Spine surgery

While studies show that more than half of spine surgeries are unnecessary, there are times when surgery is the best solution. DenverSpine is a spine center of excellence for comprehensive, innovative and patient-centered care of the pediatric and adult spine.

The surgeons at DenverSpine are fellowship-trained—the highest level of training in spine surgery. They are also board-certified and concentrate their practice exclusively on spine surgery. Their expertise includes minimally invasive spine surgery, all common surgical problems in the neck and low back, scoliosis care and surgery, as well as new innovations including total disc replacement. In addition, the surgeons at DenverSpine are already referred some of the most complex spine cases throughout the Denver region and have extensive experience with cervical myelopathy, adult scoliosis and deformity surgery and revision surgery. This experience translates into improved patient care of all spinal problems.

The following is a list of common surgical problems and issues.

Common spine surgeries

Cervical Spine (Neck) | Lumbar Spine (Low Back) | Scoliosis | Spinal Fusion | Artificial disc

Cervical Spine / Neck

Discectomy is the removal of the herniated portion of a disc to relieve The pressure on nearby nerves as they exit the spinal canal. Contrary to myths, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae. An injury, damage from a lifting incident or a twist may cause the jelly center to break through the wall of the disc. When a disc herniates, the jelly center can press on nearby nerves. In the neck, this causes arm, shoulder, scapula and, in extreme cases, spinal cord compression.

Corpectomy

A corpectomy is often performed for patients suffering from multiple levels of cervical stenosis with cord compression. The goal of a corpectomy is complete decompression of the spinal canal when stenosis encompasses more than just disc space and has moved into vertebral bodies.

Bone spurs forming toward the back of a vertebral body or the ligament behind vertebral bodies can cause the cervical spinal canal to narrow. Therefore, it may be necessary to remove one or more degenerating vertebrae and the discs above and below in order to decompress the spinal cord and nerve roots.

A corpectomy involves a vertical incision in the neck. The middle portion of the vertebra and its adjacent discs are removed to achieve decompression of the cervical spinal cord and nerve roots. A fusion accompanies a corpectomy surgery, using bone harvested from the patient's hip or from a bone bank. This bone graft is used to reconstruct the spine and provide stability.

Anterior Cervical Fusion

A fusion accompanies a anterior cervical discectomy or corpectomy. During fusion surgery, a disc Is removed, and the surgeon inserts a small wedge of bone between two vertebrae to restore disc space. Over time, the two vertebrae "fuse" together into a single solid structure. While this procedure limits movement and flexibility, it also helps relieve relieve neck pain.

Bone graft for the purpose of spinal fusion may be harvested from the patient's hip (autograft bone), from a cadaver bone (allograft bone), or from synthetic bone graft substitutes, which are currently being developed more extensively. Your surgeon will help you decide what is best for you.

Laminoplasty A laminoplasty, similar to a laminectomy, is often performed on patients suffering from spinal stenosis in the neck (narrowing of the cervical spinal canal). It is also referred to as an "open-door laminoplasty." A laminoplasty creates more space for the spinal cord and roots. The actual procedure involves cutting a “hinge” into one side of the lamina and swinging it open like a door. It relieves pressure on the spinal cord by increasing the diameter of the spinal canal and room for the spinal cord. The surgery approach is through the back of the neck. This procedure creates excellent spinal canal decompression without the instability that may be created by multiple level cervical laminectomies. [Top]

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Lumbar surgery/low back

Microdiscectomy / Minimally invasive discectomy
Discectomy is the removal of the herniated portion of a disc to relieve the pressure on nearby nerves as they exit the spinal canal. Contrary to myths, the disc does not slip out of position like a watermelon seed. Instead, the disc is like a jelly donut, acting as the functional shock absorber between two bony vertebrae. An injury, damage from a lifting incident, or a twist may cause the jelly center to break through the wall of the disc. When a disc herniates, the jelly center can press on nearby nerves. This causes back or leg pain when the hernation is in the low back, and arm pain if the disc is in the neck area (see "cervical spine/neck").

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

The surgeon can remove the damaged piece of disc through a traditional incision in the back. However, at DenverSpine, the surgeons typically use a microscope to minimize incision size, tissue trauma and recovery time. In addition, in some cases, minimally invasive discectomy can provide an even less invasive approach.

Depending on the nature of your disc problem, your surgeon will recommend the most appropriate type of surgery for you.

Anterior lumbar interbody fusion (ALIF)
In this type of spinal fusion surgery, back muscles and nerves remain undisturbed. The space between discs is fused by approaching the spine through the abdomen. This procedure is used when the spine is relatively stable, when there's a significant amount of disc space collapse, and in cases of one or two level degenerative disc disease. The surgeon will approach the abdomen through an incision (minilaparotomy) or by using an endoscope.

Posterior lumbar interbody fusion (PLIF)
This spinal fusion surgery is very similar to the anterior lumbar interbody fusion, except that the surgeon approaches the spine through the low back. This method is used when there is a greater amount of instability in the patient's spine. An advantage to this surgery is that it can also provide anterior fusion of the disc space without having a second incision.

Lumbar laminectomy
A laminectomy involves the removal of part or all of the bone covering the spinal canal. The purpose of this procedure can be to free nerve roots, remove a tumor, bone spur or to perform certain types of fusion procedures. Removing the lamina (laminectomy) is much like removing the cover on a fuse box to access the wiring. By removing the lamina, the surgeon gains access to the disc area and frees more space for the nerves inside.

A laminectomy in the lumbar spine is often used to treat recurrent disc herniations or where scar tissue is involved. Laminectomy may also be used in cases of spinal stenosis in which the entire canal is narrowed like a ring on a swollen finger, squeezing all of the nerve roots at that level of the spinal canal.

Lumbar disc replacement / artificial disc
In October 2004, the FDA approved total disc replacement (artificial disc), also called total disc arthroplasty. Some patients with degenerative disc disease who previously were candidates for spinal fusion may benefit from this motion-sparing technology.

The surgeons at DenverSpine are not only trained in the implantation of the lumbar artificial disc, they are also involved as a clinical trial site in the FDA's pending approval of a cervical artificial disc. Surgeons at DenverSpine are committed to the clinical expertise and technical precision that this new technology demands.
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Scoliosis and spinal deformity surgery Through the placement of hooks, rods and screws, a spinal curve can be corrected and stabilized. A fusion often follows scoliosis surgery, in order to maintain the correction permanently. Scoliosis is not the result of an injury and usually appears without cause. It can be inherited, and it usually affects more women than men. In the case of most spinal curves, the spine is not only bent but also twisted like a bent corkscrew. Some cases of scoliosis are not serious. Over time, if a curve worsens, surgery may be required to correct the curve and prevent pain and worsening deformity. In extreme cases, if the curve is not corrected, the spinal deformity can place pressure on internal organs, which can shorten a person's life expectancy. During scoliosis surgery, the surgeon may use special instruments that attach onto various vertebra segments. These surgical rods are the adjusted to "de-rotate" the twisted and bent corkscrew spine. Decades ago, Harrington Rods (the “first-generation” of instrumentation) were used to surgically straighten the spine. However, this technique did not untwist or correct the spine. Today, there are “fourth-generation” techniques to improve corrections, minimize levels fused and minimize the need for post-operative bracing. [Top]

Spinal fusion

Unusual movement at a vertebral segment will probably result in pain, especially if the person already has or displays symptoms of degenerative disc disease, fractures, scoliosis or a weak spine. This movement may require a discectomy and subsequently a lumbar interbody fusion. Anterior and posterior fusion techniques can be performed in the neck and the low back.

Not all patients who have spinal problems need spine surgery. They can be managed with microscopic decompression or minimally invasive techniques. Spinal fusion is reserved for patients who have spinal instability, spinal deformity or painful degenerative pain. Obviously, this is only after a patient has failed all conservative measures. In fusion surgeries, the goal is to cause bone graft to grow between two vertebrae and stop the motion at a particular segment by adding bone graft to it. This results in one long bone rather than two separate vertebrae. Anterior and posterior lumbar fusions may be done separately or can be used together for the most severe problems of the cervical (neck), thoracic (chest level) and lumbar spine (low back). Your spinal surgeon will help you decide which technique is right for you.
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Artificial disc implantation

DenverSpine is one of the first sites in the state to become authorized and trained to perform artificial disc implants. Surgeons must complete specific training and become certified in order to perform artificial disc procedures. DenverSpine is also involved in clinical studies related to cervical (neck) artificial disc implantation.

Low Back Artificial Disc
Perhaps the most anticipated advance in spine surgery over the past 20 years is the arrival of the artificial disc, which received formal approval by the Food and Drug Administration (FDA) for widespread use in the United States on October 26, 2004. It is intended for use in patients with low back pain who would otherwise receive a fusion surgery.

The artificial disc is projected to have a dramatic impact on the field of spine, just as the introduction of the artificial joint had for those with damaged knee or hip joints. Before the introduction of the artificial knee or artificial hip, these joints often had to be fused. However, thanks to artificial joint implants, thousands of people each year regain the ability to walk. Finally, this new technology is being brought to the field of spine.

The Artificial Disc for the Neck
Because of the weight of the body and the rotational stress that the trunk places on discs in the low back (lumbar) area, more stress is placed on artificial discs in the lumbar area vs. the neck (cervical) area, which only supports the weight of the head. Consequently, many surgeons anticipate FDA approval of new artificial discs for the cervical area, as wear and tear on an artificial disc in the neck area may be less than a lumbar artificial disc.

A second issue relates to the ease of the artificial disc surgery and any necessary revision surgery to replace a worn out artificial disc. Because the surgeon must access the front of the spine, an incision is made in the abdomen for lumbar discs and in the front of the neck for cervical discs. Generally speaking, access to the cervical discs can be easier than the lumbar discs.

During a fusion procedure, the damaged disc is typically replaced with bone from a patient’s hip or from a bone bank. Fusion surgery causes two vertebrae to become locked in place, putting additional stress on discs above and below the fusion site, which restricts movement and can lead to further disc herniation. An artificial disc replacement, however, is designed to duplicate the function level of a normal, healthy disc and retain motion in the spine.

Some experts estimate that over the next 10 years, more than half of patients who would otherwise receive a fusion will receive an artificial disc instead. Educated consumers nationwide are expected to migrate towards regional spine centers of excellence for access to this latest technological advance in spine care.

Why the Artificial Disc is Big News
The arrival of the artificial disc is tremendous news because of the widespread incidence of degenerative disc disease. A natural byproduct of aging occurs through the loss of resiliency in spinal discs and a greater tendency to herniate, especially when placed under a heavy load, like when we lift heavy objects. Additionally, some people have a family history of degenerative disc disease, which increases their risk of developing it.

When a natural disc herniates or becomes badly degenerated, it loses its shock-absorbing ability, which can narrow the space between vertebrae. In fusion surgery, the damaged disc isn’t repaired but rather is removed and replaced with bone that restores the space between the vertebrae. However, this bone locks the vertebrae into place, which can then damage other discs above and below.

A common aspect of all artificial discs is that they are designed to retain the natural movement in the spine by duplicating the shock-absorbing and rotational function of the discs Mother Nature gave us at birth. Most artificial disc designs have plates that attach to the vertebrae and a rotational component that fits between these fixation plates. These components are typically designed to withstand stress and rotational forces over long periods of time. Still, like any manmade material, they can be affected by wear and tear.

Manufacturers of artificial discs aim to design discs that are not only resistant to wearing out but that are easily replaced if revision surgery is needed. While artificial disc surgery is still relatively new, the potential benefits are very encouraging for those with degenerative disc disease.

Benefits
Generally speaking, those who receive artificial disc replacements return to activity sooner than traditional fusion patients. Because there is no need to harvest bone from the patient’s hip, there is no discomfort or recovery associated with a second incision site. Some of the overall benefits of artificial disc surgery include:

1. Retains movement and stability of the spine
2. Prevents degeneration of surrounding segments
3. No bone graft required
4. Quicker recovery and return to work
5. Less invasive and painful than a fusion
6. Reduces pain associated with disc disease

This is also a concern with the artificial disc. Unlike knee and hip replacement patients who are typically in their 50s or 60s, many patients can benefit from artificial disc technology at a much younger age — in their 20s or 30s. Therefore, the implantation of an artificial disc in younger patients can raise a surgeon’s concern about the potential life span of the artificial disc in the spine and the need for revision surgery to replace a worn-out artificial disc, which can be complex.

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