Simple / Outpatient Spinal Surgery
These are surgeries that are very common and straightforward, and usually performed on an outpatient basis. This includes spinal surgery for herniated or bulging discs in the lumbar or cervical spine, as well as surgery for lumbar spinal stenosis (a narrowing of the spinal canal where the spinal cord +/or nerve roots travel), and similar surgeries in the cervical spine.
This type of surgery generally involves making a small incision in the skin, opening a small window in the bone, and relieving nerve root compression by removing a small amount of bone or other tissue over the nerve root, and removing the herniated part of the disc that is compressing the nerve root.
Straightforward spinal surgery is generally indicated for the patient that has primarily extremity pain, and it is felt that the surgery required to relieve the nerve root compression would not destabilize the spine. As with all surgery, it is generally used as a last resort when the patient has failed all conservative treatment options, with the notable exception of a neurologic deficit or impending neurologic deficit. Some common procedures we perform include:
Lumbar microdiscectomy:
This procedure usually involves a very small incision (~20mm), and is performed most often through a tube and using a microscope. The surgery takes about an hour and is done as an outpatient procedure. Most patient’s usually experience substantial relief of their leg pain almost immediately after surgery.
Lumbar laminectomy / decompression:
This procedure is similar to a lumbar microdiscectomy, and is also usually performed using the same incision and approach as a lumbar microdiscectomy, but requires more bone removal. Although a 1 level decompression takes about the same time and has about the same incision size as a lumbar microdiscectomy, more levels require a slightly larger incision and more time.
Anterior cervical discectomy and fusion (ACDF):
ACDF is a type of neck surgery that involves entering from the front of the neck and removing a damaged disc to relieve spinal cord or nerve root pressure to alleviate corresponding pain and / or weakness. An ACDF is an excellent operation for those with spinal cord compression, and those with arm pain due to nerve root compression. For younger patients with arm pain however, a posterior cervical laminforaminotomy or an artificial disc (see below) may be better options. Intraoperative monitoring is usually performed (when cord compression is present) to confirm the integrity of the spinal pathways during surgery.
Cervical Laminoforaminotomy:
This is similar to the lumbar microdiscectmy, but performed in the back of the neck for patients that have arm pain only. Not everyone is a candidate for this type of surgery, but it should at least be considered as a less invasive option to the other more common treatments for arm pain (ACDF and artificial disc).
Cervical artificial disc:
This is an operation that is performed using the same approach as an ACDF, but instead of fusing the disc space an artificial disc is placed. This may reduce the need for surgery in the future compared to ACDF. While considered a better option than ACDF, it is not an option for most older patients, when the arthritis is more advanced.
Sacroiliac Joint Fusion:
Sacroiliac joint pain is a common, often unrecognized source of back pain. While this often improves with non-operative treatments (PT, chiro, pain management), surgery can occasionally be very beneficial.