Spinal decompression means creating more space and freeing the nerves and spinal cord from impinging disc material, hypertrophied bone and ligaments. On the thoracic and lumbar spine decompression is usually performed with posterior surgery (from the back of the spine).
Spinal decompression is considered for patients with intolerable back pain and/or leg pain from a prolapsed disc, degenerative disc disease or spinal stenosis. Herniated disc material, bony spurs (osteophytes) or thick ligaments cause pain by exerting pressure on the nerves and spinal cord. Spinal decompression may also be indicated after back injuries (fractures, dislocations) or when space occupying lesions (tumours, infective mass) narrow the spinal canal.
Depending on what part of the spine is removed to free the compressed neural tissues spinal decompressions may be called:
Laminectomy is the classic surgery removing the whole lamina — the back part (roof) of the vertebra that covers the spinal canal, creating more space in the spinal canal for the nerves. If only a portion of the lamina need to be removed, it is called a laminotomy. If there are herniated or bulging discs, these may also be removed (this is called a discectomy) to increase canal space. Sometimes the foramen (the area where the nerve roots exit the spinal canal) may also need to be enlarged. This procedure is called a foraminotomy. Dr Szabo uses an operating microscope during surgery which allows for ample light and magnification for a complete decompression.
A herniated lumbar disc can push on spinal nerves and cause severe, shooting leg pain, numbness and/or weakness. Minimally Invasive Lumbar Discectomy can remove a portion of the herniated disc that is compressing spinal nerves through a small incision in the skin. Dr Szabo performs minimally-invasive discectomy in many cases where surgery is necessary.
The minimally-invasive procedures spare the muscles, and are carried out with smaller incisions than used in conventional surgery. Healing time is shorter and most patients are able to return to work in 3 to 4 weeks.
Patients usually notice rapid relief of leg pain; however numbness may occasionally persist for several weeks before fading away. Patients should take care to avoid heavy lifting and strenuous exercise for at least 6 weeks following the procedure.
Fusion is a surgical technique in which two or more of the vertebrae of the spine are united together (“fused”) so that motion no longer occurs between them.
Spinal fusion is considered for a number of reasons. These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; spine instability and treatment of some disc herniations.
In most cases of spinal fusion surgery instrumentation is used to stabilize the spine. In a posterolateral fusion bone graft is placed over the transverse processes and other parts in the back of the spine then pedicle screws and rods are inserted to stabilize the spine until the bone graft heals.
Adding the instrumentation with bone graft fusion increases the strength of the spine directly after surgery, and may decrease the need for a post-operative bracing. Patients often remain in the hospital for four days to a week following the procedure and should avoid heavy lifting, bending, twisting, and turning for six to twelve weeks.
A transforaminal lumbar interbody fusion (TLIF) is performed to remove a portion of a disc that is the source of back or leg pain. A cage and bone graft is used to fuse the spinal vertebrae after the disc is removed. Lumbar fusion surgery is designed to create solid bone between the adjoining vertebra, eliminating any movement between the bones. The goal of the surgery is to reduce pain and nerve irritation. A transforaminal lumbar interbody fusion (TLIF) may be recommended for conditions such as spondylolisthesis, degenerative disc disease or recurrent disc herniations and usually combined with pedicle screw fixation.
In selected patients Dr Szabo performs lumbar fusion using a minimally invasive approach. Traditional, open spine surgery involves cutting and stripping the muscles from the spine causing significant postoperative pain and longer recovery. Minimally invasive spine surgery requires a smaller incision and muscle dilation, a surgical technique that allows the surgeon to separate the muscles surrounding the spine rather than stripping them.
MIS is an acronym for Minimally Invasive Spine Surgery. Other terms related to MIS are minimal access spine surgery, endoscopic spine surgery, or laser spine surgery. This spine surgery is minimally invasive because surgery is performed through one or more small incisions or punctures through which tubular retractors or an endoscope is inserted. MIS helps to reduce the risk of infection and decrease pain, facilitates faster recovery, and improves back muscle function.
A minimally invasive lumbar fusion procedure, such as a posterior lumbar interbody fusion, posterolateral fusion, or transforaminal lumbar interbody fusion, typically leaves a small scar or scars. Post-surgical discomfort is less, and patients are able go home sooner after surgery.
ACDF is considered for patients with intractable neck pain and/or arm pain from a prolapsed disc or cervical degenerative disc disease. Herniated disc material or bony spurs (osteophytes) cause pain by exerting pressure on the nerves and spinal cord. ACDF may also be indicated after neck injuries (fractures, dislocations) resulting cervical spine instability.
Decompression means freeing the nerves and spinal cord from impinging disc material, hypertrophied bone and ligaments. Anterior Cervical Decompression is performed on the cervical spine with anterior surgery (from the front of the neck). Dr Szabo uses an operating microscope which allows for ample light and magnification for a complete decompression.
The purpose of the Fusion is to restore the collapsed intervertebral space to the original height and stabilize the segment. A bone block (graft) or implant (cage) is placed in between the vertebral bodies to cause them to fuse together. A small titanium plate is often placed on the two vertebrae to provide further stability.
The procedure varies minimal risk of bleeding and meticulous surgical technique provide for rapid recovery and excellent cosmetic outcome.
One level cervical decompression and fusion takes about three hours. The patients require two to three nights of hospital stay. An initial two weeks of rest and relaxation is needed to ensure proper healing and adequate pain relief. Postoperative rehabilitation starts on the third week after surgery with a course of physical therapy and stretch exercise regimen. Most people are able to resume their normal activities by 4 weeks after the surgery.
In selected patients, disc replacement surgery may be indicated. This is a relatively new technology whereby the damaged disc is replaced by a prosthetic motion device. The potential advantages include preservation of motion at the disc level and protection of the neighbouring levels from accelerated wear and tear.
Cervical Disc Replacement Surgery is usually recommended for younger individuals suffering from intolerable neck pain and/or arm pain caused by a ruptured or herniated disc.
Many functional cervical disc replacements was tested and produced until now.
Prestige LP (low profile Cervical Disc) Clinical history of more than 15 years
One level cervical disc replacement requires two to three nights of hospital stay.
Recovery and postoperative rehabilitation is the same as following cervical fusion surgery.
Balloon kyphoplasty is a minimally invasive surgical technique to treat vertebral compression fractures caused by osteoporosis, spinal injury or cancer.
Osteoporosis is a debilitating bone disease that results in a reduction of bone mass predisposing the patient to an increased risk of vertebral and other fractures. Of all the fractures vertebral compression fractures (insufficiency fractures) are the most common but the least treated in the past.
If you experience sudden acute pain in your back after a minor fall or other minor incident (lifting heavy weight, jumping) consult your doctor and ask him to take an x-ray of your spine. The best way, however, to diagnose a fresh fracture of the spine is to do a MRI study with STIR weighted images. It is important to do this sooner than later because the fracture can become untreatable quickly.
Kyphoplasty is done under a light general anaesthesia. Under sterile conditions and with x-ray positioning in place, a guide pin is passed through skin into the fractured vertebral body on both sides. After several more steps to ensure correct placement of the working channels two inflatable balloons is passed inside the vertebral body into the fracture. The balloons are slowly inflated to try and restore height loss caused by the fracture and also to create a bone void.
A needle is passed into the fractured vertebra
Inflatable balloons are passed inside the vertebral body
The balloons are then removed and through the same working channels bone cement is introduced in the void created by the balloons. The cement is introduced slowly and in a low flow state so that the surgeon has control over the flow of the cement. The instruments are removed and dressings applied. The procedure takes 30-60 minutes per level. See the related weblinks:
Cement is introduced in the void
The fractured vertebra restored
After surgery the patient may sit and walk with no support and usually leaves the hospital the same day or next morning. If you develop severe pain any time after surgery you have a new fracture until proven otherwise.
The company Kyphon makes sure that surgeons are fully trained and capable to do this delicate procedure which is very safe in the right hands. For more information please visit http://www.kyphon.com/
Dr Szabo is one of the specialist surgeons in the country accredited to perform the procedure.