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Guide to treatment of Spinal Disorders
Spine surgery is a hot topic these days. You may have seen advertisements for minimally invasive spine surgery, laser treatments, disc replacement, and even fusion (by many creative names).
New technology is becoming available every day and it is important that you understand your options.
Of course, a doctor experienced in the full range of treatment options available should be consulted.
There are some basic facts about these procedures you should know.
Options include;
Arthroscopic Spine Procedures - Sometimes called Laser Spine Surgery
For decades arthroscopy has been utilized to operate on knees and shoulders. Now surgeons can apply this technology, sometimes using laser tools, in outpatient surgical treatment for pain relief of spinal disorders.
There are 3 arthroscopic spine procedures you should understand:
Foraminotomy: A foraminotomy helps to temporarily relieve symptoms caused by nerve root compression. The foramen are passageways between the vertebrae through which nerve roots exit the spinal canal. A foraminotomy may be performed to treat foraminal stenosis, bulging or herniated discs, pinched nerves, scar tissue formation, bone spurs (osteophytes), spinal arthritis, or sciatica. During a foraminotomy, the surgeon arthroscopically removes bone and tissue compressing the spinal nerve root.
Laminotomy: The lamina are two bony plates, extending dorsally and medially from the pedicles to complete the roof of the vertebral arch. This forms an entryway to the spinal canal and nerve structures. A laminotomy is performed to remove some of this bone and increase the space around nerve roots and the spinal cord. The procedure helps to temporarily reduce symptoms by reducing pressure on these nerves.
A laminotomy is performed to treat bone spurs (osteophytes), pinched nerves, scar tissue, spinal arthritis, and spinal stenosis. This does not however resolve what may be the primary cause of these conditions, degenerated discs. Laminotomy can destabilize the level leading to ongoing complications, additional surgery, and future pain.
Arthroscopic Discectomy: Discectomy is the surgical removal of bulging or herniated disc material. Degenerated, bulging, and herniated discs are a common cause of nerve root and spinal cord compression.
During this procedure, the surgeon uses a laser to vaporize disc material to reduce pressure on the spinal cord and nerve roots. This does not repair the disc and can weaken the disc leading to additional loss of disc height, additional complications, and future pain. This is called Post Discectomy Syndrome.
Depending on the diagnosis and surgical needs, sometimes more than one arthroscopic procedure is performed during a single surgery.
Fusion Surgery
Once known as the "Gold Standard" for treating degenerated discs, it is now considered a last resort surgery. This procedure takes months to recover from and even a "good" outcome has effectively disabled the fused level of the spine. The truth is that fusion accelerates degeneration of the adjacent level discs, and it has been proven, often leads to additional fusion surgeries. With fusion large and invasive incisions in the back necessitate patients be hospitalized for long periods, increase complication risks, and recovery includes extensive rehabilitation and a lengthy and painful recuperation.
Dr. Ritter-Lang on fusion;
"The difference between fusion and artificial disc replacement is that fusion surgery would be more invasive in surgical techniques and you will have more time for re-convalescence. With artificial disc replacement you can restore the movement of the segment and the patient can go back to normal life quality in a shorter time"
Disc Replacement
Disc Replacement, developed in Germany over 20 years ago, is now the new gold standard, and has all but eliminated the debilitating tragedy of spinal fusion (except in the US, where this process has been slowed by regulation).
The first generation of disc replacement implants (still in use so be careful) were ball-in-socket designs, evolved from hip and knee technology. These implants, Charite and ProDisc, had alarming rates of revision surgeries caused by implant migration, have unpredictable motion characteristics, and can cause future complications due to design issues. Long term studies of these hard plastic core devices show wear of the cores and other complications related to degeneration of the facet joints and other tissues.
Disc replacement technology has come a long way in the last few years. Improved disc replacement implants now provide a natural "Quality of Motion" unlike any of the early implant designs. Unlike the early designs, the advanced implants now available offer improved end-plate fixation, reducing implant migration and the risk of revision surgery. These implants also have motion control, to reduce the post-op complications caused by early ball-in-socket implants, which can stress facet joints, ligaments, and muscles. They also have added the safety of shock absorption, to prevent injury to adjacent structures.
Lumbar disc replacement require an anterior access to the spine for the implantation of artificial discs. Lumbar discs can be implanted via a trans-peritoneal or a retro-peritoneal approach, of which the latter is favored by most surgeons.
At Stenum our surgeons have developed and perfected a retroperitoneal approach that carefully avoids trauma to critical structures. Complications are reduced with technique and surgeon experience. Complications like injury to nerves causing sexual dysfunction and nerve damage to urologic structures are now very rare with these improved techniques.
Interspinous Process Devices
Interspinous process devices are designed to keep open the space where the nerve endings exit the spinal cord into the legs. It is thought that these devices may also unload the disc. They can be effective for patients, but should be used only at levels that are still in the early stages of disc degeneration. They work by limiting the spinal extension (the position the spine takes on when bending backward). This backward bending position may be painful for patients with Degenerative Disc Disease because it pinches the posterior aspect of the disc narrowing the foraminal openings. Most cases where loss of disc height is present would not be advised for these devices.
The interspinous devices may be implanted with the patient under a mild sedative and local anesthesia as an outpatient surgery procedure (patient goes home the same day) or under light anesthesia. This may be particularly beneficial for elderly patients for whom more extensive open surgery may present too great of a surgical risk due to less favorable general health and fitness level.
Dr. Ritter-Lang has used the Wallis interspinous process device in combination with Disc Replacement on levels that are still in the early stages of degeneration or are inaccessible for disc replacement.
Why wait? Find out what procedure is right for you.
To begin your evaluation process; click the link below and complete the online form. Then, send images, patient data form (print and include), etc.. In 2-3 weeks, at no cost to you, you will receive your written diagnosis, surgery options, cost, and scheduling options.
Click here to begin the evaluation process.
See Spinal Kinetics M6 Lumbar Disc
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