Treatments: Common Procedures for Spine Disorders
Lumbar Artificial Disc Placement | Posterior Cervical Fusion | Spinal Cord Stimulator | Laminectomy and Microdiscectomy
Lumbar Artificial Disc Placement
Definition
The placement of an artificial disc is used for patients with degenerative disc disease. The artificial disc is designed to mimic the function a patient's own disc. It is intended to maintain normal movement between the vertebrae and to prevent collapse. Not everyone is an appropriate candidate for this procedure; the patient needs to discuss the options with the neurosurgeon prior to planning for this procedure.
Procedure
This procedure is done with the patient lying on their back and the incision is made in the front (anterior) at their lower abdomen. The organs in the abdomen and the blood vessels are moved to the side to allow the surgeon to see the front of the spine. The surgeon the uses X-ray to identify correct placement. The surgeon then removes the collapsed degenerative disc in order to create the space for the artificial disc. The artificial disc is then implanted in the space. The artificial disc is designed to stay in place by the spinal ligaments and the compressive force of the spine. After the disc is placed, a final X ray is taken and the abdominal incision is closed.
Day of Surgery
You will be asked to change into a hospital gown. You may be given medicine in you IV to help you relax or make you drowsy. You will be taken on a cart to the operating room and them moved from the cart to a special bed. You will get general anesthesia to keep you completely asleep during the surgery. A central IV catheter may be placed into a large vein under your collarbone, in you neck or in your arm. A machine called evoked potential will be used to watch your nerve activity during the surgery. Sticky pads will be taped to your skin to make this machine work right. Tight elastic pressure stockings to help keep blood from staying in the legs causing clots will be applied at the time of surgery. In addition, pneumatic boots or leggings will be put on your feet or legs over the pressure stockings. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
After Surgery
You will be taken to the recovery room where you will be watched closely until you wake up. You will then be taken back to a hospital room. You will be wearing an abdominal binder to support your incision area. You may wear this in bed, or only when you get out of bed as you feel most comfortable. Do not get out of bed until you are instructed to and are assisted. You will be assisted and instructed by physical and occupational therapy. You will be wearing a heart monitor so that your heart is being watched all the time to make sure your body is handling surgery well. You will be asked to use an incentive spirometer. This helps you take deeper breaths. You will be instructed how to properly use this device. It is very important that you use this 10 times in a row every hour while awake. You will resume eating very slowly. Once your stomach growling sounds are heard, you will begin with liquids and slowly advance to regular food. For elimination, a tube called a Foley catheter may be placed into your bladder to drain your urine. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you can urinate on your own. Patients usually need to stay in the hospital 3 days after an artificial disc surgery.
Medicines
You will be given antibiotics through your IV in surgery as well as after surgery for prevention of infection. If you become nauseated or begin to throw up, there are medicines ordered for this. Pain medicine and anesthesia can make you nauseated, so please ask for this medicine for relief. For your pain, you will probably be connected to IV pain medication called PCA- patient controlled anesthesia. This is a narcotic medication given when the patients uses the button for delivery. It is very important that only the patient's using this button to medicate themselves and no one else is pushing the button for them.
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Posterior Cervical Fusion
Definition
A posterior cervical fusion is performed through an incision in the back of the neck. This surgical procedure is used to stop motion between 2 or more vertebrae, to recreate the normal curve of the spine and to keep a spinal deformity from getting worse. This procedure is also performed after a fracture or dislocation of the cervical spine.
Procedure
An incision is made in the back of the neck and the muscles are moved to the side. The then uses X ray to identify correct placement. Bone graft either taken from the top rim of your pelvis or from a bone bank is used on the back surface of the problem vertebrae. The surgeon then uses X-ray to identify correct placement. Bone graft either taken from the top rim of you pelvis or bone bank graft is used on the back surface of the problem vertebrae. During the healing process, the vertebrae grow together, creating a solid piece of bone. The fusion may also be done in a way to spread the vertebrae apart in order to try and restore the normal curvature of the spine. Increasing the distance between the vertebrae also widens the opening, also known as the formina, where the nerves come out of the spine. Restoring the area of the foramina relieves the nerves and irritation from bone spurs where the nerves pass through the foramina.
Day of Surgery
You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved from the cart to a special bed. You will get general anesthesia to keep you completely asleep during the surgery. A central IV catheter may be placed into a large vein under your collarbone, in your neck or in your arm. A machine called evoked potential will be used to watch your nerve activity during the surgery. Sticky pads will be taped to your skin to make this machine work right. Tight elastic pressure stockings to help keep blood from staying in the legs and causing clots will be applied at the time of surgery. In addition, pneumatic boots or leggings will be put on your feet or legs over the pressure stockings. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
After Surgery
You will be taken to the recovery room where you will be watched closely until you wake up. You will then be taken back to a hospital room. You will be wearing a cervical collar on at all times. This will hold your head and neck in the right position so that it can heal best. Do not get out of bed until you are instructed to and are assisted. You may be wearing a heart monitor so that your heart is being watched all the time to make sure your body is handling surgery well. You will be asked to use an incentive spirometer. This helps you take deeper breaths. You will be instructed how to properly use this device. It is very important that you use this 10 times in a row every hour while awake. You will probably have a thin rubber tube and reservoir collection device to drain fluid from around your incision. This drain will be removed when the incision stops draining. You will resume eating very slowly. Once your stomach growling sounds are heard, will be begin with liquids and slowly advance to regular food. For elimination, a tube called a Foley catheter may be placed into your bladder to drain your urine. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you can urinate on your own.
Medicines
You will be given antibiotics through your IV in surgery as well as after surgery for prevention of infection. If you become nauseated or begin to throw up, there are medicines ordered for this. Pain medicine and anesthesia can make you nauseated, so please ask for this medicine for relief. For your pain, you will probably be connected to IV pain medication called PCA –patient controlled anesthesia. This is a narcotic medication given when the patient uses the button for delivery. It is very important that only the patient's using this button to medicate themselves and no one else is pushing the button for them.
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Spinal Cord Stimulator
Definition
For pain in the lower extremities and lower back, the stimulator electrode implant is placed over the lower end of the spinal cord. Spinal cord stimulation uses a small system that is surgically placed under the skin to send mild electrical impulses to the spinal cord. The electrical impulses are delivered through a lead (special medical wire) that is also surgically placed. These electrical impulses block the pain signal from reaching the brain.
Procedure
In the operating room, the patient is place on their abdomen. A lamiectomy, (removal of the lamina bone), is done at the appropriate level to facilitate placement of the spinal cord stimulator implant paddle electrodes behind the dura (soft covering of the spinal cord). The spinal cord stimulator implant electrodes are then connected to a pulse generator. The leads are brought out through an incision several inches away from the open surgical site. Once the patient is awake, stimulation begins. The sensation felt varies but most people report a tingling sensation in the area of their pain. The patient usually stays in the hospital for a few days to determine whether the device is providing any relief. After a few days, the patient returns to surgery to implant the battery permanently within a pocket under the skin, usually below the rib cage. The patient will be positioned on their side for this part of the procedure. The stimulator does not make any noise. It may be felt like a small bulge under your skin. The device is about 6cm wide, 5.2 cm high and 1cm thick and is not typically visible through your clothing.
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Laminectomy and Microdiscectomy
Definition
These procedures are typically done for treatment of a herniated disc and/or to relieve pressure on the nerves causing by narrowing of the space, therefore causing pain and discomfort.
Procedure
The procedure is performed through an incision down the center of the back over the area of the herniated disc. The muscles are moved to the side so that the surgeon can see the back of the vertebrae. X Rays may be done during surgery to make sure the correct vertebrae is located. The surgeon cuts a small opening through the lamina bone on the back of the spinal column. The making of an opening in the lamina, also called 'laminotomy' or removal of the lamina, a 'laminectomy'is done to give the surgeon room to see and work inside the spinal canal. Nerve roots are moved out of the way. Upon locating the problem disc, the surgeon removes it, easing pressure and irritation of the nerves of the spine. Small instruments that fit inside the disc are used to remove as much of the nucleus as possible. This is called a 'discectomy'. This prevents the remaining disc material from herniating in the future. The muscles of the back are returned to their normal position around the spine. Microdiscectomy is the same as a traditional discectomy, except a much smaller incision is made for this procedure. A small incision is made in the back just above the area where the disc is herniated. Muscles are moved aside to see the vertebrae. The surgeon then positions a microscope in the small incision. The remainder of the surgery is performed like the traditional method.
Surgery Day
You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved from the cart to a special bed. You will get anesthesia to keep you completely asleep during the surgery.
After Surgery
Typically, patients go home on the same day as surgery, either in the afternoon or that evening. You need to make sure you have a ride home for that day.
Medicines
You will be given antibiotics through your IV in surgery as well as after surgery for prevention of infection. If you become nauseated or begin to throw up, there are medicines ordered for this. Pain medicine and anesthesia can make you nauseated; you need to ask for this medication for relief. For your pain, you will be given a narcotic pain medication and it is important that you take it only as directed.
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