There are many different treatments available when it comes to spine conditions. Spine surgery should always be the last resort after failing conservative or non-operative treatments. All treatment options have benefits and risks. Not doing anything also has inherent risks. Not every treatment is appropriate for every patient, and not every surgeon agrees on a specific treatment plan. At Cleveland Spine Specialists, we will help you get to the root of the problems causing you back or neck pain. We will work with you to make informed decisions about your individual treatment options, and determine what will provide the best outcome for your condition.
Listed below are descriptions of some surgical options that our practice provides.
Laminotomy & Laminectomy
The lamina is part of the bone of the spinal column. This area can be removed to allow more space for the spinal nerves. A partial removal of this area is termed laminotomy, while a complete removal of this bone is called a laminectomy.
When the disc material is herniated and pushing on the spinal nerves, partial removal of the disc is often performed. A discectomy is the medical term for this procedure, and can sometimes be performed with a microscope through a small incision or microdiscectomy.
As mentioned previously, the opening or hole where the spinal nerves exit from the boney spinal column is referred to as the foramen. This opening can be enlarged by removing bone, allowing more room for the spinal nerves. This is referred to as a foraminotomy.
In some instances, two or more of the spine vertebrae should be fused together into one piece of bone. This is typically combined with the above procedures after removal of the compressive elements on the spinal nerves. Fusion is also performed to prevent spine curve progression when patients have a curvature to their spine. Rods and screws have been developed over the last 30 years to act as anchor points and to help to hold the bones in place while your body fuses the bones together into one piece. These screws are called pedicle screws, although other devices are also used, including hooks and wires. Smoking and other medical conditions greatly decrease the rate of fusion, and are risk factors for a fusion failure, known as a pseudoarthrosis.
In some instances, removal of the disc material and placement of a device or bone may be indicated to help obtain a fusion. This is termed an interbody fusion. This space that remains between the vertebral bodies after disc removal can be filled with a number of different items to help obtain a fusion. This includes different types of medical-grade plastic devices, bone from your own body and pelvic area (autograft), or with bone from a cadaver or the bone bank (allograft), or with other bone building block materials (calcium, phosphate, and others). Cadaver bone has been processed to remove and reduce the chance of disease transmission.
At times, your surgeon may want you to wear a specific type of brace, also called an orthosis. This brace will help to limit some motion while your body is healing. Braces are named based on the area of the body that they are treating or limiting motion. There are several different types and these include CO (cervical orthosis), CTO (cervical thoracic orthosis), TLSO (thoracolumbar orthosis), LSO (lumbosacral orthosis), corset brace, Jewett & CASH braces (types of TLSOs – cruciform anterior spinal hyperextension brace), among others.