A laminectomy is a type of decompression surgery that relieves pressure on the spinal cord and exiting nerves by enlarging the spinal canal. Lamina along with the spinous process are located in the back portion of each vertebra. During this procedure the lamina is removed along with a portion of the enlarged facet joints and thickened ligaments overlying the spinal cord and nerves.
Two bilateral laminae are located the back portion of each vertebra. They are the part of the vertebral bone that forms the vertebral arch or posterior roof of the spinal canal through which the spinal cord travels.
When the spinal canal narrows due to deterioration of the spinal column, pressure on the spinal cord and nerve roots develop. This narrowing of the spinal canal is known as spinal stenosis and this condition can give rise to symptoms of pain and other neurological dysfunction. In some cases of spinal cord compression myelopathy can develop, producing sensory changes and weakness in both extremities, a loss of coordination, and incontinence in bowel/bladder function.
A surgical procedure known as a laminectomy may be recommended when conservative therapy has failed to provide relief, when symptoms interfere with daily life, or if the spinal cord is at risk of permanent injury. The goal of the procedure is to relieve pressure on the nerve roots and the spinal cord, as well as to help the surgeon gain better access for treating other spinal damage, such as a herniated disc or bone spurs.
In the process of “unroofing” the spinal canal with a laminectomy, enlarged ligaments along the back of the spine are removed. Arthritic facet joints may also be shaved to provide more room for exiting spinal nerves. In conjunction with a laminectomy additional surgical procedures may be performed to further relieve nerve pressure, remove excess or damaged tissue, and provide stability to the spine.
Contingent upon the extent of the spinal stenosis one or more vertebrae may required the laminectomy procedure. In suitable cases, a laminotomy, or removal of only a portion of the lamina that is causing the impingement of a nerve is possible.
Spinal fusion is a surgical procedure to permanently join two or more vertebrae in the spine. The connected vertebrae fuse together to form a one solid bone and immobilize that segment of the spine.
Spinal fusion may be indicated to reduce significant pain and symptoms that have not responded to non-surgical treatment, to improve spine stability, or correct a significant spinal deformity.
A spinal fusion procedure may be suggested in cases of:
Immobilizing adjacent vertebrae with spinal fusion reduces the pain associated with movement of that spinal segment. In order to fuse the vertebrae the placement of a bone graft and/or bone graft substitute is required. The graft will stimulate bone growth and healing, so that the vertebrae eventually fuse together into one bone. Internal fixation in the form of screws, plates, or rods, may be used at the time of surgery to stabilize that segment and promote healing. Additional procedures may be performed in conjunction with spinal fusion to address other issues such as stenosis and disc problems.
Spinal fusion can restrict spine mobility but since it is typically confined to a small segment, the overall effect is limited. However because there is no movement between the vertebrae that have been fused, additional stresses may be placed on the adjacent vertebrae.
It will take some time for the bone to fully fuse. In some cases a brace might be recommended to support the spine and keep it correctly aligned. A successful spine fusion outcome relies on appropriate post-operative care. Instructions and physical therapy to learn how to sit, stand, and walk will be given. Avoiding activities that may place the bone graft at risk is essential.
Disc replacement is the substitution of an artificial disc for an unhealthy intervertebral one. It is performed to alleviate the symptoms of degenerative disc disease, which occurs when the discs wear out from the effects of long-term stress and strain on the spine due to aging or as a result of injury. An artificial disc is designed to imitate the functions of a healthy disc by allowing spine to maintain its natural mobility.
Artificial disc replacement (ADR) may be considered in the presence of severe and prolonged symptoms from a damaged disc that have not responded to a course of non-surgical therapy. Up until recently, spinal fusion was the most common surgical procedure performed to treat unremitting disc problems. Today safe and effective artificial intervertebral discs replacement procedures offer select patients another surgical option.
Artificial disc replacement may be performed for the lower back (lumbar spine) or the neck (cervical spine). The goal of replacing a damaged disc with an artificial one is to reduce debilitating symptoms and to restore normal motion to the spine. A new prosthetic disc facilitates the natural mobility of the spine and restores function to that segment. It also reestablishes the height between the vertebrae. This helps to alleviate any nerve impingement and reduce unhealthy stresses that have been placed on adjacent intervertebral discs and structures. These improvements can ward off further deterioration of nearby spinal structures and prevent additional problems.
Patients who have undergone a disc replacement procedure may be up and walking soon after surgery. The doctor will monitor the healing process and provide guidelines for a resumption of activity along with recommendations for supportive therapies.
Scoliosis is a term used to describe disorder in which a sideways curve of the spine is present. A normal backbone appears straight when viewed from the front or back and does not exhibit any lateral curvature. Scoliosis can occur as single arc to either the left or right side, or arc twice giving the spine an “S” shape.
Individuals of all ages can have scoliosis. The most common type of scoliosis is idiopathic scoliosis, which means it occurs for an unknown reason. Idiopathic scoliosis affects approximately 2% of the population and is the most common form of the disorder found in children and adolescents. Scoliosis in adults is often a degenerative scoliosis, which develops as a result of illness or injury, previous back surgery, or osteoporosis. In neuromuscular conditions such as cerebral palsy, spina bifida, or muscular dystrophy a type of scoliosis known as neuromuscular scoliosis is frequently seen. Scoliosis may also be present at birth in cases where the vertebral bones have not developed normally.
Idiopathic scoliosis most typically occurs in children and adolescents from ten to eighteen years of age. There may be a family history of this type of scoliosis. In most instances the disorder is spotted at a routine physical with the family doctor, at a school screening, or observed by a parent. Girls are more likely to be affected than boys by idiopathic scoliosis. Although the majority of the cases of this type of scoliosis are mild, with growth the degree of curvature can worsen. This is the reason the doctor will monitor the degree of curvature in these patients with scheduled periodic physical exams and order diagnostic tests as needed.
Signs and symptoms of scoliosis can include:
If and how scoliosis is treated depends on the type of scoliosis present, the underlying cause, the degree of curvature, the individual’s age, and if growth is still expected. Preventing a severe curvature from developing is very important. A high degree of curvature may not only be disfiguring, it can result in further spine problems as well as be detrimental to the lungs and heart. Mild cases of scoliosis may only require observation. Wearing a brace is recommended for children and adolescents who have a moderate curve to prevent the curvature from increasing while they continue to grow. Individuals with a significant degree of scoliosis, or growing youngsters exhibiting a worsening curve may need surgery.
The term “kyphosis” refers to an abnormal curving of the spine typically in the thoracic region resulting in a rounding of the back that produces a slouching or hunchback posture.
A healthy spine exhibits a series of normal front to back curves. When viewed from the side these curves give the spine a soft “S” shaped appearance. Each of these curves is designed to manage the load applied to the spine from the weight of the body and to allow the head to balance directly over the pelvis. A condition known as kyphosis occurs when the natural arch in the thoracic region bends to greater degree than normal.
While mild kyphosis may cause few problems, pronounced cases can result in more debilitating symptoms and disfigurement. The most severe cases of thoracic kyphosis can lead to compression of the spinal cord and related neurological impairment. It can also compromise the chest space and lead to the development of cardiac and pulmonary problems.
Abnormal kyphosis may be postural or structural. The most common type of is caused by poor posture and generally does not lead to a severe curve or significant problems. Structural deformities of the vertebrae are present in Scheuermann’s kyphosis, seen in young teens, and in congenital kyphosis, which is the least common type of abnormal kyphosis.
In adults, abnormal kyphosis can be the result of other conditions or insults to the spine. Among these disorders are degenerative diseases of the spine, including arthritis or disc degeneration, multiple compression fractures from osteoporosis, ankylosing spondylitis, spindylolisthesis, spine infections, and spine tumors.
During a physical examination the doctor will evaluate the curvature of the spine and perform a neurological exam. Based on these findings further diagnostic testing may be recommended.
Treatment of kyphosis depends on the cause of the disorder. Postural kyphosis usually responds to physical therapy, as well as mild pain relievers and anti-inflammatory medications. Surgery is recommended if the kyphosis is very severe and/or causing painful and debilitating neurological symptoms that have not responded to conservative treatment. Cases of congenital kyphosis often involve surgery when the patient is an infant to allow for improved growth and development
If conservative treatments to alleviate the symptoms of a herniated disc are unsuccessful, a surgical procedure known as a “discectomy” may be recommended.
When a disc becomes herniated, a portion of the disc is dislocated and may impinge upon the adjacent nerve roots or the spinal cord. This can cause pain, numbness, tingling, or muscle weakness to develop. Depending upon the location of the damage disc, symptoms can affect the neck or back and may radiate down the arms or legs.
A microdiscectomy is a minimally invasive type of discectomy that uses special microscopic magnification to provide the orthopedic surgeon with an illuminated and magnified view of the affected area of the spine. With this enlarged view, the surgeon can perform the procedure using smaller incisions and instruments. Since a microdiscectomy procedure is minimally invasive, less damage to the surrounding tissues occurs. This facilitates quicker healing and recovery.
A microdiscectomy may be indicated in the presence of:
During a microdiscectomy the surgeon will remove the fragment of the spinal disc that is causing pressure on the nerve. The goal in removing the impinging part of the herniated disc is to provide relief from the symptoms that have developed as well as to facilitate a restoration of function. In some situations additional procedures may be performed to further relieve pressure and to provide stability.