- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
Spinecare Topics
Surgical Interventions
Surgical Interventions
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Surgical Interventions
Laser Discectomy
Laser discectomy was first performed in 1991. It is considered a very minimally invasive form of discectomy similar to percutaneous discectomy. Instead of using a mechanical forceps or nucleotome to remove the select portion of disc material, a laser is utilized to vaporize the compromising disc material. To have a favorable outcome with any kind of percutaneous procedure the intervertebral disc must be accessible through a minimal incision and be visualized. Because the laser also cauterizes the tissue at the same time, some surgeons report a faster recovery with this technique.
Laminectomy or Laminotomy
The laminectomy or laminotomy (partial laminectomy) is traditionally performed for one of two reasons. The first reason is to make more room for the spinal contents particularly the nerves and blood vessels. The second reason is to create a surgical window through which a surgeon can operate on the site of involvement. This latter procedure is used to access the spinal canal from the back of the spine. It is a more common procedure in the lumbar spine. To perform the laminectomy the spine surgeon will make a 1-2 inch incision over the back. The surgeon then moves spinal muscles away from the spine exposing the bone (lamina). He or she then uses a surgical instrument to remove bone of the lamina from one or more vertebrae to gain access to the spinal canal and the intervertebral disc. The bony lamina essentially forms a roof over the central spinal canal. The lamina can be removed on one or both sides in order to provide greater volume to the spinal canal and to decompress the exposed contents of the central spinal canal.
During a microdiscectomy, partial removal of the lamina is usually sufficient to gain access to the affected nerve root. In the case of degenerative spinal stenosis, a more extensive decompressive laminectomy is usually performed which may require removal of the entire lamina on both sides of the midline including the spinous process. The procedure may include removal of the lamina and spinous process at more than one adjacent level. In rare cases it is necessary to remove the entire bony lamina and a portion of the adjacent spinal (facet) joint. This is referred to as a wide laminectomy. When a wide laminectomy and partial facetectomy is performed there is greater risk for developing excessive movement of the vertebrae (instability) secondary to the removal of supportive tissue. If a surgeon is concerned that the wide laminectomy may lead to instability, a fusion may be performed in addition to the laminectomy. A laminectomy can be used to gain access to numerous problems in the spine including hematoma, tumor, and blood vessel abnormalities, to reach a bone spur, and to access to any disc problems.
Foraminotomy
The foramina refer to the small openings along the right and left sides of the spine. The spinal nerves exit the spine though the foramen. Degenerative disc disease associated with a loss of disc volume can lead to narrowing of the bony foramen. Degenerative changes leading to thickening of the facet joint capsule, bony overgrowth and bone spur projection all contribute to narrowing of the foramen. Narrowing of the foramen can result in compromise of the exiting nerve roots. A surgical foraminotomy refers to careful shaving off of bone around the foramen to increase the volume of the opening and to make more room for the nerves and their blood vessels. A successful foraminotomy decompresses the nerve and results in reduced irritation and inflammation of the nerve.
Laser discectomy was first performed in 1991. It is considered a very minimally invasive form of discectomy similar to percutaneous discectomy. Instead of using a mechanical forceps or nucleotome to remove the select portion of disc material, a laser is utilized to vaporize the compromising disc material. To have a favorable outcome with any kind of percutaneous procedure the intervertebral disc must be accessible through a minimal incision and be visualized. Because the laser also cauterizes the tissue at the same time, some surgeons report a faster recovery with this technique.
Laminectomy or Laminotomy
The laminectomy or laminotomy (partial laminectomy) is traditionally performed for one of two reasons. The first reason is to make more room for the spinal contents particularly the nerves and blood vessels. The second reason is to create a surgical window through which a surgeon can operate on the site of involvement. This latter procedure is used to access the spinal canal from the back of the spine. It is a more common procedure in the lumbar spine. To perform the laminectomy the spine surgeon will make a 1-2 inch incision over the back. The surgeon then moves spinal muscles away from the spine exposing the bone (lamina). He or she then uses a surgical instrument to remove bone of the lamina from one or more vertebrae to gain access to the spinal canal and the intervertebral disc. The bony lamina essentially forms a roof over the central spinal canal. The lamina can be removed on one or both sides in order to provide greater volume to the spinal canal and to decompress the exposed contents of the central spinal canal.
During a microdiscectomy, partial removal of the lamina is usually sufficient to gain access to the affected nerve root. In the case of degenerative spinal stenosis, a more extensive decompressive laminectomy is usually performed which may require removal of the entire lamina on both sides of the midline including the spinous process. The procedure may include removal of the lamina and spinous process at more than one adjacent level. In rare cases it is necessary to remove the entire bony lamina and a portion of the adjacent spinal (facet) joint. This is referred to as a wide laminectomy. When a wide laminectomy and partial facetectomy is performed there is greater risk for developing excessive movement of the vertebrae (instability) secondary to the removal of supportive tissue. If a surgeon is concerned that the wide laminectomy may lead to instability, a fusion may be performed in addition to the laminectomy. A laminectomy can be used to gain access to numerous problems in the spine including hematoma, tumor, and blood vessel abnormalities, to reach a bone spur, and to access to any disc problems.
Foraminotomy
The foramina refer to the small openings along the right and left sides of the spine. The spinal nerves exit the spine though the foramen. Degenerative disc disease associated with a loss of disc volume can lead to narrowing of the bony foramen. Degenerative changes leading to thickening of the facet joint capsule, bony overgrowth and bone spur projection all contribute to narrowing of the foramen. Narrowing of the foramen can result in compromise of the exiting nerve roots. A surgical foraminotomy refers to careful shaving off of bone around the foramen to increase the volume of the opening and to make more room for the nerves and their blood vessels. A successful foraminotomy decompresses the nerve and results in reduced irritation and inflammation of the nerve.
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