Specialties

MRI of lumbar spine showing herniated L4-L5 disc (red arrow).

Axial image (cross-section) of lumbar MRI showing herniated L4-L5 disc (red arrow) and compressed right L5 nerve (yellow arrow).

What is Microdiscectomy?

A microdiscectomy is a surgical procedure to remove a herniated disc in the spine.

Discs are round cushions sitting between the vertebrae (bones) of the spine. Discs consist of a gel-like center called the nucleus pulposus, which is encased by a strong tissue called the annulus fibrosus. They act as shock absorbers when we walk and run, and they let us bend and move without our vertebrae rubbing against each other.

Sometimes, whether due to aging or traumatic injury, these portions of these discs can herniate and push out from between the vertebrae. The gel-like center can push through the encasing tissue (annulus fibrosis) and put pressure on spinal nerves or the spinal cord. This can lead to pain, numbness, and weakness in the back, legs, or arms. The goal of the discectomy is to relieve this pressure on the nerves by removing the herniated disc.

Why would someone undergo this procedure?

A herniated disc can often be relieved with conservative treatments such as rest, pain medications, and physical therapy. However, if those non-surgical treatments fail to relieve the symptoms after a period of time (usually a few weeks to months), a discectomy may be considered, especially in the following situations:

• There is so much pain that it hinders moving around and performing daily activities
• Persistent numbness or weakness from the disc pressing on the nerves
• Problems with bladder or bowel control
• Trouble standing or walking

Regardless, discectomy should only be recommended as a treatment option after your doctor completes a number of assessments. These include the patient’s spinal condition, age, activity levels, medical history, etc. Physical examinations and diagnostic tests (X-rays, MRI scans) are often carried out to confirm the diagnosis and rule out any other conditions. Talk to your doctor or contact us to set up an appointment and see if discectomy is the appropriate treatment for you.

How is Discectomy performed?

The patient will have general anesthesia administered so that they are unconscious during the procedure. They will be either lying face down. Once the patient is asleep, the surgeon will make an incision over the affected disc. Muscles and soft tissues are retracted to gain vision and accessibility to the herniated disc. Sometimes bone and ligaments may have to be removed so the surgeon can access the disc without damaging nerve tissue, this is called a laminectomy. For more information on laminectomy, visit this page here.

Once the surgeon has a clear view and enough access, they will remove the section of protruding disc and any other disc fragments. The muscles and soft tissues are put back in place, the incision is closed, and the patient is taken to the recovery room.

What does postoperative recovery look like?

Some patients may feel immediate relief after surgery, but for others it may require time for symptoms to improve. You may feel pain at the incision site as well, but pain medications may be prescribed to help relieve this post-op pain. How long you stay at the hospital will vary but it usually won’t be more than a few days. Most people with jobs that are not physically demanding will be able to return to their normal daily lives after 2-4 weeks. Those whose lives demand more physical labor should expect to return to work after 6-8 weeks or sometimes longer. Regardless, all physical therapy and other treatments prescribed by your surgeon will play a role in your recovery time, do not ignore them.

What are the risks and complications?

As with all surgical procedures, risks and complication can arise and may include but are not limited to:

• Blood loss
• Infection
• Spinal fluid leakage
• Injury to nerve tissue
• Recurrent herniation (another piece of disc extruding from the disc space)

All risks should be discussed with your surgeon before the procedure. You should make an educated and informed decision beforehand, so do not hesitate to ask any and all questions. If you have any questions, comments, or concerns pertaining to the discectomy procedure, contact us through our website to set up an appointment.

Cervical kyphosis

Following surgery to correct kyphosis

What is adult cervical deformity and what causes it?

Adult cervical deformity is a condition in which there is abnormal alignment of the cervical spine (neck).  This can be an abnormal alignment when viewed from the side (“kyphosis”) and/or the front (“scoliosis”).  Cervical deformity has a broad range of causes, including degenerative (due to wear and tear), neoplastic (resulting from tumor), traumatic (from a fracture or injury), autoimmune, infections, congenital (abnormalities present from birth), and neuromuscular disease.  The most common form of cervical deformity is kyphosis (reversal of the normal C-shaped curve of the neck), which can impact the ability to look upright and maintain “horizontal gaze” and produce neck and arm pain and myelopathy.

What are the symptoms?

Symptoms associated with adult cervical deformity are variable and range from mild or none to significant symptoms that can markedly impact quality of life.  Symptoms may include neck and arm pain, myelopathy (spinal cord malfunction), swallowing and breathing difficulties, and loss of horizontal gaze (ability to hold the head upright and look forward).

How is cervical deformity diagnosed?

Cervical deformity is diagnosed based on clinical examination and imaging studies.  On clinical examination cervical deformities may be readily apparent based on how a patient is able to hold his or her head upright when viewed from either the front or from the side.  Clinic evaluation also includes a neurological examination to assess for myelopathy (spinal cord malfunction) and arm and leg strength and sensation.  Imaging studies often include x-rays to assess alignment of the neck and the rest of the spine.  Other imaging studies may be obtained if needed to assess the bone anatomy (CT imaging) or the spinal cord and nerves (MRI).

What treatment options are available?

In the absence of significant or progressive weakness or evidence of rapid worsening of deformity or alignment, most patients are encouraged to at least initially pursue a course of non-operative treatments with the hope that these will be sufficient in providing relief.  These may include physical therapy, pool therapy, targeted steroid injections, and medications such as gabapentin or NSAIDs.

For patients who do not get satisfactory relief with non-operative treatments, surgery may be an option. Since surgeries for cervical deformity tend to be fairly extensive with long recoveries and relatively high risk of complications, these procedures tend to be saved for those who cannot get sufficient relief with other treatments.  The decision of whether to pursue operative treatment for cervical deformity is often very personal.  Patients must weigh the risks and benefits and should have an open discussion with their surgeon.  The good news is that clinical research studies have shown the potential for surgery to provide significant improvement in pain and function for patients with cervical deformity.

If you or a loved one is suffering from cervical deformity, talk to your surgeon or contact us to set up an appointment.

Pre-op sagittal imbalance

After surgical correction

What is sagittal imbalance and what are the causes?

Sagittal imbalance is an imbalance of the spine when looking at it from the side- usually too pitched forward. The spine is supposed to have two normal front to back curves. The thoracic (middle) spine has an outward, kyphotic (forward) curve. The lumbar (lower) spine has an inward, lordotic (backward) curve.

If either of these curves becomes too pronounced or too flat, this can lead to sagittal imbalance. There are two general types of sagittal imbalance:

• Flatback syndrome: The lumbar spine loses its curve and flattens, making the thoracic spine the only curve, causing the person’s center of gravity to go too far forward.
• Kyphosis: The curve of the thoracic spine becomes greater than what it’s supposed to be (usually a curve of ~50 degrees or more), which causes the upper back to round forward and give the person a “hunchback” appearance. You can find out more information on kyphosis on this page.

Flatback syndrome and kyphosis, which result in sagittal imbalance can be caused by:

• Injury
• Congenital birth defects
• Degenerative disc disease
• Neuromuscular conditions such as cerebral palsy or MS
• Surgical fusion of the spine in a flat position

What are the symptoms?

Symptoms can vary depending on the severity, age of the patient, and type of sagittal imbalance. But the most common symptoms include:

• Low back pain
• Difficulty walking
• Disfigured appearance (Ex: hunchback due to kyphosis)
• Inability to continue standing up straight or looking straight ahead when upright

More severe cases of sagittal imbalance may put pressure on the spinal nerves, leading to weakness, numbness, or pain in the back and extremities (arms, hands, legs). There can even be pressure put on the lungs, which can cause difficulty breathing.

How is sagittal Imbalance diagnosed?

The doctor will get a brief history including the medical and family history of the patient, followed by a physical examination. Diagnostic tests such as X-rays, MRI’s, or CT scans are used to gather images of the spine and confirm the diagnosis, while also helping ruling out any other conditions.

If you suspect yourself or a loved one to be exhibiting symptoms of sagittal imbalance, don’t wait for the problem to potentially worsen. Talk to your doctor or contact us through this website to set up an appointment for an official diagnosis.

What treatment options are available?

The treatments will vary based on the patient’s specific condition and the severity of the sagittal imbalance. However, non-surgical treatments aren’t often effective, especially in more severe cases. Regardless, the goal of surgery is to regain overall sagittal imbalance. Regardless, the goal of surgery is to regain overall sagittal balance.

Osteotomy, or bone “cuts”, can help correct the spinal deformity. Osteotomy is combined with use of screws to secure the vertebrae together and keep the spine aligned. This also includes using bone graft to help facilitate the bones healing together to create long-term stability. For more information on spinal fusion surgery, please visit our page here.

If you or a loved one is suffering from sagittal imbalance, or have any questions, comments, or concerns, please contact us through the website to set up an appointment.

Patient with adult idiopathic scoliosis

Following surgical deformity correction

What is adult scoliosis and what causes it?

Scoliosis is a spinal deformity in which the spine curves when viewing it from the front, instead of being in a straight line. This condition can occur in all ages, but we primarily focus on caring for adults who develop this condition.

In adults, there are multiple types and causes of scoliosis.  The most common cause is degenerative disease.  Although it isn’t entirely clear how scoliosis develops with age and degenerative changes, it is thought that asymmetric (more one side than the other) degeneration of the discs between the spinal vertebra and the joints that connect these bones together leads to early curvature, which can then progress.  This type of scoliosis most commonly affects the lumbar (lower back region) or the lower part of the thoracic (chest) region and is referred to as degenerative scoliosis or de novo (“out of no where”) scoliosis.

Adults may also present with scoliosis that is left over from when they were younger that was either not treated or perhaps treated but then developed further problems.  The most common type of this scoliosis is termed adult idiopathic scoliosis.  The most common type of scoliosis in children and adolescents is adolescent idiopathic scoliosis (AIS), which sometimes warrants spinal fusion depending on severity and rate of progression.  Why AIS develops is unknown.  Adults with a history of AIS from when they were younger may present with symptoms as their spines age and accumulate wear and tear.  Adult idiopathic scoliosis most commonly affects the thoracic spine but not uncommonly affects both the thoracic and lumbar spine (double curves).

What are the symptoms?

Symptoms of adult scoliosis can vary but most commonly patients present with pain and disability.  Pain often includes a combination of back and leg (“sciatica”) symptoms.  Sometimes the scoliosis curve results in significant coronal imbalance (shifting of the spine/body off to one side) and may impact the patient’s ability to stand and walk without fatigue and pain.  In some patients affected with adult scoliosis, there may be weakness due to compression of nerves or spinal cord.

How is Scoliosis diagnosed?

First, a brief history will be taken which includes the medical and family history of the patient, followed by a physical examination. Diagnostic tests, which include X-rays (and sometimes MRI and CT), will be completed to confirm the diagnosis, characterize the alignment measurements and to assess for areas of stenosis (narrowing) around nerves and spinal cord.

If you or a loved one are showing symptoms of scoliosis, do not wait. Talk to your physician or contact us through our website to make an appointment for an official diagnosis.

What treatment options are available?

In the absence of significant or progressive weakness or evidence of rapid worsening of deformity or alignment, most patients are encouraged to at least initially pursue a course of non-operative treatments with the hope that these will be sufficient in providing relief.  These may include physical therapy, pool therapy, targeted steroid injections, and medications such as gabapentin or NSAIDs.

For patients who do not get satisfactory relief with non-operative treatments, surgery may be an option. Since surgeries for adult scoliosis tend to be fairly extensive with long recoveries and relatively high risk of complications, these procedures tend to be saved for those who cannot get sufficient relief with other treatments.  The decision of whether to pursue operative treatment for adult scoliosis is often very personal.  Patients must weigh the risks and benefits and should have an open discussion with their surgeon.  The good news is that clinical research studies have shown the potential for surgery to provide significant improvement in pain and function for patients with adult scoliosis.

If you or a loved one is suffering from scoliosis, talk to your surgeon or contact us to set up an appointment.

Pre-op: severe spinal cord compression at C4-6 (red arrows)

Following C4-6 ACDF

What is Anterior Cervical Discectomy and Fusion (ACDF)?

ACDF is a surgical procedure that can treat a herniated disc, stenosis (narrowing), neck pain, and instability in the cervical or neck region, and is performed by approaching the spine anteriorly, or from the front of the neck. An advantage of having it performed from the front is that it provides easier access to the cervical spine, and it may result in less pain and a faster recovery.

The primary goals of the surgery often include removal of the damaged spinal disc, trimming of bony overgrowths that can cause painful nerve compression, and achievement of stability by fusing (healing together) the adjacent vertebrae with bone graft in the space created.

What is Cervical Disc Herniation

The cervical region of the spine (the neck), is made up of 7 vertebrae that are separated by discs that act as shock absorbers. Each disc has two parts, a tough exterior called the annulus fibrosus, and a gel-like center called the nucleus pulposus.

Trauma, or just general wear and tear over time, can damage the disc and cause that gel-like center to herniate or protrude through the tough outer layer. This can put painful pressure on the spinal cord, ligaments, or nerve roots. But that’s not the only way nerve compression can occur. Sometimes it can be caused by bony overgrowths or spurs in the cervical spine. As a result, the patient can experience neck pain, as well as pain, numbness, weakness, and lack of coordination in the arms and fingers.

If these symptoms cannot be resolved through non-surgical means and they are affecting your ability to perform daily activities, then talk to your surgeon or contact us to setup an appointment to see if ACDF surgery is right for you.

How is ACDF surgery performed?

The patient will lie on their back and be put under general anesthesia. Once the patient is asleep, an incision (often horizontal and extending to one side) will be made on the front of the neck. Muscles and other important structures in the neck are carefully retracted to gain access to the surgical area, and the following steps are performed:

1. The affected cervical disc is identified by X-ray imaging.
2. The disc material is surgically removed to decompress and relieve the areas of nerve root and spinal cord compression.
3. Any bone spurs causing the same issue are also removed.
4. The space left from removing the disc is measured to receive the correct size bone graft.
5. The bone graft is prepared and placed in that space. Alternatively, a fusion cage made of artificial material such as titanium or PEEK (polyetheretherketone, an organic thermoplastic polymer) is packed with bone graft and inserted in the space.
6. A metal plate may be screwed into the vertebrae to provide stability
7. Finally, the muscles and other important structures are carefully released from retraction and the incision is closed.

With the help of the bone graft, over time the adjacent vertebrae will grow and fuse together to form a solid piece of bone.

What happens after surgery?

You’ll be placed in a neck brace for stability and comfort, which you will be asked to wear for a specified period of time. You will also be prescribed the appropriate medication for any post-op pain. Smoking and using non-steroidal anti-inflammatory drugs or NSAIDS should be avoided as they can interfere with the bone healing and fusion process. You will be instructed to avoid lifting heavy objects or excessively bending forward or backward. Post-operative exercises can also be provided to safely restore movement as early as possible. Depending on your level of activity and your course of recovery, you may return to work and carry on with your normal life within a few weeks.

What are the risks and complications of this procedure?

As with all surgical procedures, ACDF may be associated with certain risks and complications.  Some of these include:

• Infection
• Blood loss
• Blood clots
• Nerve/spinal cord damage
• Difficulty swallowing
• Hoarse voice
• Bowel and bladder problems
• Failure of the adjacent vertebrae to fuse, which may require an additional surgery
• Accelerated degeneration of adjacent spine levels

If you have any questions, comments, or concerns about ACDF and if whether it’s the right procedure to relieve your condition, talk to your surgeon or contact us to book an appointment.

Grade 2 L4-5 Spondylolisthesis

L4-5 TLIF

What is transforaminal lumbar interbody fusion (TLIF)? 

Transforaminal lumbar interbody fusion, or TLIF, is a type of posterior spinal fusion procedure used to join 2 or more vertebrae in the lumbar region of the spine to relieve pressure on the spinal nerves/cord and to stabilize the spine. Posterior just means that the surgeon approaches the spine from the back, making an incision in the middle of the back that also lines up with the affected vertebrae.

When should TLIF be recommended as a treatment option?

TLIF may be recommended for those suffering from severe lower back or leg pain that non-surgical treatment cannot fix. Most of the time these patient’s symptoms can be associated with the following spinal conditions:

• Degenerative disc disease
• Herniated disc
• Spondylolisthesis (vertebra slipping forward over vertebra below it)
• Spinal stenosis (narrowing of the spine)

How is the TLIF procedure performed? 

1. After anesthesia is administered to the patient, an incision is made in the middle of the patient’s back over the affected vertebrae
2. Muscles and soft tissues are carefully retracted to gain access to the spine
3. X-ray is used to confirm the vertebral levels
4. The lamina and facets (joints) are removed
5. Scrapers and other tools are used to remove the disc between the vertebra, followed by insertion of bone graft and a specialized cage (spacer) inside the space created between the adjacent vertebrae
6. Rods are then affixed to connect the screws and to stabilize the spine
7. After that, the muscles and soft tissues are put back to where they were and the incision is closed

As healing occurs after the procedure, the bone graft fuses with the spine. This stimulates growth of a solid mass of bone which helps in stabilizing the spine.

What does postoperative recovery look like?

Many patients notice early improvements of their symptoms, while others may notice improvements more gradually over time. You may experience discomfort, pain at the incision site, and muscle spasms in the back. Care is taken to try to provide and adjust pain medications to help with these symptoms.

The duration of your hospital stay will vary depending on your recovery. If needed, a brace and pain meds may be prescribed upon discharge to help alleviate discomfort. Although we typically encourage early mobilization, it is best to avoid rigorous activities, heavy lifting, and aggressive bending and twisting while recovering and while the bone is healing.

Smoking and using NSAID’s for pain relief should be avoided as these can interfere with the bone healing and fusion process. We recommend you strictly follow the post-operative instructions given to you by your surgeon to promote healing, reduce possibility of complications, and to facilitate getting back to doing the things you love in life.

What are the risks and complications?

As for all surgical procedures, risks and complications may happen.  Some of these include:

• Infection
• Need for blood transfusion
• Blood clots or blood loss
• Nerve/spinal cord damage
• Bowel and bladder problems
• Adverse reactions to anesthesia
• Failure to fuse
• Failure of instrumentation
• Need for future surgery
• Durotomy (opening of the spinal fluid sac)

The underlying risk of any spinal fusion procedure is failure of the vertebral bone and bone graft to fuse together, which may require an additional surgery.

Educate yourself and make an informed decision with the help of medical professionals. If you have any questions, comments, or concerns pertaining to TLIF and if it’s right for you, talk to your surgeon or contact us to set up an appointment.

Thoracic tumor with severe
spinal cord compression

After surgery to decompress and stabilize the spine

What is a spinal tumor?

Spine tumors are abnormal growths of tissues or cells in or around the spine. Like any other tumors that can be found throughout the body, they can either be cancerous (malignant) or non-cancerous (benign).

Commonly occurring non-cancerous (benign) tumors include:

• Osteoma
• Osteoblastoma
• Hemangioma
• Osteochondroma

While commonly occurring cancerous (malignant) tumors include:

• Chondrosarcoma
• Ewing’s sarcoma
• Lymphoma
• Osteosarcoma
• Multiple myeloma

Tumors that begin in the spine are called primary spinal tumors. Tumors that spread to the spine from other parts of the body (breast, prostate, lung, etc.) are referred to as secondary (or metastatic) spinal tumors.

What are the causes of spinal tumors?

While researchers do not yet know what causes most primary spinal tumors, they have found them to occur more commonly in those with certain genetic alterations. Secondary spinal tumors occur when cancer cells (from kidneys, lungs, breasts, and other parts of the body) spread to the spine.

Other causes include:

• Exposure to radiation
• Exposure to chemicals
• Genetics (for example, neurofibromatosis, a hereditary disease that can cause tumors in the spinal nerves)

What are the symptoms of spinal tumors?

Those who have a spine tumor can experience symptoms such as:

• Persistent and chronic back pain
• Numbness or loss of sensation
• Burning and tingling sensation
• Weakness of arms/legs
• Difficulty with balance
• Bladder or bowel control problems

The above symptoms may be associated with conditions other than spinal tumors.  Evaluation by your physician is important if you develop these symptoms.

How are spinal tumors diagnosed?

A general and neurological examination can provide clues that are helpful for the diagnosis and localization of spinal tumors, but imaging and laboratory tests are commonly used to confirm the presence and location of spinal tumors.  Some of these tests include:

• Cerebrospinal fluid (CSF) examination
• Blood tests for cell counts and markers
• Spine myelogram
• Spine computed tomography scan
• Spine magnetic resonance imaging scan
• Spine X-ray

In addition to these tests, bone scans and PET scans (which reveal the metabolic or biochemical function of tissues and organs) may be done to help medical professionals narrow down the location and extent of the tumor. If a tumor is found, a biopsy may be done to help identify the type of tumor and facilitate the necessary treatment.

How are spinal tumors treated?

There are numerous treatments available for spinal tumors and which ones are used depends on many factors including the severity of the tumor, its type, where it is located, and whether it is benign or malignant.

Medications such as corticosteroids and anti-inflammatory drugs may be prescribed to reduce inflammation and swelling around the spinal cord in some conditions. External braces are sometimes used to provide support and ease pain.

There are also treatments such as surgery, radiation therapy, chemotherapy, and physical therapy that may be indicated:

• Surgery: Goals of surgery typically include partial or complete removal of tumor and spinal stabilization if required. In addition, surgery allows sampling of tumor tissue for pathology and diagnosis. 
• Radiation therapy: For some tumors, radiation may be indicated to help destroy any remaining cancer cells. Sometimes an advanced device called CyberKnife is used to provide painless and non-invasive treatment by passing high doses of radiation to targeted areas of the spinal.
• Chemotherapy: By using a combination of anti-cancer drugs, chemotherapy can help to shrink tumors, stop the tumor cells from increasing in number, and reduce their to surrounding and distant tissues. Drugs such as methotrexate, doxorubicin, cyclophosphamide, carboplatin, and ifosfamide, enter the bloodstream and reach the cancer cells to destroy them.

What are the complications of surgery and the various treatment options?

Complications can occur with any spinal surgery.  Some of these include infection, need for blood transfusion, risk of nerve or spinal cord deficits such as new weakness or sensory loss, and risks of anesthesia.  Since there are many different treatments available, specific risks of complications vary and should be discussed with your physician based on your specific condition and management plan.

Example of a plate that is used for fusion (healing together of the bones) of the cervical spine (neck) from an anterior (front of the neck) surgical approach. The plate spans one or more disc spaces and the screws anchor it into the vertebral bones of the neck. This immobilizes the spine segment and facilitates the bones healing together (fusion) across the disc space(s).

Example of a spacer that can be inserted between the vertebral bones (interbody) after a disc has been removed. This specific type of spacer is inserted from the back of the spine as part of a procedure called a transforaminal lumbar interbody fusion (TLIF).

Example of a pedicle screw. These screws are inserted into the bony structures called the pedicles that are along the sides of the vertebra. Two of these screws are often placed into each vertebral bone of the spine (one on the left and one on the right) across the levels that are being fused. Rods can then be contoured to fit into and connect the heads of the screws on each side of the spine, with locking caps then placed to secure the rod to each screw heads. This enables immobilization across the spinal levels to help facilitate fusion (healing together) of the bones the metal spans.

What are spinal implants?

Spinal implants are medical devices used during surgery to treat deformities, stabilize and strengthen the spine, and facilitate fusion. Disorders that can be treated by the insertion of spinal implants include:

• Degenerative disc disease (wear and tear on spinal disc)
• Spondylolisthesis (slippage of a vertebral bone on an adjacent vertebral bone)
• Scoliosis (sideways curvature of spine)
• Kyphosis (excessive forward rounding of back)
• Fractures

Fusion spinal implants

Spinal Implant 3Spinal fusion is a procedure where the surgeon combines two or more vertebrae by inserting secondary bone tissue to increase the bone healing process and have them fuse together. The bone graft can either come from the patient (autograft) or from another person (allograft).

Spinal implants used in fusion include cages, plates, and screws and rods. Cages (or interbody spacers) are placed inside the empty space (created from removing an affected intervertebral disc) between two vertebrae. With a hollow center filled with bone-growth promoting material, bone can grow through the cage (and around it) and it eventually becomes part of the spine. This adds stability and support to the spine after surgery.

Plates are attached to the vertebrae with screws and also assist in stabilizing the spine.  Plates are most commonly used when doing surgery from the front of the spine.  For example, plates are often used when performing surgery from the front of the neck (see section on ACDF) or sometimes when performing removal of disc from the front of the lumbar spine.

Screws and rods help to stabilize the spine.  Screws in the thoracic (chest area) and lumbar (lower back) parts of the spine are most commonly placed in the pedicles of the vertebra.  The pedicles are the parts of the vertebra that connect the front and back portions of the bone together.  The screws provide multiple points of anchorage into the vertebra.  The screw heads are cup-shaped rods are bent to capture the screw heads and lock onto them to provide stability across two or more vertebra.

What are these spinal implants made out of?

These spinal implants can come in all shapes, sizes, and heights to accommodate any patient. They’re also body-friendly and made out of materials such as:

• Titanium: a lightweight, high strength, corrosion resistant metal that’s been widely used for spinal reconstruction since its introduction in 1986. It has good flexibility and promotes bone growth pretty well. They can also be seen very well in MRI scans.
• Polyethylene: The most commonly used plastic today. Made up of long molecular chains that can transfer loads and provide high impact strength to the implants, especially artificial discs
• Cobalt-chrome: A strong, rigid, corrosion resistant alloy metal formed by mixing together cobalt and chromium metals
• Stainless steel: While other materials are better suited to react to compressive loads, this mixture of iron and carbon can produce very strong implants.

We only utilize the best implants for our patients. If you have any questions, comments, or concerns about these amazing medical devices, feel free to contact us through our website.

Example of image-guided surgery equipment layout in an operating room. Note the surgical table (purple top) and the fluoroscopy imaging device (C-shaped device adjacent to the operating room table). The fluoroscopy imaging device is used to take x-rays of the patient’s spine. Cameras (located on the horizontal bar on top of the pole with wheels) detect the precise positions of instruments in the operative field and relay this information to computers that then calculate the relative positions of the instruments to the patient’s spinal anatomy based on the pictures from the fluoroscopy device. Monitors then project images for the surgeon to see of the patient’s anatomy that also show the relative position of the surgeon’s instruments. This allows the surgeon to “see” the inside anatomy of the patient’s spine in order to direct instrumentation from the surface.

What is Computer-navigated Spine Surgery?

Your spine isn’t just a bunch of vertebrae stacked upon each other. It’s your body’s central support structure, complete with delicate blood vessels, nerves, and various moving parts. Avoiding trauma to these structures during spinal surgery is our utmost concern. That, and the increased need for precision has paved the way for computer assistance during some complex spine procedures.

Computer navigation can play a passive role by providing real-time information to help the surgeon make critical decisions on the go, or by limiting their movements beyond a certain point. In the fture, this technology may also take on a more active role and actually help perform the surgery!

What is Image-guided Spine Surgery (IGSS)?

Imaging techniques, such as CT scans and fluoroscopy, can be integrated into the system and facilitate pre-operative planning of the surgery. By taking a series of images beforehand, we can display them on the screen and have the surgeon show you the plan for surgery to keep you informed, and with a better peace of mind. Not only that, but these images can also serve as real-time guidance for the surgeon to view and navigate instruments/implants as they’re placed during the surgery.

We can pair these spine images with computer navigation systems. The technology works by using a tracking optical camera to view and select certain body parts as landmarks with infrared markers. These are then transferred to a software that compares them to a model created by the stored CT scan images of the patient’s spine taken during the pre-plan. This can help ensure that the procedure is being carried out in accordance with your individual anatomy.

When is Image-guided Spine Surgery used?

IGSS is being used in many spinal procedures such as the insertion of implants and the decompression of pinched spinal nerves.

For example, in the past thoracic spinal surgery has been faced with many challenges due to the narrow spinal canal and the variable small sizes of the bony pedicles used for stabilizing your thoracic spine. As a result, traditional procedures were met with higher screw misplacments.  Use of complex image guidance can help facilitate screw placement for these and other more challenging cases.

Follow-up CT image of a patient who underwent instrumented lumbar fusion. Note the mature bony fusion masses lateral to the screws (red arrows).

Illustration of an instrumented L3-L5 spinal fusion. Note the 3 screws on each side of the spine that are connected by vertical rods. Just lateral to the rods on each side are strips of graft material (red arrows) spanning across the transverse processes (bony projections off each bone) that will eventually lead to a vertical bony fusion mass connecting the L3-5 vertebrae.

What is spinal fusion?

Spinal fusion is combining two or more vertebrae by inserting secondary bone tissue to increase the bone healing process and fuse them together. This secondary tissue can be obtained either through autograft (tissues from the same person) or allograft (tissues from another person).

Spinal fusion is more commonly done to the lumbar region (lower back) of the spine rather than the cervical (neck) or thoracic (mid back) regions, but it can be performed at any level if needed. Thoracic is more immobile (due to the rib cage) and thus tends to require fusion less frequently.  In contrast, the lumbar region is more prone to degeneration due to increased motion and stress. This section will focus mainly on lumbar spinal fusion. Talk to your doctor or contact us if you have any questions on spinal fusion in the cervical or thoracic regions.

When is lumbar spinal fusion recommended?

 Usually spinal fusion is recommended in patients with neurological problems or severe pain that hasn’t responded to non-surgical or conservative treatments. Lumbar fusion may be indicated if the spine has instability or if instability will be created through another medically necessary spine procedure such as removal of joints to enable removal of pressure on nerves or spinal cord.  Spinal fusion may also be needed to help correct spinal deformities such as scoliosis.

Lumbar spinal fusion may be used to treat conditions such as:

• Spinal stenosis (narrowing of the spine)
• Damaged disc
• Spinal tumor
• Fractures of the spine
• Scoliosis and kyphosis (abnormal curvatures of the spine)

If you’re diagnosed with any of the conditions above, talk to your physician or contact us to set up an appointment to see if lumbar spinal fusion is right for you.

How is spinal fusion performed?

This procedure can be performed through different angles depending upon the specific advantages of each and the choice of your surgeon. Interbody fusion can be employed where bone graft is placed in the space present between the two vertebrae. Other techniques for spinal fusion may involve the entire removal of the disc between the affected vertebrae. A specially designed device made of plastic or titanium may be placed between the vertebrae to help maintain spine alignment and normal height of the disc.

Whichever technique is used, fixation will be done after that involves fitting of metallic screws, rods, plates or cages to stabilize the vertebrae and accelerate bone fusion. Complete fusion can take several months or even a year or two.  Patients are often healed on the outside long before the healing process on the inside is finished.

 What are the risks and complications of spinal fusion?

 As with all surgical procedures, spinal fusion carries risks and complications such as:

• Infection
• Nerve/spinal cord damage
• Blood clots
• Blood loss
• Bowel and bladder problems
• Adverse effects of anesthesia
• Failure to fuse
• Failure of instrumentation
• Need for future surgery
• Durotomy (opening of the spinal fluid sac)

The primary risk of spinal fusion is failure of the vertebral bones to fuse together, which may require additional surgery.

Before going ahead with any surgical procedure, educate yourself and make an informed decision! Talk to your surgeon, or contact us to setup an appointment if you have any questions, comments, or concerns about spinal fusion.