried out in two steps beginning with the laminotomy. Lamina is the Latin name given to the bone protecting the spinal canal, and otomy means opening or hole. The laminotomy simply opens up the spinal canal in order to visualize the pinched nerve root.
Fusion
Fusion is a surgical technique in which one or more of the vertebrae of the spine are united together ("fused") so that motion no longer occurs between them. The concept of fusion is similar to that of welding in industry. Spinal fusion surgery, however, does not weld the vertebrae during surgery. Rather, bone grafts are placed around the spine during surgery. The body then heals the grafts over several months - similar to healing a fracture - which joins, or "welds," the vertebrae together. The ultimate goal of fusion is to obtain a solid union between two or more vertebrae. Fusion may or may not involve use of supplemental hardware (instrumentation) such as plates, screws and cages. Instrumentation is sometimes used to correct a deformity, but usually is just used as an internal splint to hold the vertebrae together to while the bone grafts heal. Spinal Fusion Educational Information
Cervical Fusion
Anterior Cervical Decompression and Fusion is done either by removing the discs
(ACDF-Anterior Cervical Discectomy and Fusion) between two vertebra or by removing
the vertebral body and the discs above and below (corpectomy) then placing bone
graft or a cage between the remaining vertebral bodies. A plate with screws is then
applied to hold the vertebra from moving to allow fusion from one vertebrae to the
next. Post-op patients wear a collar for 6 weeks.
Posterior Cervical Fusion is done through an incision in the back of the neck. Screws
are used to fuse the spine anywhere from the back of the skull down to the thoracic
spine. Post-op patients wear a collar for 6 weeks.
Thoracic Fusion
Thoracic Fusion is done anteriorly between the ribs or by removing one or more ribs
to access the spine. The surgery is similar to anterior cervical decompression and
fusion. An anterior fusion may be supplemented by pedicle screws in the back through
a separate incision. At times only a posterior approach is needed for decompression
and fusion if the majority of the problem can be treated from a posterior approach,
such as in a benign tumor. Postoperatively, a brace is used for up to 3 months.
Patients are allowed to walk as soon as they can tolerate walking but should wear
the brace at all times when walking. They may remove the brace for sitting, lying,
or showering.
Lumbar Fusion
Posterolateral Fusion (PLF) is a procedure that places bone between the transverse
processes. Usually screws are placed into the pedicles along the sides and connected
by a titanium rod. The bone graft is either taken from the patient or from donated
bone that is treated to prevent infection or rejection by the body. Posterolateral Fusion can be done through
MIS.
Interbody Lumbar Fusion (LIF) is a procedure designed to attempt to eliminate instability
of the back due to degenerative discs and facet joints that cause unnatural motion,
pain, pinched nerves and spondolisthesis (slipping of one vertebrate over another.
Fusion is accomplished by removal of most of the intervertebral disc to prepare
the adjacent ends for implantation of the intervertebral spacer to restore disc
height and spinal alignment and bridge the space and fuse the joint. Interbody Lumbar Fusion can be done through MIS.
Instrumentation
The role of spine fusion instrumentation is to provide additional spinal stability
while helping the fusion set up and does not need to be removed.
Various forms of instrumentation have been developed with the goal of improving
the rates of successful spinal fusion. Because bone tends to fuse more effectively
in an environment where there is little motion, instrumentation helps the fusion
set up by limiting the motion at the fused segment.
There are four primary types of spine surgery instrumentation: Facet screws, pedicle
screws, anterior interbody cages, and posterior lumbar cages.
Facet Screws Facet fixation has grown in
popularity as a less invasive means of providing the posterior stabilization necessary
in lumbar fusion cases. This is a fast, simple, and minimally invasive means to
instrument an interbody fusion involving facet fixation. With transfacet fixation,
the screws are inserted posteriorly through the superior side of the facet, across
the facet joint, and into the pedicle
Pedicle screws provide a means of gripping
onto a vertebral segment and limiting its motion. Titanium rods attach to each
pedicle screw to provide overall stabilization
Anterior interbody cages are devices that
are made to be inserted into the lumbar disc space through an anterior (from the
front) approach.
Posterior lumbar cages are also made to
be inserted into the lumbar disc space but are modified to be inserted through
a posterior (from the back) approach.
Revision Surgery
In most cases revision surgery is not due to an error or mistake of a previous operation. Spinal surgery is a complex field, and even the very best and most experienced surgeons do not always get excellent results. Common reasons for revision surgery include such problems as pseudoarthrosis (failure to achieve solid fusion) which may be due to poor tissue healing and guest related factors. Another element to consider is that the spine is a living and dynamic structure. Even after apparent successful surgery, the function and shape of the spine can deteriorate, requiring further surgery to remedy a problem. Revision surgery is a complex field, and each patient must be evaluated and treated in a very individual manner to understand what is causing the problem and how best to address it.
Bone Growth Stimulators are a nonsurgical
treatment of the spine that uses a low-strength pulsed electromagnetic field (PEMF)
to aid in the healing of bone fusions. Treatment time varies and is based upon a
daily therapy schedule, usually 4 hours daily.
Spinal Cord Stimulators have a lead that
is placed within the spinal canal but outside the dura. The stimulator is placed
anywhere around the back, sides, or abdomen where a pocket can be created within
the subcutaneous soft tissues. Pulses from the stimulator may help patients with
chronic pain.
Pain Pumps also have a tube that is placed
percutaneously through the dura. The pain pump is also placed in a subcutaneous
soft tissue pocket. The pain pump gives the pain medication directly within the
spinal fluid. Postoperatively, patients are allowed gradually increased activities.
Wound care is the same as for other spine surgeries.
