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Spine/back pain treatment options

Our neurosurgeons offer traditional as well as minimally invasive surgical treatment options for spinal disorders, back injuries and lower back pain.

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Minimally Invasive Spine Surgery

Minimally invasive spine surgery uses advanced techniques and technology to treat a patient’s spine condition without disrupting the surrounding soft tissues. Computer-assisted technology and highly specialized tools and instruments are used to assist the surgeons with visualization and control.

Advantages of minimally invasive spine surgery include:

Smaller surgical incisions
Less soft-tissue damage
Reduced blood loss
Less post-operative pain
Faster recovery time
Less scarring
Improved function

Microdiscectomy

A microdiscectomy is a minimally invasive outpatient spine surgery. This procedure treats patients with “pinched” nerves in the spinal column caused by herniated or ruptured discs.

Ruptured discs can apply pressure to nerves, causing:

Pain and weakness of the legs
Numbness in the extremities
Impaired bowel and bladder function

A microdiscectomy can offer a safe and efficient alternative to traditional procedures and a quicker and less painful recovery for patients.

What to expect during a microdiscectomy

This procedure requires a one-inch incision in the midline of the lower back. Once the incision is made, the surgeon inserts microsurgical tools to act as a guide to the ruptured disc.

The surgeon then removes a small portion of the bony material covering the spine to gain access to the ruptured disc. The doctor then removes the ruptured portion of the disc and any disc fragments that are causing pressure on the nerves.

Microdiscectomy recovery

Most patients are able to return home the same day of their surgery and can usually resume normal activity soon after.

Microforaminotomy

Microforaminotomy surgery is a procedure to enlarge the openings through which spinal nerves pass, with the use of microscopic tools. When these openings become smaller due to injury or other spinal problems, the nerves can become compressed, causing pain and discomfort for patients.

What to expect during a microforaminotomy

Many spinal conditions or injuries can cause the reduction of these openings, and depending on the patient’s specific situation, the procedure may or may not be able to be performed in a minimally invasive manner.

If minimally invasive approach is suitable, the surgeon uses an endoscope and sophisticated tools to carefully enlarge the openings, using a large screen or microscope to help guide the tools.

Microforaminotomy recovery

Hospital stays and recovery time depend on how invasive the procedure is and the patient’s specific health care needs. If this form of minimally invasive spinal decompression surgery is performed, the patient can usually return to normal activity in a matter of weeks.

Microlaminectomy

Microlaminectomy is a minimally invasive surgical procedure used to treat patients suffering from:

Bone spurs compressing the spinal nerves
Lumbar spinal stenosis
Herniated lumbar discs (slipped discs or ruptured discs)

These conditions can be very painful and are usually caused by excessive heavy lifting, twisting or a fall.

Traditional surgery uses large incisions that cause trauma to the muscle and nerve tissue, often resulting in increased pain and a longer hospital stay. In contrast, microlaminectomy is a microscopic surgical approach that uses two- to three-centimeter long incisions that do not damage muscle and other soft tissues.

What to expect during a microlaminectomy procedure

The surgeon makes tiny incisions in the lower back directly over the problem discs. Special tools and a surgical microscope are used to allow the surgeon to visualize the area of the spine.

The surgeon inserts retractors to move the discs back to healthy positions. After the retractors are in place, the nerves eventually return to their normal size and the pain is alleviated.

Microlaminectomy recovery

Most patients return home one to two days after surgery. They typically can begin light work several weeks after the procedure and normal activities four to six weeks after the procedure.

Artificial Disk Replacement

An artificial disc replacement in the neck replaces a diseased or damaged disc with a specialized implant that tries to preserve motion in the neck. This procedure is called an Artificial Cervical Disc Replacement, or ACDR. Discectomy refers to the fact that the diseased disc must be taken out first before it can be replaced.

What to expect during Artificial Disc Replacement procedure

The standard surgical procedure for a cervical disc replacement requires an anterior approach (from the front) to the cervical spine. This surgical approach is the same as that used for an anterior cervical discectomy and fusion (ACDF) operation.

The cervical ADR surgery will typically include the following:

An incision is made in the front of the neck.
The affected disc is completely removed, as are any disc fragments or osteophytes (bone spurs) that are pressing on the nerve or spinal cord.
The disc space is distracted (jacked up) to its prior, normal disc height to help decompress (relieve pressure) on the surrounding nerves. Restoring the original disc height is important; when a disc becomes worn out, it will typically shrink in height, which can contribute to the pinching of the nerves in the neck.

Using X-rays or fluoroscopy as guidance, the artificial disc device is implanted into the prepared disc space.

Artificial Disc Replacement recovery

Postoperatively, the patient typically can go home within 24 hours with minimal activity limitations.

Cervical Discectomy

Cervical discectomy and fusion surgery is a minimally invasive procedure to remove a herniated or ruptured disc in the neck. This surgical procedure may relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, numbness and tingling.

What to expect during a cervical discectomy procedure

The procedure is usually accompanied by a fusion surgery in order to stabilize the spine. This minimally invasive technique allows our surgeons to access the disc through the front of the neck as opposed to the back.

The less complicated approach provides access to the entire upper portion of the spine, and typically causes less postoperative pain and a faster recovery time for patients than traditional surgery.

After the surgeon makes a one- to two-inch incision on the front of the neck, only one thin muscle needs to be cut to access the spine. The surgeon then removes the ruptured portion of the disc and any disc fragments that are causing pressure on the nerves.

A bone graft is inserted into the empty disc space to create a spinal fusion, realigning the bones.

Cervical discectomy recovery

Four to six weeks after your surgery you may have physical therapy. It can take six months to a year for a full recovery.

Minimally Invasive Lumbar Fusion (MIS, TLIF, MIDLIF)

Minimally invasive lumbar spinal fusion is an operation that uses small incisions to cause the vertebrae (bones of the spine) in the lower back to grow together. The goal of the lumbar fusion is to have the two vertebrae fuse (grow solidly together) so that there is no longer any motion between them.

What to expect during a Minimally Invasive Lumbar Fusion procedure

Removing the intervertebral disc (cushion between the bones) or bone spurs can reduce some of the pressure on the nerves, helping to reduce pain. Additionally, by fusing the two vertebrae together, this may stop the formation of bone spurs at that location, further reducing pain and potential nerve injury.

Minimally Invasive Lumbar Fusion recovery

A few weeks after surgery, you typically can resume your normal daily activities. Long-term results will vary by person and take months for full recovery.

Anterior Lumbar Interbody Fusion

Anterior Lumbar Interbody Fusion (ALIF). The ALIF approach has the advantage that, unlike the Posterior Lumbar Interbody Fusion and posterolateral gutter approaches, both the back muscles and nerves remain undisturbed. Another advantage is that placing the bone graft in the front of the spine places it in compression and bone in compression tends to fuse better.

What to expect during Anterior Lumbar Interbody Fusion procedure

This type of spinal fusion involves placing bone graft in the disc space. Cushion between vertebrae is removed so they can be fused together.

Anterior Lumbar Interbody Fusion recovery

Full recovery time varies, but around six weeks there will be notable improvement.

Extreme Lateral Interbody Fusion (XLIF)

XLIF, or eXtreme Lateral Interbody Fusion, is an advanced, minimally invasive and minimally disruptive approach for spinal fusion. In this procedure, neurosurgeons access the spine from the side of the body instead of from the front or back, as in traditional open procedures.

XLIF is useful for a variety of spinal and back conditions including:

Degenerative disc disease
Spinal Stenosis
Spondylolisthesis
Recurrent Disc Herniation
Scoliosis

Many patients are eligible for this innovative minimally invasive surgery, which often can:

Minimize complications
Relieve pain by providing decompression of the nerves
Optimize spinal balance
Achieve a solid fusion

What to expect during an XLIF procedure

To correct the alignment of the spine, neurosurgeons replace the damaged areas with height-restoring cages and biological agents. This minimally invasive approach not only limits the surgical scars, but also the blood loss, pain and many of the complications associated with the large incisions that have traditionally been used.

XLIF recovery

Patients may have immediate relief. Recovery from this surgery can be quicker than it would be in traditional spinal fusion surgery. Patients treated using the XLIF procedure often experience shorter operative times, shorter hospitalizations, and shorter recoveries, while achieving similar success in pain relief when compared to traditional open surgeries.

Minimally Invasive Sacroiliac (SI) Joint Fusion

When a spine condition affects the SI joint, daily activities such as walking and standing become extremely painful and difficult. The SI joint is located at the bottom of your spine and is responsible for connecting your spine to your pelvis. Specifically, the SI joint connects the sacrum to the left and right hip bones. The lumbar spine is immediately above the SI joint, which is the reason why most people confuse SI joint pain with lumbar pain. The purpose of the SI joint is to stabilize the spine and allow it to remain strong and upright when standing, running or walking. Imagine the SI joint as the base of the spine; it needs to be strong to support all of the vertebrae and discs that make up the spine.

What to expect during a Minimally Invasive Lumbar Fusion procedure

During the procedure, the surgeon will enter the SI joint through a small incision in the back. Through this incision, and with the help of special instruments, the surgeon will fuse together the sacrum and the pelvis to stabilize the spine and decompress the affected nerve to provide relief from chronic lower back pain and limited mobility.

Minimally Invasive Sacroiliac (SI) Joint Fusion recovery

The goal of minimally invasive SI joint fusion procedure is to decompress the nerve that is affected in the lower area of the spine and then immediately stabilize the spine to help patients return to their normal daily activities. Rehabilitation can begin 4-6 weeks after the procedure. Complete recovery is around 6 months to a year.

Kyphoplasty

Kyphoplasty is a procedure used to treat vertebral compression fractures and abnormal configurations typically caused by osteoporosis. The minimally invasive technique has high success rates for:

Stopping pain caused by fractures

Stabilizing the bone

Restoring some or all vertebral body height lost due to compression

Kyphoplasty Procedure

The procedure involves making a small incision behind the target area so that a narrow tube can be inserted into the fractured portion of the vertebrae.

A special balloon is then inserted through the tube and inflated. This elevates the fracture, restoring a more natural shape, while also compacting the soft inner bone to create a cavity in the center of the vertebrae.

After deflating and removing the balloon, a cement-like material is inserted into the cavity through a low-pressure injection. The material hardens quickly, stabilizing the bone.

After kyphoplasty surgery

Patients can often go home the same day after kyphoplasty surgery, returning to normal activity levels quickly. Complications and risks are rare.

Traditional Surgery

Traditional surgery options include: Spinal fusion – Neck (Cervical) and Lumbar Spinal Fusion Surgery

Spinal Fusion Surgery

Spinal fusion is surgery to fuse together two vertebrae to eliminate motion between the two vertebrae and to relieve pain. This procedure connects two or more vertebrae together, such as within the lumbar or neck region, with metal screws and rods so they have a chance to grow together, or fuse.

Neurosurgeons may perform spinal fusion surgery on the neck or lumbar area to treat:

Spinal stenosis
Spinal injuries
Spondylolisthesis
Scoliosis
A weak or unstable spine
A herniated or ruptured disc

It is usually only offered to patients whose pain and disability are not alleviated with conservative treatments such as pain medication, physical therapy, massage and rest.

What to expect during spinal fusion surgery

During the procedure, surgeons make an incision in the back or neck to access the spine. In some cases, access may be through the side of the body using the minimally invasive spinal fusion technique called XLIF®

Cervical (neck) or lumbar fusion may be done with bone grafts or with a small metal cage filled with bone graft material. The cage is placed between the spinal bones. The surgeon will implant screws and plates or rods to hold the bones in place to help them fuse together.

Spinal fusion surgery recovery

Immediately following, sitting or standing in one position for a period of time may be difficult. Light activities may resume after 4-6 weeks and full recover can be 6 months to a year.

Spinal Reconstruction Surgery

Spinal reconstruction surgery may be necessary for patients who have a deformity or misalignment that affects a major portion of the spine.

The procedure involves more than one level of the spine and corrects significant spinal deformities, stabilizes the newly shaped spine with rods and pins and fuses the vertebrae together. In some cases, entire vertebrae are removed and replaced with artificial devices to replace the diseased segment. The most common conditions to be treated with spinal reconstruction are scoliosis, spondylolisthesis and kyphosis.

What to expect during a spinal reconstruction surgery procedure

During spinal reconstruction, neurosurgeons use a variety of surgical techniques, depending on the extent of the deformity. Minimally invasive surgery, artificial disc replacement, endoscopy, stereotactic spine radiosurgery, kyphoplasty, spinal fusion and other surgical procedures may all be performed.

Fusion recovery

Non-strenuous activities may resume after 4-6 weeks and full recover can be 6 months to a year and you may need a back brace while your back heals.

Tumor Resection Surgery

The spinal cord and surrounding tissues are rare sites for tumors to grow. When they do occur, they are often benign and rarely spread beyond the spinal column. Because of their location, tumors may put pressure on the spine and cause significant neurological problems. For this reason, neurosurgeons typically recommend resection, or surgical removal of the tumor.

Resection surgery can be performed for a number of spinal tumors, including:

Meningiomas
Neurofibromas
Schwannomas

What to expect during resection surgery

During resection surgery, our surgeons make an incision over the tumor and dissect the soft tissues to expose the back of the spine. The spinal bones (laminae) are removed to access the spinal canal.

The tissue-lined compartment that contains the spinal cord and nerves that are surrounded by spinal fluid is called the dura. The surgeon opens the dura to expose the spinal cord and nerves and remove the tumor.

Then the dura is then sutured and closed.

Tumor resection recovery

Patients are usually admitted to the hospital for several days after surgery. They must remain in bed to promote wound healing, and may work with a physical therapist or rehabilitation specialist, depending on the extent of neurological damage.

Computed Tomography (CT) Image-Guided Surgery

Computed tomography (CT) image surgery, an innovative level of precision in spine surgery that works similarly to global positioning. Blending 64-slice CT scanning technology with real-time computer modeling, our surgical team accurately positions screws and other hardware that is used in a variety of spine procedures, from spinal fusion to complex scoliosis cases.

Benefits of CT-Guided Surgery

Because of the spine’s flexibility, traditional placement techniques have an error rate of up to 30 percent, which can lead to discomfort, instability, or the need for corrective surgery. With CT image-guided approach, surgeons know that all hardware is positioned accurately before completing the procedure.

What to expect during a CT procedure

The CT scan creates a map that surgeons follow. They are then able to use minimally invasive tools to complete the procedure.

CT recovery

Recovery times are shorter compared to more traditional approaches.

Lumbar Laminectomy Surgery

A lumbar laminectomy is a surgical procedure to remove a small portion of a vertebra, or back bone in the lower back (lumbar). Lumbar laminectomy is usually done to take pressure off the spinal cord or a spinal nerve. It may also be done to access the spinal cord, bones and discs below the lamina, or the removed part of the bone.

Spinal problems such as ruptured discs, bony spurs, or other problems can cause narrowing of the canals that the nerves and spinal cord run through. If it gets too narrow, it can irritate the nerve, causing:

Pain in the leg
Numbness or weakness

A lumbar laminectomy procedure is often performed along with a disc removal to help make the canal larger and take pressure off the irritated nerve.

What to expect during a lumbar laminectomy procedure

The surgeon will make a few small incisions and insert a scope and small instruments into the area. The lamina is removed using a drill or other tools. Once the lamina is removed, the surgeon can inspect the spinal cord and discs that were hidden under the lamina.

In some cases, open surgery is necessary, and involves making a larger incision in the skin over the problem area of the lower back. Depending on the cause of the patient’s symptoms, the disc may need to be removed, or a spinal fusion may necessary.