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, less than 1 inch, takes about an hour, and is done as an outpatient procedure. Most patient’s usually experience very substantial relief of their leg pain almost immediately after surgery. This surgery can be done with a small retractor, or more frequently using a small tube.
Lumbar laminectomy / decompression: This procedure is similar to a lumbar microdiscectomy, but requires more bone removal. A 1 level decompression is about the same time and same incision size as a microdiscectomy, but more levels require a larger incision to reach and more time. These procedures generally use a small retractor, but 1 and 2 level cases can be done using a small tube.
Anterior cervical discectomy and fusion (ACDF): ACDF is a type of neck surgery that involves removing a damaged disc to relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness, and tingling. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression. It is an excellent operation for those with spinal cord compression, and those with arm pain due to bone spurs. 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 ht back of the neck for patines that have arm pain. 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 artidifficial disc).
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 ned for surgery in the future from the other levels wearing out faster. While considered a better option than ACDF, it is not an option for most older patients, and not when the arthritis is 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.
Pain Procedures: Occasionally, when patients have had previous spinal surgery and have persistent back and leg pain, a spinal cord stimulator can be placed. This is usually in consultation with your pain management physician, and after a successful trial has been performed.