Surgery for Degenerative Disease of the Cervical, Thoracic, and Lumbar Spine
Diseases of the spine are, unfortunately, very common and can be responsible for severe pain and disability. Over the past decade many treatment modalities, both surgical and non-surgical, have been developed to address these conditions. There is often more than one choice available for approaching the same condition. The specific therapy or type of surgery employed will often depend on the surgeon’s training, experience and preference. In our experience, short-term medical therapy, physical therapy and lifestyle modification are usually adequate to control back pain in the majority of patients. When surgery is required, our choice of the specific procedure is typically dictated by the procedure’s published track record, as well as our own experience. While we strongly believe in incorporating significant technological advances into our practice, we avoid utilizing unproven technologies for their own sake and from marketing the “latest” or the most “minimally-invasive” techniques. We feel that some of these techniques are at odds with offering our patients the safest and most long-lasting therapy available.Expand all
Benign and malignant tumors can originate in the bone of the spine, the tissues covering the spinal cord, and the spinal cord itself. Treatment of these tumors often requires a multidisciplinary team of physicians including surgeons, medical oncologists, and radiation oncologists. Depending on the specific disease, the goal of surgery may be removal of the tumor and/or stabilization of the spine rendered unstable by tumor, employing fusion and instrumentation techniques. Present use of microscopic technique, intra-operative nerve monitoring, and advances in spinal instrumentation have made surgery for spinal tumors significantly safer.
Minimally-invasive microscopic surgery allows the surgeon to minimize the size of incision and removal of bone required for decompression of nerves in conditions such as disc herniation and spinal stenosis. Hospital stays and recovery times are typically shortened as well. This is a well-established minimally-invasive technique with a proven track record.
Spinal fusion and instrumentation is undertaken when simple decompression of the nerves is inadequate due to the presence of spinal instability (abnormal motion) or likelihood of development of instability due to the extent of bone removal required to achieve adequate decompression of nerves. A fusion procedure links adjacent spinal vertebrae by promoting bone growth between them. Doing so eliminates the pain associated with abnormal motion between the vertebrae and prevents further injury to the nerves caused by compression and traction on the nerves produced by the abnormal motion
Cervical disc replacement surgery is a recent advance in spinal surgery, allowing the surgeon to replace a diseased and painful disc without performing a fusion of the adjacent vertebrae. Doing so allows preservation of normal motion of the spine across the replaced disc and possibly slows the degenerative process in the adjacent discs. The development of this technology is still in progress. Implants which allow patients to undergo post-operative MRI scans should be available in the near future
Chiari malformation is a condition in which the cerebellum (a structure in the back and bottom of the brain) protrudes into the spinal canal. Chiari type I malformation usually causes symptoms in young adults and is often associated with syringomyelia, in which a tubular fluid cavity develops within the spinal cord. Symptoms of Chiari type I malformation typically begin with headaches occuring when straining and may progress to numbness and weakness in the arms and legs, difficulty walking, and bowel and bladder problems. Surgical treatment of Chiari type I malformation is usually required to prevent progression of symptoms. Surgery typically consists of removal of bone at the base of the skull and the first cervical spine segment, followed by placement of a graft to expand the dura (the covering over the brain and spinal cord) to create more room for the descended cerebellum and take pressure off the spinal cord.
Chiari type II malformation is typically diagnosed shortly after birth. It is frequently associated with a myelomeningocele (a developmental defect of the spine) and hydrocephalus (abnormal accumulation of spinal fluid in the brain). Chiari type II malformation and its associated conditions are usually treated by pediatric neurosurgeons soon after birth.