Neck bone spur surgery

Laminectomy

You will have an x-ray of your spine. You may also have an MRI or CT myelogram before the procedure to confirm that you have spinal stenosis.

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • Prepare your home for when you leave the hospital.
  • If you are a smoker, you need to stop. People who have spinal fusion and continue to smoke may not heal as well. Ask your doctor for help.
  • For the one week before surgery, you may be asked to stop taking blood thinners. Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). If you are taking warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.
  • If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
  • Talk with your surgeon if you have been drinking a lot of alcohol.
  • Ask your surgeon which medicines you should still take on the day of the surgery.
  • Let your surgeon know right away if you get a cold, flu, fever, herpes breakout, or other illnesses you may have.
  • You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

  • You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.

When Surgery Is Needed for Neck Pain

Neck surgery usually is considered a treatment for neck pain only when all other approaches have failed. Most doctors would rather a patient first try treating their neck pain using medicine, rest, and physical therapy. For one thing, with all its risks and side effects, there is no guarantee neck surgery will help. However, when successful, it can provide the pain relief you’re looking for.

Neck Surgery: When to Consider It There are times when surgery is the best option for treating the medical condition responsible for your neck pain. Neck surgery is generally performed for one of these reasons:

  • To relieve pain caused by a nerve root that’s being pinched by bone spurs or material from a ruptured or herniated disk, a condition called cervical radiculopathy. More than 9 of 10 patients who have a herniated disk removed enjoy complete or significant relief of their pain.
  • To remove pressure on the spinal cord caused by bone spurs, a condition known as spinal stenosis. This involves more complex surgery, and the success rate ranges from 50 to 90 percent, depending on the factors involved.
  • To keep vertebrae from grinding together as a result of degenerative disk disease, which creates neck pain from pinched nerves.

Neck Surgery: The Procedures Surgical procedures to treat neck pain include:

  • Anterior cervical discectomy. This is the most common surgery to relieve neck pain caused by a nerve-pinching herniated disk. The surgeon exposes your spine through an incision in the front of your neck right next to your windpipe. Through that incision, the doctor removes the herniated disk and any bone spurs that may be causing pain. Afterward, the space left between the vertebrae is refilled with a piece of bone (either your own, taken from your hip bone, or a bone graft from a donor) or other material, fusing the adjacent vertebrae together.
  • Laminectomy. This procedure is used to relieve pressure on the nerve roots or spinal cord. The laminae are bony plates on the back side of the vertebrae that cover and protect the spinal cord. Removing the laminae can reduce pressure on the spinal cord and nerves. Doctors also can remove sections of herniated disk and bone spurs through the new opening in the vertebrae.
  • Laminoplasty. This is used to help people with spinal stenosis by creating more room for the spinal cord within the spinal canal. After exposing the spine through an incision on the back of the neck, the doctor then reconstructs the vertebral laminae to enlarge the spinal canal.
  • Cervical spinal fusion. This surgical procedure joins together two vertebrae that are grinding against each other because the disk between them has herniated or been worn away. A bone graft or metal implant is used to join the vertebrae, which eventually grow together.

These surgeries involve a hospital stay of up to a week, and you will often have to wear a neck brace or other protective equipment to support the neck and keep it still during healing. Complete recovery takes about five weeks. You’ll need to exercise care and avoid heavy lifting or exertion for several months afterward.

Neck Surgery: Risks and Complications

Because neck surgery is performed around the throat and near the spinal cord, there is a small but real risk of very serious complications. These can include:

  • Damage to one of the large arteries and veins that go through the neck into the brain
  • Damage to the nerves or spinal cord
  • Infection of a bone graft or the area around the spine
  • Displacement of the bone graft before fusion can occur
  • Failure of two vertebrae to fuse together

Some of these complications can be treated with antibiotics, but others may require a second operation.

Neck surgery is rare, but if it is recommended for the underlying cause of your neck pain, arm yourself with as much information as possible to get the best outcome.

Do I Have the Symptoms of Cervical Bone Spurs?

Diagnosing Cervical Bone Spurs

Since bone spurs are an outgrowth of your normal bones, current medical technology makes them fairly easy to detect. First, your doctor will conduct a thorough medical exam. This includes gathering information about your symptoms, medical history, and personal habits. Your doctor will also perform a physical examination to detect muscle weakness and other conditions associated with bone spurs (like cervical myelopathy).

To confirm the presence of bone spurs, your doctor may order more diagnostic testing. This process typically starts with an x-ray to obtain a clear image of your cervical spine. If those results are inconclusive, then advanced imaging may be necessary. This includes CT scans or MRIs. These methods will give your doctor a more complete picture of the issues that are causing your neck pain. Finally, your doctor may order a nerve conduction study and/or electromyogram to determine the specific location of any affected nerves.

Treatment Options for Cervical Bone Spurs

Unless your symptoms are severe, your doctor will generally start with conservative treatments. In most cases, this will help with your neck pain and increase mobility and functioning. These nonsurgical treatments may include:

  • Resting the Area: A couple days of avoiding any strenuous activity involving the neck may lessen some of the acute pain and inflammation. During this rest period, your doctor may recommend using an ice or heat pack.
  • Pain Medications: Typically, as an initial course of treatment, your doctor will suggest over-the-counter or anti-inflammatory drugs and pain relievers. If these don’t work, he or she may order you prescription drugs instead. If these drugs still fail to provide you with adequate relief after a few weeks, your doctor may order epidural steroid injections. During this treatment, your doctor will inject a corticosteroid medicine directly into the affected area to block pain signals.
  • Physical Therapy: A physical therapist can perform and prescribe exercises, like neck stretches to strengthen the muscles supporting the neck. In addition, he or she may suggest certain activity modifications, such as basic techniques for improving posture. Even simple postural tweaks can prevent your symptoms from worsening.
  • Holistic Therapies: Certain holistic treatments like acupuncture or chiropractic adjustment can assist in reducing your pain and improving your neck mobility.

Surgical Treatments for Osteophytes

If, after weeks of conservative treatments, you aren’t achieving the necessary relief, surgical treatments may be available. Although rarely needed, these treatments can be incredibly beneficial in finally addressing the neck pain associated with bone spurs. Some of these minimally invasive treatments include:

  • Laminectomy: A procedure to remove bone spurs and other tissues that cause nerve compression. This creates more space for the spinal nerves to function adequately.
  • ACDF: In which your surgeon accesses the spine through a small incision in the front of the neck to remove a damaged disc caused by a protruding bone spur. Subsequently, the bones around the removed disc are fused together using a bone graft to stabilize the area.
  • Posterior Cervical Laminoplasty: If a bone spur is compressing your spinal cord, then your surgeon may enter in through the back of your neck to relieve the pressure. This often involves cutting a bone near the spine, known as the lamina so that it hinges open and gives the spinal cord more room to heal.

By using the latest technology, these surgical procedures can be “minimally invasive” (or resulting in minimal trauma to the spine). This allows for less scarring and pain. In addition, since these types of procedures cause less damage to soft tissues than open surgeries, recovery times are usually significantly shorter.

Seeking Treatment for Your Neck Pain

If you are experiencing significant neck pain because of bone spurs, our surgical team at the Advanced Spine Center is ready to help. We specialize in both nonsurgical and surgical treatments to help you find the most appropriate care for your neck and spine issues.

By scheduling an appointment at the Advanced Spine Center today, you are assured that our multidisciplinary, fellowship-trained team of spine experts will be handling your case. From there, you can expect a customized treatment plan based on your condition, preferences, and goals for recovery. We empower you with knowledge about the latest conservative treatments as well as the most effective surgical approaches to help you return to your life–free of pain.

Causes of Pinched Nerves

A pinched nerve occurs when there is “compression” (pressure) on a nerve.

The pressure may be the result of repetitive motions. Or it may happen from holding your body in one position for long periods, such as keeping elbows bent while sleeping.

Nerves are most vulnerable at places in your body where they travel through narrow spaces but have little soft tissue to protect them. Nerve compression often occurs when the nerve is pressed between tissues such as:

  • Ligament
  • Tendon
  • Bone

For example, inflammation or pressure on a nerve root exiting the spine may cause neck or low back pain. It may also cause pain to radiate from the neck into the shoulder and arm (cervical radiculopathy). Or pain may radiate into the leg and foot (lumbar radiculopathy or sciatic nerve pain).

These symptoms may result from changes that develop in the spine’s discs and bones. For example, if a disc weakens or tears — known as a herniated disc — pressure can get put on a spinal nerve.

Nerve compression in your neck or arm may also cause symptoms in areas such as your:

  • Elbow
  • Hand
  • Wrist
  • Fingers

This can lead to conditions such as:

  • Peripheral neuropathy
  • Carpal tunnel syndrome

If nerve compression lasts a long time, a protective barrier around the nerve may break down. Fluid may build up, which may cause:

  • Swelling
  • Extra pressure
  • Scarring

The scarring may interfere with the nerve’s function.

The vast majority of people — more than 90% — with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen.

Cervical disc disease is caused by an abnormality in one or more discs — the cushions — that lie between the neck bones (vertebrae). When a disc is damaged — due to arthritis or an unknown cause — it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots.

Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

Often, a procedure is performed to close the space that’s left when the disc is removed and restore the spine to its original length. Patients have two options:

  • Artificial cervical disc replacement
  • Cervical fusion

In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Since then, several artificial cervical discs have been developed and approved. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. It’s also not known how the artificial discs will last over time. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.

Anterior Cervical Discectomy & Fusion (ACDF)

  • Vertebrae failing to fuse. There are many reasons why bones do not fuse together. Common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.
  • Hardware fracture. Metal screws and plates used to stabilize the spine are called “hardware.” The hardware may move or break before the bones are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.
  • Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) is not used or if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.
  • Transitional syndrome. Fusion of a spine segment causes extra stress and load to be transferred to the discs and bones above or below the fusion. The added wear and tear can eventually degenerate the adjacent level and cause pain.
  • Nerve damage or persistent pain. Any spine surgery comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to surgery. Like furniture on the carpet, the compressed nerve doesn’t spring back. In these cases, spinal cord stimulation or other treatments may provide relief.
  • Sources & links

    If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

    Sources

    1. Bose B: Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14:3-9, 2001.
    2. Hilibrand AS, et al.: Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 83-A:668-73, 2001.
    3. Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107-16, 2007.

    Links

    www.knowyourback.org

    Glossary

    allograft: a portion of living tissue taken from one person (the donor) and implanted in another (the recipient) for the purpose of fusing two tissues together.

    autograft (autologous): a portion of living tissue taken from a part of ones own body and transferred to another for the purpose of fusing two tissues together.

    bone graft: bone harvested from ones self (autograft) or from another (allograft) for the purpose of fusing or repairing a defect.

    discectomy: a type of surgery in which herniated disc material is removed so that it no longer irritates and compresses the nerve root.

    foraminotomy: surgical enlargement of the intervertebral foramen through which the spinal nerves pass from the spinal cord to the body.

    fusion: to join together two separate bones into one to provide stability.

    interbody cage: a device made of titanium, carbon-fiber, or polyetheretherketone (PEEK) that is placed in the disc space between two vertebrae.

    updated > 11.2018
    reviewed by > Robert Bohinski, MD, Mayfield Clinic, Cincinnati, Ohio

    Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. This information is not intended to replace the medical advice of your health care provider.

    Typically, you will only have to stay in the hospital for a short period of time after having surgery. However, that does not mean you will have recovered as soon as you return home. Rather, your neck surgery recovery time may be significantly extended and you must make sure that you follow the post-operative instructions that your physician gave you so that your wounds can heal.

    In most cases, surgery is performed in order to address problems with one or more nerves within the spine. The spinal cord contains many different nerves at each level and they may become irritated or compressed if there is an abnormality within the spine.

    Usually, this is down to an issue with your discs, which are jelly-like, soft structures within your spine, effectively cushioning the bones that make up the spine. They can be displaced or they can degenerate, which in turn causes irritation and/or compression on the nerve.

    Alternatively, the foramen can tighten, which can also cause significant pain. The most commonly offered procedures, which all address the aforementioned issues, are:

    1. Anterior cervical discectomy, whereby the pain of a degenerated or herniated disc is addressed. A surgeon will get to the spine through the front (anterior), taking out the disc in question, and using a bone graft to stabilize the area. Any bone spurs that are touching the spinal nerve may also be removed. Usually, only one overnight stay is required following this surgery. You will be discharged depending on whether you can eat, your mobility, and the extent of your pain. Usually, you will be able to return to your normal activities within three to six months. Neck fusion surgery recovery varies depending on how quickly the bone graft is able to fuse. This will be monitored regularly by your physician who will provide you with advice on how to recover and what level of activity is acceptable.
    2. Posterior cervical discectomy and foraminotomy, which is quite similar to the previously mentioned surgery because it aims to take out disc tissue that is causing problems. However, with this particular procedure, the disc will be approached through the back (posterior). In addition, no bone fusion will be required as only parts of the disc will be removed. Hence, neck fusion surgery recovery tips are not relevant in this case. Instead, this surgery simply aims to make the space in which the nerve gets out of the spine bigger, thereby preventing compression. It does not aim to improve pathological joints that, through movement, generate pain. Rather, the surgery relieves compression my making more space, thereby reducing irritation of the nerve and reducing pain sensations. Usually, a keyhole incision will be made behind the neck and the nerve will gently be moved sideways, after which the surgeon will clear the space in the foramen. Sometimes, displaced disc material and bone spurs will also need to be removed. Usually, you will have to remain in the hospital for around two days following this surgery. Further recovery will happen over the next four to six weeks, after which you can return to light activities. Full recovery takes around two to three months. You are likely to be put forward for physical rehabilitation therapy as well.
    3. Disc replacement or cervical arthroplasty procedure. With this surgery, damaged cervical disc will be taken out and an artificial disc will be put in its place. The artificial disc is a type of prosthetic that works in the same way as a joint, meaning there should be no loss of movement. This surgical procedure is quite similar to the first surgery because the entire disc is taken out and fusion will be required. What is different is the implant, which is a bone graft with the anterior cervical discectomy but a prosthetic device with the disc replacement procedure. In this procedure, a small incision is made to the neck’s front and the soft tissue is pulled aside. Bone material and the disc itself will then be taken out and the surgeon will put the artificial disc in place. The remaining tissue will gently be put back into position and the incision will be stitched. How long you will need to remain in the hospital will depend on your condition, although many do not require an overnight stay. Usually, you can return to light activities around two weeks afterwards and it will take around six weeks to recover in full.

    Benefits of Having Neck Surgery

    As previously stated, nobody wants to have surgery and most people will avoid it as much as possible. However, neck surgery also offers a number of significant benefits that you must be aware of. They include:

    • Less pain and thereby a better quality of life. Once you have fully recovered, you will be able to resume your regular life, never thinking about experiencing the debilitating pain again. Having neck pain is a debilitating and life limiting condition, but surgery can resolve that issue.
    • Better health. Usually, neck pain is a symptom of an underlying condition that must be addressed. By having surgery, this issue is addressed, thereby stopping it from getting worse.

    Factors That Affect Recovery Time

    There are numerous factors that will affect how long it will take you to recover from neck surgery. How bad your condition is and which type of surgery you have are two of the most important factors that impact recovery time. Other factors include:

    • Your age. If you are still quite young, then you are likely to recovery more quickly than if you are older. Younger people usually beat the milestones of the average patient. On the other hand, it is quite rare for younger people to require neck surgery.
    • Your overall health. If you have any other pre-existing condition or live an unhealthy lifestyle, it is more likely that your recovery time will take longer. The healthier you are at the start of the procedure, the shorter your recovery time will be. Things such as smoking, being overweight, drinking to excess, and having chronic illnesses all impact negatively on how long it will take your wounds to heal.
    • Your lifestyle. Those who lead an active lifestyle and engage in regular healthy physical activity tend to recover quickly. Those who have very demanding, physical jobs, however, tend to recover much more slowly. If you are highly active, it will usually take you longer to get back to that level of activity as well.

    How Long Does It Take to Recover from Neck Surgery? 5 Important Tips

    Surgery is always physically demanding, but perhaps never more so than with neck surgery. This is because it impacts the cervical spine, which is the part of your body that is responsible with facilitating movement and supporting your head. Hence, it is very different from a broken arm, for instance, which only requires a bit of rest and a cast. It is impossible to take all pressure away from your neck after surgery, which is one of the reason why recovery is often somewhat longer than with other types of surgery. Nevertheless, there are some important neck surgery recovery tips that you can implement to help reduce your healing time as much as possible.

    You do have to be aware of the fact that these tips are provided as a guide only. In addition, they will not make you magically heal. Rather, they are designed to decrease how much time you need. What is even more important is that you follow the guidelines as set out by your surgeon, who will generally create a program specific to your situation. Let’s take a look at the five most important tips.

    1. You must protect the site of the surgery and your spine from undue pressure and that is done by resting. It may be tempting to get back to work or take part in physical exercise again as soon as possible, but that isn’t a good idea. You have to take the time to rest and recuperate because your surgery may actually fail if you overexert yourself. You should not push yourself and when you do return to your physical activities, it should be because your surgeon has given the go signal.
    2. Physical therapy. You are likely to have been referred to this therapy after your surgery. Unfortunately, a lot of people will only attend to receive their rehab instructions and then don’t follow them through. If you want to recover fast from your surgery, you need to work at that and that means committing to the program and taking part in your sessions, as well as doing your homework. This will have a huge impact on your overall recovery time.
    3. Hydration and diet. You must make sure that your blood is properly oxygenated and full of essential vitamins and minerals. This will enable your blood to move freely and to deliver vital nutrients to the surgical site, helping it to heal. While you may feel like you can lounge in bed and order Chinese food every night, that isn’t a good idea. Instead, munch on veggies and fruits and always have water by your side. This will ensure you stay fully hydrated all day long, fighting inflammation and encouraging your body to recover.
    4. A clean surgical site. This can be a little bit difficult if you had a posterior surgery, but if it was anterior, you should be able to keep your site clean with ease. Your doctor should have given you tips and guidelines on how to look after the site and you must follow those to the letter.
    5. While we previously mentioned that you have to take it easy and that is correct, it is also important that you engage in exercises that are actually good for your neck. You must make sure that you don’t seize up and that your neck remains mobile and has a full range of motion. Light exercise, such as a leisurely stroll around the neighborhood, will help you to recover much more quickly.

    Surgical Anxiety

    One thing that is bad for your recovery is being anxious before and after the procedure. That is because, when you’re anxious, your body is flooded with hormones that impact your immune system and body’s defenses. Hence, while it is normal to experience some anxiety and being nervous, it is important to remain calm as well. Thankfully, there are some good tips to help you manage your anxiety, so that you go into your surgery with a calm mind and body. These include:

    • Understanding what is making you feel anxious and looking into that more specifically.
    • Properly planning for your procedure.
    • Educating yourself on what to expect.
    • Speakng with your surgical team and support network about your anxieties.

    Post-Operative Care

    Last but not least, it is very important that you look after yourself as soon as the surgery is over. If you want to recover as quickly as possible, you also need to be safe and comfortable. It is likely that your physician will have prescribed you some painkillers and you have been given you instructions on how to look after your wound. You will also have been advised on things you absolutely cannot do, such as engaging in strenuous activity. Your surgeon will also have told you how long you will need to stay off work.

    There are also some other things to expect after your surgery, including:

    • Limitations to certain physical activities. Bending over to pick something up or lifting in excess of 8 lbs is generally not allowed. Hence, make sure you have a support network to give you help around the house while you recover.
    • The fact that driving is not allowed for at least two weeks, to protect both you and other road users.
    • The fact that showering should be limited as you do not want any foreign bodies to get into the wound and cause infections. You must give the sutures the time they need to close the wound itself. Again, your physician should have informed you about that.

    Furthermore, if you have a fever, notice blood or pus from the wound, have difficulty in breathing or using the bathroom, or feel pain or numbness, you must inform your physician. Listening to your body while following the advice of your surgeon is the most important thing you can do to shorten your recovery time. For more information about neck surgery contact our expert spine surgeon Dr. Sandro Larcocca.

    Types of Minimally Invasive Spine Surgery

    Minimally invasive spinal surgery involves the use of smaller incisions that minimize damage to the surrounding muscles and ligaments of the spine. These less invasive surgeries allow for the following benefits when compared to traditional surgeries, including:

    • Faster recovery times
    • Reduced infection and blood loss
    • Faster return to your regular lifestyle.

    At MedStar Georgetown, our fellowship-trained spine surgeons offer the most advanced techniques and minimally invasive treatments available, including:

    • Corpectomy
    • CyberKnife®
    • Disectomy
    • Foraminotomy
    • Laminectomy
    • Kyphoplasty
    • Resection of Synovial Cyst
    • Spinal Cord Stimulator Implantation
    • Spinal Fusion
    • Spinal Instrumentation
    • Tumor Resection

    Discectomy

    A discectomy is the surgical removal of material that is pressing on a nerve root or the spinal cord due to a herniated or bulging disc. A discectomy is used to treat a pinched nerve (nerve root compression), bone spur, sciatica, or raditating pain through the limbs called radiculopathy

    In a minimally invasive discectomy, surgeons use special retractors and a microscope or endoscope to perform the removal of the herniated disc. This allows our surgeons to make smaller incisions that lead to a faster recovery. These surgeries are completed under general anesthesia, typically take less than an hour and patients are able to go home several hours later.

    Anterior Cervical Discectomy and Fusion

    Anterior Cervical Discectomy and Fusion (ACDF) is a surgical procedure where the disc is removed through the front of the neck (anterior approach) in order to relieve pressure from the spine (decompress) and relieve pain. This procedure is combined with a fusion surgery in order to stabilize the neck.

    ACDF is used to treat herniated disc and degenerative disc disease.

    Foraminotomy

    A foraminotomy is a procedure that widens the tunnel (foramen) in your back where nerve roots leave your spinal canal. It is used to relieve the symptoms of nerve root compression, also known as a “pinched nerve” or “ radiculopathy.” These symptoms may include pain, numbness, tingling or muscle weakness. The procedure can also be performed using a minimally invasive approach that requires no hospitalization.

    A foraminotomy of the spine is used to treat the following conditions:

    • Foraminal stenosis
    • Herniated disc
    • Pinched nerve (nerve root compression)
    • Bone spur
    • Sciatica
    • Radiculopathy

    Laminectomy

    In a laminectomy, the surgeon removes the lamina (the back part of the vertebra that covers and protects your spinal canal). The procedure takes pressure off the spinal cord or a spinal nerve in cases such as a lumbar stenosis, a herniated disc or bone spur.

    A laminectomy can be performed at any level of the spine and using minimally invasive techniques. Patients with single-level or two-level stenosis of the lumbar spine are usually sent home on the day of surgery. A laminectomy can be used to treat spinal stenosis, degenerative disc disease or a herniated disc.

    Spinal Fusion

    Spinal fusion is a surgery performed to permanently join together two or more bones in the spine so there is no movement between them. To fuse the bones together, the surgeon uses a graft.

    There are several different types of graft material. An autograft is composed of strips of bone obtained from the area of surgery or another part of your body, such as your pelvic bone. An allograft is cadaver bone obtained from a bone bank. Grafts can also be made from synthetic material.

    Fusion surgery of the spine can be approached from the front, the side or the back. A number of recent technological advances have allowed fusion surgery to be performed using minimally invasive techniques in select cases.

    Our surgeons routinely perform minimally invasive fusion of the lumbar spine from the side (XLIF or DLIF surgery) as well as from the back (TLIF or PLIF surgery). These less invasive techniques can reduce infection rates and blood loss and lead to a faster recovery.

    To promote proper bony fusion, the surgeon often fixes the vertebrae together with rods, screws, plates or cages to keep the bones from moving until the grafts fully heal. This is called spinal instrumentation.

    While fusion surgery takes away some spinal flexibility, most spinal fusions involve only small segments of the spine and do not limit motion very much.

    Spinal fusion may relieve symptoms of many back conditions, including the following:

    • Degenerative disk disease
    • Spondylolisthesis
    • Spinal stenosis
    • Scoliosis
    • Fracture
    • Infection
    • Tumor

    Spinal Instrumentation

    Spinal instrumentation is a method of keeping segments of the spine immobile after spinal fusion surgery. During this procedure, the surgeon inserts screws and rods to the spine to keep the bones in alignment while the bone graft heals and they fuse together.

    Two types of minimally invasive spinal instrumentation procedures are available at Medstar Georgetown University Hospital:

    1. Percutaneous pedicle screws: In percutaneous pedicle screw fixation, the surgeon uses a minimally invasive technique to insert the screws and rods. The surgeon makes small incisions in your back on both sides of your spinal column, and all of the instrumentation is inserted through these small incisions while the surgeon uses X-ray imagery. This minimally invasive approach allows the surgeon to stabilize your spine while disrupting as little healthy tissue as possible.
    2. Percutaneous facet screws: Facet screws are used to eliminate unwanted motion between joints in your spine called facet joints. They are used to fuse the targeted joints in a permanent position in conjunction with the placement of bone grafting materials when problems with joints have led to pain or structural damage.

    These minimally invasive methods of screw insertion when used with other fusion techniques allows the surgeon to stabilize your spine while disrupting as little healthy tissue as possible.

    Corpectomy

    A corpectomy is the surgical removal of part or all of a vertebra for the purpose of taking pressure off the spinal cord and nerves. Corpectomy is often used to relieve pressure caused by stenosis, bone spurs, fractures, a spinal tumor or infection in the cervical (neck) thoracic (mid-back) or lumbar (lower back) spine.

    The discs above and below the affected vertebra are removed, along with the middle portion of the bone. A bone graft or metal prosthesis is typically inserted to keep the spine stable after the damaged structures have been removed.

    Resection of Synovial Cyst

    During this procedure, a surgeon removes the synovial cyst and any structures compressing the nerves. Our surgeons perform these surgeries on an outpatient basis with minimally invasive techniques avoiding the need for fusion surgery in select cases.

    Spinal Cord Stimulator Implantation

    A spinal cord stimulator implantation is a procedure where a small pulse generator is implanted into the back in order to send an electrical current to the spinal cord and relive chronic pain. The low voltage stimulation to the spinal nerves causes tingling sensation to the back and blocks pain.

    This procedure is used to treat the following conditions:

    • Failed back surgery syndrome
    • Chronic pain

    Kyphoplasty

    Kyphoplasty is an outpatient procedure used to treat compression fractures in the spine. A compression fracture is when all or part of a vertebra collapses due to problems like osteoporosis (thinning of the bones), cancer or injury.

    In this minimally invasive procedure, the patient is put under local or general anesthesia. The surgeon places a needle through the skin into your vertebra. The surgeon then inserts a special balloon through the needle, into the bone, and inflates it. The balloon can help to restore the vertebra to its original shape. Bone cement is injected into the space to impart stability and make sure it does not collapse again.

    Tumor Resection

    Tumor resection is the surgical removal of tumors from the spine whether benign or malignant.

    CyberKnife® Radiosurgery

    Though it sounds like a surgical procedure, CyberKnife is actually a painless and non-invasive form of radiation that offers accurate, effective treatment for tumors anywhere in the body—even in places previously considered unreachable. CyberKnife uses a combination of computers, image-guided cameras, and robotic technology to concentrate radiation directly at tumor cells, while limiting radiation exposure to surrounding healthy tissue.

    CyberKnife is one of the most advanced and effective stereotactic radiosurgery technologies, which is a method of controlling or destroying tumors by aiming beams of radiation at them from multiple directions. Multiple X-ray cameras and powerful software pinpoint the exact location of a tumor. A robotic arm then points a linear accelerator directly at the tumor from more than 1,400 different angles, aiming high-powered radiation beams at it. Because the robotic arm has unparalleled flexibility, the beams of radiation can be directed even at difficult-to-reach areas of the body. And, because the beams are so precise, they focus only on the tumor, not on any surrounding healthy tissue.

    Learn more about CyberKnife and other oncology treatments available at MedStar Georgetown.

    Types of Cervical Spine Surgery

    Cervical Spine Surgery

    Surgery is rarely the first option for relieving neck pain. At Neurosurgery One (formerly South Denver Neurosurgery), we carefully evaluate all patients, and provide a range of more conservative non-surgical options before exploring surgery as treatment.

    We thoroughly educate each and every patient about the advantages and disadvantages of surgery for your particular condition and for achieving your recovery goals.

    When surgery is necessary, it’s important to choose neurosurgeons with the experience necessary to effectively treat your pain, with the procedure appropriate for your particular condition. The expert neurosurgeons at Neurosurgery One perform 300-400 spine surgeries each year — more than many neurosurgeons perform over several years — successfully reducing pain and restoring activity for our patients.

    Whenever possible, we use minimally invasive techniques to help you recover faster and with less pain. We also utilize robotic guidance to ensure the highest possible level of accuracy. And we are skilled in a variety of cervical spine procedures, which assures that we can provide the best possible surgical option, and the optimal outcome, for each patient.

    Learn more about our surgical specialties which include:

    • Anterior cervical discectomy and fusion (ACDF)
    • Decompression and fusion surgeries
    • Artificial disc replacement

    Learn more about:

    • Choosing a surgeon
    • Preparing for neck (cervical spine) surgery
    • Recovery from neck (cervical spine) surgery

    How Safe Is Cervical Spine Surgery?

    Every surgical procedure carries a risk of complications. But even if the risk is low, serious complications can occur. Spine researchers seeking to better understand death rates of patients undergoing cervical spine surgery found that death is a very rare, virtually nonexistent complication of neck surgery.

    “In our multi-center retrospective study, there was no case of intraoperative death after cervical fusion,” said Zorica Buser, PhD, and Jeffrey Wang, MD, 2 of the co-authors of the study, which was published in Global Spine Journal. “In general, this is a very rare event. An elective cervical spine fusion can be a safe procedure as long as the patient’s spinal pathology and other conditions are carefully evaluated.”
    While as much as 80% of neck problems can be managed with non-surgical therapies, surgery may be necessary to decompress nerves and/or stabilize the spine.Neck Surgery Common in the United States
    Neck problems are one of the top 5 surgically treated conditions in the United States.

    The study authors noted that the neck’s anatomical design makes it susceptible to excess stress and pressure, which leads to spinal conditions like herniated discs and spinal stenosis.

    While as much as 80% of neck problems can be managed with non-surgical therapies, such as medication, surgery may be necessary to decompress nerves and/or stabilize the spine.

    A Closer Look at the Study
    The purpose of this study was to identify how often death occurred during (intraoperatively) cervical spine surgery, along with any associated risk factors.

    To learn how often death occurs during neck surgery, the researchers reviewed medical records of 258 patients who had elective spine surgery at 1 of 21 surgical centers. The average patient age was 54, and the surgeries were performed between 2005 and 2011. Most of the surgeries were done using the anterior (front of body) approach, followed by posterior (back of body) and circumferential (360°).

    The researchers found no cases of death during the procedures—a 0% mortality rate. Additionally, the overall complication rate was low among the patient sample.

    Elective Versus Emergent: A Factor in Spine Surgery Safety?
    The researchers noted that one of the key factors that may increase death risk during surgery is whether the procedure is an emergency or elective (routine). The researchers referenced a previous study that found 19 people who had emergent cervical surgery died during surgery, versus 1 who died during an elective procedure.

    Emergent cervical spine surgery may occur after a trauma or if the patient has a spinal tumor.

    Low Risk, But Complications Exist
    The success rate of cervical spine surgery is very high, but complications have been reported.

    “The take away is that most of the complications were very rare, some were almost nonexistent,” Buser and Wang said. “Dural tear and C5 palsy were the most common, but again, they had a very low frequency.”

    While dural tear (a tear in the protective covering of the spinal cord) is the most common neck surgery complication, its total incidence is only 0.77%. C5 palsy (a temporary paralysis in one or both arms) is the second most common complication, with a total incidence of only 0.42%.

    The dura or dural mater, is the outermost membrane covering the arachnoid mater; another tissue membrane that protects the spinal cord.

    While complications are generally quite rare, you may be at a higher risk for certain complications based on the type of neck surgery you undergo.

    For example, neck surgery complications frequently involve the esophagus. Patients undergoing an anterior cervical discectomy and fusion (ACDF) are at a higher risk of dysphagia (difficulty swallowing), nerve injury in the larynx (voice box), and pharynx wall swelling.

    While those esophageal complications may not be a cause for concern on their own, they can lead to aspiration pneumonia, which can be fatal.

    Though cervical surgery’s complications are extremely rare, the authors wrote that people who have cervical myelopathy have higher death rates associated with surgery compared to people who don’t have myelopathy. Cervical myelopathy is a condition in which spinal cord in the neck region is compressed.

    “Myelopathy can contribute to various post-operative complications, which can interfere with the vital functions of the body,” Buser and Wang said. “In a very severe case, this could lead to death. That means that myelopathy would have an indirect role in intraoperative death.”

    Now What? How You Can Use This Study’s Findings
    While this study reinforces the safety of routine cervical spinal fusion, you can do your part to improve your surgery’s success by discussing your risks and benefits with your surgeon before undergoing your procedure.

    “Each patient is unique, and careful pre-operative planning is a key for the successful surgery,” Buser and Wang said. “It is important to evaluate spine pathology and any other comorbidities, such as smoking, diabetes, and mental disorders. Patients should discuss their conditions with their surgeon, and how they might impact both the fusion success and a chance of post-operative complications.”

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