At Advanced Neurosurgery Associates, we offer a full spectrum of spinal surgery techniques from minimally invasive to complex open procedures. In many cases these surgical procedures can use fusion to correct problems with the vertebrae by fusing together the small bones that are causing pain so they can heal into a single strong bone. Fusion can be done with or without instrumentation, which is using medical devices such as rods, plates or screws to improve the success of spinal fusion.
The following brief explanations of spinal terminology will help you understand some of the technical terms related to different spinal surgical services based on various degrees of surgical complexity.
Minimally invasive spinal surgery is a specialized technique where our skilled neurosurgeons use specialized instruments such as a tubular retractor system to expose the spine for surgery, allowing much smaller incisions. Sometimes, several incisions are used rather than one in the center of the spine. Once the spine is surgically exposed in this fashion, the procedure may involve a microsurgical phase for decompression of the spine. Hardware implementation and fusion might then be performed. It is important to discuss, in detail, your personal expectations and your individualized needs with your neurosurgeon and to decide together if this type of treatment is your best option.
Sometimes a marketing concept of minimally invasive surgery is to state that it allows for the avoidance of “cutting muscle.” This is not accurate, as muscle in general should never be cut even in large open operations. Instead, muscle is preserved and the connective tissue plane between different muscles is developed, or muscles may be separated from a portion of their bony attachment, or sometimes, in either minimally invasive or open surgery, muscle is spread along the direction of the fibers, preserving its structure.
Sometimes our spine specialists use an endoscopic approach for a spinal surgery, using an endoscope, a small flexible tube with a camera to assist with the surgery through a minimally invasive surgical approach. In general, we favor this most in the thoracic spine, or the upper and middle back area, to avoid a larger operation that involves a large chest wall incision. Using any minimally invasive approach can shorten the hospital stay and improve recovery significantly. The disadvantage to all endoscopic surgery is that the surgeon has only 2-D vision provided by an endoscopic camera as compared to the 3-D vision of the operating surgical microscope. It is, therefore, a technique that we generally use for special procedures, rather than routine use. Sometimes we may also use an endoscopic-assisted approach in which the endoscope is used to allow the neurosurgeon to see with an angled lens in directions otherwise not possible.
This has been called the “gold standard” operation for treatment of lumbar disc herniation. While there are variations in how this might be performed, we use a small incision, sometimes as small as 18-26 mm, depending on a patient’s body build. We use X-ray localization in a similar fashion to the minimally invasive technique, which allows precise placement of a small incision. It is important to know that the incision we use for this technique is almost always smaller than what is used for the minimally invasive technique, which requires a skin incision of at least 30 mm to allow introduction of the 28 mm tubular system.
In general, all of our procedures use as small an incision as possible and use X-ray localization at the start of the procedure to plan the incision and place it in precisely the right location to allow minimizing its size. Most lumbar fusions would be in the minimal incision or mini-open category.
A laser is an alternative method of cutting tissue that uses focused energy of particular frequencies. A skilled and seasoned surgeon’s most valuable asset is years of development of microsurgical eye-hand coordination and a sense of how much manipulation of tissue can be done safely.
Sometimes patients have pain related to a nerve root being pinched. This may be from a herniated disc or a bone spur. By understanding the details of each patient’s history, performing a neurological exam and looking at specialized imaging studies, your neurosurgeon may determine that your symptoms of pain, numbness or weakness may be related to compression. Decompressive surgery often involves a laminectomy, or the process of enlarging your spinal canal to relieve pressure on the spinal cord or nerves by removing the arch of bone on the back of the spine. In the neck, sometimes the disc may need to be removed from the front of the spine.
In some cases, fusion or joining of vertebrae is necessary, usually in conjunction with a decompression, but fusion may also be performed if your spine is unstable and exhibiting abnormal motion. Abnormal motion can be dangerous to your spinal cord or nerve roots and may be from degenerative changes, referred to as spondylosis. Sometimes it may be due to congenital problems such as a non-union on bone (spondylolysis) and slippage of a lumbar vertebra on another, which is called spondylolisthesis.
A fusion means bone graft is used to cover a portion of your spine that will fuse with the spine and create a new mass of bone that will prevent movement. Hardware is usually implanted to stabilize the spine during the early phases of healing of the bone. If the bone fuses, the hardware will usually last indefinitely. If the bone graft does not fuse with the spine, persistent pain and hardware failure could result. This may lead to the need for more surgery.
Certain factors can restrict successful bone fusion. For optimal results, individuals can alter these factors for more successful bone graft fusion, including smoking cessation prior to surgery, optimizing their weight and control of diabetes.
While the term pinched nerve is commonly used to refer to a spinal nerve root, sometimes a peripheral nerve may be compressed in another area. This would include carpal tunnel syndrome, in which the median nerve is compressed at the wrist leading to numbness of usually the first three fingers and sometimes weakness. The ulnar nerve can be entrapped at the elbow producing cubital tunnel syndrome, which causes numbness of the fourth and fifth fingers and sometimes weakness.
To schedule an appointment with our brain and spine experts at Advanced Neurosurgery Associates, call 678-312-2700 so that our staff can readily assist you.