Spine surgery may be indicated for you if conservative or non-surgical treatment options haven’t worked for you and your pain is persistent and disabling.
During your consultation, Dr. Ball decides if conventional spine surgery or minimally invasive spine surgery is right for you. That decision often depends on the problems you present, and what your radiographs or MRIs look like. Some patients are better off with a conventional technique of gently retracting the muscles away from the spine, getting the pressure off the nerves, and possibly re-stabilizing the spine with hardware if it is unstable. Other patients, though, may benefit from a minimally invasive technique where the incisions are smaller, robotic assisted platforms used, and there is less damage to tissue. These methods allow Dr. Ball to focus the surgery on the area of interest, get the pressure off of the nerves and restore the patient back to his/her full activity.
If you have conventional spine surgery, there are several options for you and Dr. Ball to discuss. Some options include:
Anterior Cervical Discectomy and Fusion (ACDF). ACDF is a surgical procedure where the disc is removed through the front of the neck (anteriorly) to relieve pressure from the spine (decompress) and relieve pain. This procedure is combined with a fusion surgery in order to stabilize the neck. This surgery is typically recommended as a treatment for herniated disc, and degenerative disc disease and spinal stenosis that may cause loss of balance, dexterity, and clumsiness.
Artificial Disc Replacement. Dr. Ball is experienced in performing artificial disc replacement surgeries for both the cervical and lumbar spine. He teaches and certifies other spine surgeons to perform these procedures. Dr. Ball uses implants that have FDA clearance at one and two levels.
Artificial disc replacement is a motion-preserving surgery, recommended for patients who have degenerative disc disease or who have previously failed decompression surgeries or microdiscectomies. The concept of motion preservation in spine surgery is to preserve the motion of a diseased spinal motion segment by implanting a mobile replacement device into the disc space. (Mobi-C from Zimmer Biomet is one such device.) In contrast to fusions, this method prevents added force or pressure on the surrounding discs and reduces the risk of the next level breaking down.
The procedure involves removal of the disc and its replacement by a synthetic disc that helps restore height and movement between the vertebrae. Studies performed for FDA approval have shown superiority over fusion procedures.
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. This pressure is often due to stenosis, bone spurs, fractures, tumor, or infection in the cervical (neck), thoracic (mid-back), or lumbar (lower back) spine.
Typically, a bone graft or prosthesis is inserted to keep the spine stable after the damaged structures have been removed.
Discectomy. A discectomy involves the removal of the herniated portion of a disc to relieve irritation and inflammation of a nerve. A discectomy may be done to treat conditions such as herniated disc, pinched nerve, bone spur, sciatica, and radiculopathy (pinched nerve).
Foraminotomy. In a foraminotomy, Dr. Ball widens the tunnel (foramen) in your back where nerve roots leave your spinal canal. It is done to relieve symptoms of nerve root compression. This procedure is done to treat conditions such as foraminal stenosis, herniated disc, pinched nerve, bone spur, and sciatica.
Laminectomy. In a laminectomy, Dr. Ball removes the lamina, the back part of the vertebra that covers your spinal canal. The procedure takes the pressure off the spinal cord or spinal nerve. It is done to treat conditions such as spinal stenosis, degenerative disc disease, and herniated disc.
Spinal Cord Stimulator Implantation. During this procedure, a small pulse generator is implanted into the back to send an electrical current to the spinal cord to relieve chronic pain. The low voltage stimulation to the spinal nerves causes a tingling sensation to the back and blocks pain. This procedure is often recommended for patients who have failed back surgery syndrome or chronic pain and is considered a salvage procedure done after all anatomic problems have been corrected but the patient continues to have pain from damaged nerves (neuropathic pain).
Spinal Fusion. Spinal fusion is an operation performed to join together two or more bones in the spine so there is no movement between them, typically done in conjunction with discectomy and laminectomy. A graft is used to fuse the bones together. Dr. Ball may use an autograft (bone from another part of your body), an allograft (bone from a bone bank), or a graft made from synthetic material. In select cases, fusion surgery can be performed using minimally invasive techniques. A combination of spinal instrumentation such as rods, screws, plates, or cages is also used to keep the bones from moving while the grafts fully heal.
A spinal fusion may be necessary for a variety of different types of spinal pathologies of the neck and back, such as degenerative disc disease, spondylolisthesis, spinal stenosis, scoliosis, fracture, infection, and tumor.
The most common reason to do a spinal fusion is spondylolisthesis, which is a fancy word that basically means spinal instability due to the vertebral bodies slipping on each other. In order to prevent that slipping, you might have to consider fusing the spine in that area. Another reason to do a spinal fusion may be scoliosis where the spine itself is structurally deformed. In order to fix that damage, we have to do fusion in order to prevent further damage. Most patients receive the fusion at the levels at which the pathology is, however, the act of performing a spinal fusion does put the adjacent segments at additional risks and that is something of consideration. Most patients who undergo spinal fusion surgery require a 6-12 week recovery time which means 6 weeks of no bending, lifting, or twisting followed by an additional 6 weeks of physical therapy. After 3 months, all restrictions may be lifted.
Vertebroplasty and Kyphoplasty. These procedures are used to repair compression fractures of the vertebrae caused by osteoporosis (thinning of the bones), cancer, or injury. A compression fracture is when all or part of a vertebra collapses. Tiny 2 millimeter incisions are made on the left and right side of the fractured vertebra, and a small cannula is placed, followed by expansion of the collapsed fractured vertebra; a bone cement is then used to stabilize the fracture. Both procedures include the injection of glue-like bone cement that hardens and strengthens the bones, preventing the vertebrae from collapsing again.