Procedures and Conditions

Surgery

Whether the need for spine surgery is the result of a congenital condition, ongoing deterioration or other condition, the necessary surgical procedures you require are offered through the Nebraska Spine Hospital. This may require the removal of all or part of a vertebrae or disc, or the use of special devices developed specifically for the conditions of the spine. These include:

Discectomy (Microdiscectomy) – removes the herniated disc material that is pressing on a nerve root or spinal cord causing pain

A discectomy addresses the pain caused from a herniated lumbar disc. A disc herniates when the outer portion of the disc ruptures and some of the softer disc nucleus material squeezes out. Because a herniated lumbar disc is bulging out of position it can push on spinal nerves and cause severe, shooting leg pain, numbness and/or weakness.

Removing part of the disc in a discectomy procedure can prevent the disc from irritating the nerve. During the procedure an incision is made in the middle of the low back to expose the lumbar vertebrae above and below the herniate disc. Next, surgical instruments are used to remove apportion of the lamina to provide access to the herniated disc. The herniated portion of the disc is removed to relieve the pressure on the compressed nerve.

Decompression (Laminectomy) – designed to relieve pressure on the spinal cord or spinal nerve that is causing leg pain

A posterior laminectomy, which is also called decompression, is done to treat pain caused by degenerative conditions in the lower back. Disc degeneration, bone spurs, and other conditions can cause pressure on the spinal nerves exiting the spine. A laminectomy procedure removes part of the vertebral lamina to reduce the pressure.

Lamina is part of a boney ring that attaches to the back of each vertebral body. The second part of this ring is made up of the pedicle bones. The two pedicle bones and two lamina bones form a protective housing around the spinal cord.

During the procedure an incision is made in the middle of the lower back. Surgical instruments are used to remove the spinous processes and lamina. Bone spurs and other sources of spinal nerve compression are also removed. The extra space provided alleviates pressure on the spinal nerves.

A detailed animation of a laminectomy can be found on our partner site, Spine-Health.com.

Spinal Deformity Reconstruction (Scoliosis) – helps to reshape the spine to make it more stable

Minimally Invasive Surgery – allows surgeons to perform a variety of procedures effectively through smaller incisions using microscopic technology and equipment

Spinal Fusion

Spinal fusion is a surgical procedure where two or more vertebrae is joined together using bone tissue, which then grows with the body’s natural processes and “fuses” the vertebrae together for added support to the spine. Pain is the most common symptom of back conditions that require spinal fusion surgery for relief.

Very often, it is recommended after other options have been unsuccessful in alleviating the problem or the pain associated with it. Depending on location of the problem, the cause and the individual patient, physicians may recommend:

Lateral Interbody Fusion (XLIF) – allows surgeons to approach the spine from the side, removing disc material and placing bone grafts to the affected vertebrae

Interspinous Process Distraction/Decompression (X-Stop) – a special device or spacer is inserted to relieve pressure on the spine and nerves that causes pain, loss of movement in the legs and even normal bladder or bowel function.

Anterior Lumbar Interbody Fusion (ALIF) – approaching the spine from the front, a large portion of a degenerated disc is removed and replaced with a bone graft to fuse the vertebrae together.

The term ALIF is an abbreviation for anterior lumbar interbody fusion. An ALIF is performed to remove a large portion of a degenerated disc that is frequently the source of back pain. It is called an anterior procedure because the spine is approached from the front of the body avoiding potential damage to the low back muscles.

An incision is made on the lower abdomen and surgical instruments are used to remove a portion of the degenerated disc. The removed portion is replaced with bone grafting material and adjacent vertebrae fuse to provide support. Part of the disc material is often retained to enclose bone graft implants.

A drill is used to prepare the disc for inserting screw-shaped cages that contain bone graft. The bone graft that is placed in the cages will help new bone grow in and around each cage. The cages are screwed into place between the vertebrae to provide stability while the bone grows in place.

Transforaminal Lumbar Interbody Fusion (TLIF) – a portion of a disc is removed and a single bone graft is inserted where the material has been removed to avoid moving or damaging the nerve roots during the procedure.

TLIF is the abbreviation for the procedure called transforaminal lumbar interbody fusion. A TLIF is performed to remove a portion of a disc that is the source of back or leg pain. Bone graft is used to fuse the spinal vertebrae after the disc is removed. The TLIF procedure places a single bone graft between the vertebrae from the side where the facet joint has been removed to avoid moving or damaging nerve roots during the procedure.

The first step of a TLIF procedure is decompression. To remove the degenerated disc an incision is made in the middle of the low back. Surgical instruments are used to remove the entire facet joint to allow access to the degenerated disc and remove it. Removing the facet joint and disc relieves pressure on the compressed spinal nerve, allowing it to return to the proper position.

The next priority during the procedure is to stabilize the spine before the bone grafts are added. A drill is used to make holes in the pedicle area of the vertebrae and screws are placed and rods are positioned and fastened in place. The rod and screw instrumentation provides stability and prevents the vertebrae from moving while the bone graft fusion takes place.

Once the spine is initially stabilized a bone graft is place in the disc space from the lateral (side) aspect through the area exposed when the facet joint was removed. The bone graft will provide long term stability to the spine when it fuses with vertebrae above and below it. In variations of this procedure, spacers, cages packed with graft materials, or ground bone graft material may also be packed into the disc space to aid with the fusion.

Thoracoscopic Anterior Spine Surgery – effective for various fusion surgeries, this procedure allows surgeons to reach the area through the chest cavity, with the patient lying on his or her side.

Cervical Disk Replacement

Cervical disk replacement may be indicated for those who are unable to find relief from pain from other conservative spine care treatment oprions. For some, their conditions are a gradual process that eventually impacts their ability to do even the most basic tasks because of pain in the neck or arms. For others, it’s more immediate, resulting from an injury, a fall, a bump, or an accident. But the impact can be felt with ongoing pain and difficulty in movement.

Whatever the cause of your pain, our leading spine surgeons at Nebraska Spine Hospital are able to perform a wide range of procedures to alleviate your pain through the use of fusion techniques that remove matter causing pain and insert a bone graft that then “fuses” with the vertebrae to support the spine. Some of these include:

Anterior Cervical Decompression and Fusion (ACDF) – Through a small incision at the front of the neck, surgeons remove a ruptured or herniated disc that is causing pain in the neck, arms and even legs.

ACDF is the abbreviation for a spine surgery procedure called anterior cervical discectomy and fusion. ACDF procedures are performed to relieve the pressure on nerves from disc herniations.

A disc herniates when the outer portion of the disc ruptures and some of the softer disc nucleus material squeezes out. The herniated disc pushes against the spinal cord or spinal nerves and causes pain in the neck or arms. Removing the herniated disc alleviates pressure on the nerves or spinal cord relieving the pain.

To remove the herniated disc an incision is made to one side of the front of the neck. Through this incision the front of the cervical spine and the herniated disc is exposed. Surgical instruments are used to remove a portion of the herniated disc to alleviate pressure on the nerve.

After the disc material is removed a bone graft is placed between the vertebrae to add stability. Bone graft keeps the disc space at a normal height and fuses the vertebrae above and below the removed disc.

A metal plate is placed over the bone graft. Four screws are placed through the plate to the vertebra. The metal plate provides additional support while the bone graft grows in place fusing the vertebrae.

Posterior Cervical Fusion – To add stability, surgeons place bone grafts along side the vertebrae and support with metal screws or rods to repair damage from an injury or other conditions.

Motion Preservation

Restoring movement and alleviating pain are two of the most common reasons people give for deciding to undergo spine and neck surgery. To ensure patients have access to the latest procedures and devices, the surgeons at Nebraska Spine Hospital actively pursue innovative techniques and approaches to spine and neck care, including motion preservation.

For many, it can be an effective option for treating spine and neck conditions that result from degeneration or injury. Specifically, these procedures help to address the need to restore the distance between vertebrae and relieve compression, to stabilize the spine and to limit or control motion.

At Nebraska Spine Hospital, the motion replacement procedures address the key areas of the spine where problems most frequently occur and include:

Cervical Total Disc Replacement – Surgeons reach the affected area of the cervical spine (neck) from the front, first removing the damaged disc completely and then positioning the spine to its normal position before implanting the artificial disc, resulting in the relief of pain and movement.

Lumbar Total Disc Replacement – Through an incision on your stomach, the surgeon removes the damaged disc completely and then replaces it with an artificial disc designed to position vertebrae to their optimal distance and relieve associated pain and movement.

Injections

At Nebraska Spine Hospital, specialists use a variety of spinal injections in their diagnoses – pinpointing the source of the problem. Just as there are many conditions that can cause pain in the back, neck, legs and arms, there are a variety of injection procedures designed to diagnose and treat them.

In many cases, injection therapy also offers the most effective means of treatment and can also provide relief from pain and limited mobility. This is especially important in cases where surgery is not an option.

Some of the injections offered at the Nebraska Spine Hospital include:

Epidural Steroid Injections – are often used to inject anesthetic and anti-inflammatory medication to reduce nerve inflammation and the resulting pain

Selective Nerve Root Blocks – helps to determine the specific spinal nerve root that is the source of pain and to inject medicine that reduces inflammation to relieve the pain

Trigger Point Injections – deliver pain relief and anti-inflammation medicine to relax back and neck muscles that cause pain

Facet Joint injections/Nerve Blocks – allow physicians to diagnose and treat neck, middle back, low back pain and associated radiating pain.

Sacroiliac Joint injections – is used for both the diagnosis and treatment of pain caused by the sacroiliac or SI joint.

Radiofrequency Ablation (Rhizotomy) – uses radio frequency waves to generate heat around a nerve to relieve pain in the lumbar.

Provocation Discography – used for the diagnosis of pain

Fracture Repair

An accident, injury or even ongoing osteoporosis can cause painful fractures of the spine and the resulting pain and limited motion can have devastating effects.

Through a variety of surgical and non-surgical options, our surgeons are able to address the immediate issue, alleviate pain, restore movement, provide support and help to prevent the symptoms from worsening.

Tumor Surgery

A spinal tumor can be the cause of pain, numbness, or limited motion. The surgeons at Nebraska Spine Hospital use specially developed instruments and techniques to remove the tumor, thus relieving the pressure that can be the source of pain. Ultimately the work to stabilize and restructure the spine to preserve mobility and even restore bowel and bladder function.

Working in conjunction with other specialists, surgery is often combined with radiation therapies for the best possible outcomes.

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