Anterior Cervical Fusion
Anterior cervical fusion can be done at many levels or a single level. This is the most common surgery I do in the cervical spine which involves an incision in the front of your neck moving your esophagus and your cartoid artery and operating and removing the discs, or correction the deformity, pinched spinal cord or nerves directly from the front which uses cage, plates, or STALIF C by Centinel Spine, the link to that is also on our website.
Posterior Cervical Surgery
Posterior cervical surgery can be either decompressions or simply taking the pressure off the nerve with or without fusion. Generally, the fusion in the posterior cervical spine is a rod/screw system and requires a bit larger incision and more surgical trauma for the paraspinous muscles than an anterior cervical fusion.
Thoracic surgery can either be through the chest or posteriorly with rod/screw systems or by removing a rib laterally. This can either be decompression alone, with laminectomy, or instrumentation with rod/screws.
The Lumbar Spine
The lumbar spine can have multiple options, posteriorly there is a laminectomy or removal of the bone and the bone spurs from the neural structures. A microdiscectomy which is simply taking out a small piece of a disc, and is done as an outpatient procedure. A very small laminotomy. The standard instrumentation in the lumbar spine is rod and screws. In my pra, tice I use very few of those over the last 10-15 years, even though in the early 1990s I pioneered a great deal of that technology with Synthes or with the AO which is a Swiss research And development organization.
For Isthmic Lytic Spondylolisthesis
For isthmic lytic spondylolisthesis it is mandatory for rod/screw systems. These are done by removing the muscle from the spine and decompressing the loose or broken piece of the spine from the spondylolisthesis and then using bone graft to achieve a fusion.
The Anterior Lumbar
The Anteriorly in the lumbar spine is a joint effort between vascular surgeon and spinal surgeon. The vessels and the abdominal contents are moved out of the way and the spine is directly operated for fractures, degenerative disc disease, spondylolisthesis, tumors, infections, and reconstruction is generally done with either cages that screw in, cages that have screw anchorage to the spine, or cadaver bone. Cadaver bone is used less and less. The anterior fusion for welding the 2 bones together is done with osteobiologic synthetic bone or bone morphogenic protein.
Anterior Lateral Lumbar
Anterior lateral lumbar surgery is surgery through the side. This is minimally invasive. It can be done with very small incisions and used to correct degenerative disc disease, degenerative spondylolisthesis, isthmic lytic spondylolisthesis at a higher level in the lumbar spine, scoliosis, kyphosis, or flat back in the lumbar spine. It has generally 1-2 hospital days. It is generally used in conjunction with minimally invasive posterior decompression and stabilization. In the elderly patient these are generally done in two operations, generally a week or two apart.
Sacroiliac fusion of the sacroiliac joint is where the pelvis fastens to the sacrum or the spine. these joints could become painful, especially in patients who have had spine fusions, which adds additional stress to the joint, and these can be fused by simply placing two steel bars across the sacroiliac joint through a very small incision and patients can generally go home within an hour.
Bone graft in the years past required actually taking pieces of bone out of the iliac or your pelvis. This, unfortunately, was more painful than doing the operation. With modern techniques the Thompson Company had developed a bone graft harvester for the bone generated by removing the disc for the laminectomy or decompression. This is saved and recycled and then a synthetic bone is added to it. This gives it a quite adequate amount of bone graft and has eliminated the need for taking bone from the patient’s pelvis. This technology is called Bone Bak Trap by Thompson. The link will be in this website, please investigate this technology.