Procedures

Cranial Procedures

Craniotomy

What is it?

Craniotomy is an operation that involves removing a piece of bone from the skull (cranium) to provide access to the brain and its surrounding structures. The term craniotomy is derived from the Latin words cranium (head) and -otomy (act of making an opening).

The human skull is formed by the union of several cranial and facial bones, and provides a rigid container that supports and protects the brain. The skull is divided into two primary compartments, divided by the tentorium, a membrane that supports the cerebral cortex above and the cerebellum and brainstem below. The region of the skull through which the surgeon selects to perform a craniotomy is based on the type of condition requiring treatment.

Why is it done?

Patients who suffer from the following cranial conditions are potential candidates for this operation:

• Tumors (e.g., brain, pituitary, optic nerve, acoustic neuroma)
• Cysts (e.g., arachnoid, colloid)
• Hematomas (blood clots), including subdural, epidural, and intracerebral hematomas
• Aneurysms (weaknesses in blood vessels)
• Arteriovenous malformations (abnormal blood vessels or AVMs)
• Cerebrospinal fluid (CSF) leaks
• Trigeminal neuralgia
• Chiari malformations
• Premature fusion of the normally separate bones of the skull (craniosynostosis)
• Infection in the brain (brain abscesses)
• Skull trauma (e.g., fractures)

The Operation

An understanding of what a craniotomy involves will help you to approach your operation and recovery with confidence.

Incision
Part of the scalp is shaved and cleaned. An incision is then made through the scalp to the skull.

Exposure
A small hole, called a burr hole, is drilled through the skull to the brain. In some cases, several burr holes are drilled to allow your surgeon to lift and remove a piece of the bone. The bone between these holes is cut to create a flap in the skull through which the surgeon can access the brain and its surrounding structures. Next, the dura is cut to expose the brain.

Related Procedure
At this point in the operation, depending on the condition for which you are receiving treatment, several different procedures are performed. For example, your surgeon may remove tumors, clip aneurysms, drain cysts, or decompress portions of the brain or nerves.

Closure
The dura is then sutured closed, and the bone that was removed from the skull is put back in place and secured with metal plates and screws. The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection and blood loss, are some of the potential adverse risks of cranial surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.

Lumbar Procedures

Lumbar Laminectomy

What is it?
Lumbar laminectomy is an operation that involves approaching the spine through an incision in the lower back to remove a portion of the bone over and/or around the nerve roots to provide them additional space.

Why is it done?
Patients who have pain caused by pinched nerves are potential candidates for this procedure.

The Operation

The operation is performed with you lying on your stomach.

Incision
Your surgeon makes an incision in your lower back to access your spine. To have a clear view of your spine, the surgeon then retracts the muscles and ligaments.

Bone/Disc Removal
Your surgeon removes a portion of the lamina, the bony rim around the spinal canal, if it is contributing to pressure on the dural sac or nerve roots. This part of the procedure is called a laminectomy. The term laminectomy is derived from the Latin words lamina (thin plate, sheet, or layer), and -ectomy (removal).

An opening is then cut in the ligamentum flavum - a ligament that connects vertebrae to the sacrum. A portion of the bone over the nerve root and/or disc material around the nerve root is removed to give your nerve root additional space.

Closure
The operation is completed when your surgeon closes and dresses the incision. Your surgeon may choose to place a drain into the wound after the surgery to protect the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. By the end of your first day after surgery, you will normally be up and walking in the hospital.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.

Lumbar Kyphoplasty

Lumbar Microdiscectomy

Microscopic Discectomy

Spinal Fusion

Interbody Fusion

Interbody Fusion with Cages

Cervical Procedures

Anterior Cervical Discectomy

What is it?

Pain in the neck and extremities, among other symptoms, may occur when an intervertebral disc herniates - when the annulus fibrosus (tough, outer ring) of the disc tears and the nucleus pulposus (soft jelly-like center) squeezes out and places pressure on neural structures, such as nerve roots or the spinal cord. Bony outgrowths, called bone spurs or osteophytes, which form when the joints of the spine calcify, may also cause these symptoms.

Anterior cervical discectomy is an operation that involves relieving the pressure placed on nerve roots and/or the spinal cord by a herniated disc or bone spurs - a condition referred to as neural compression.

Through a small incision made near the front of the neck (i.e., the anterior cervical spine), the surgeon removes disc material and/or a portion of the bone around the nerve roots and/or spinal cord to relieve these compressed neural structures and to give them additional space.

Discectomy involves removing all or part of an intervertebral disc. The term discectomy is derived from the Latin words discus (flat, circular object or plate) and -ectomy (removal).

Why is it done?

Pressure placed on neural structures, such as nerve roots or the spinal cord, by a herniated disc or bone spur may irritate these neural structures and cause: pain in the neck and/or arms; and lack of coordination, numbness or weakness in the arms, forearms or fingers. Pressure placed on the spinal cord as it passes through the neck (cervical spine) can be serious since most the nerves for rest of the body (e.g., arms, chest, abdomen, legs) have to pass through the neck from the brain.

Patients who suffer from these symptoms are potential candidates for this operation.

The Operation

An understanding of what an anterior cervical discectomy involves will help you to approach your operation and recovery with confidence.

Incision
The operation is performed with you lying on your back. A small incision is made to one side of the front of your neck.

Exposure
After pulling aside the soft tissue - fat and muscle - your surgeon exposes the source of the neural compression.

Removal
Disc material - and, in some cases, a portion of the bone - around the nerve roots and/or spinal cord is then removed to relieve the compressed neural structures and to give them additional space.

Closure
The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan. You will normally be up and walking in the hospital by the end of the first day after the surgery.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection, blood loss and bowel or bladder problems are some of the potential adverse risks of spinal surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.

Foraminotomy

Cervical foraminotomy is an operation to enlarge the space where a spinal nerve root exits the cervical spinal canal to relieve the symptoms of a "pinched nerve."

Indications for Operation:
Compression of the cervical nerve roots can cause neck pain, stiffness, and pain radiating into the shoulder, arm, and hand, as well as numbness, tingling and/or weakness in the arm and hand. Protruding or ruptured discs, bone spurs and thickened ligaments or joints can all cause narrowing of the space where the nerve exits the spinal canal and cause the above symptoms. Patients who do not improve with conservative treatment may be candidates for the operation.

What happens afterward?
Some pain at the operative site is expected, but generally resolves over time and can be controlled with oral pain medicines. Some patients can be discharged the same day of surgery, but most patients will require 24-48 hours in the hospital. Most patients will notice immediate improvement in some or all of their symptoms, however some symptoms may improve only gradually. A positive attitude, reasonable expectations and compliance with the doctor's recommendations all contribute to a satisfactory outcome. A cervical collar (brace) is rarely necessary. Most patients can return to their regular activities within several weeks.

The Operation

Incision
A small incision is made in the middle of the neck after localizing the area of interest with an X-ray.

Decompression
The affected muscles on the side of the spine are dissected and a retractor is placed. (Sometimes an endoscope and tubular retractor or microscope are used). Bone from the posterior arch of the spine and joint over the nerve are removed using special cutting instruments and/or a drill. Thickened ligament, bone spurs and/or bulging discs are removed to decompress the exiting nerve, which is checked with a probe to ensure adequate space around the nerve root.

Closure
The muscles and tissues are closed in layers with absorbable sutures. The skin may be closed with absorbable sutures and steri-strips, or surgical staples, which are removed when the wound is well healed.

Corpectomy

Cervical corpectomy is an operation to remove a portion of the vertebra and adjacent intervertebral discs for decompression of the cervical spinal cord and spinal nerves. A bone graft with or without a metal plate and screws are used to reconstruct the spine and provide stability.

Indication for operation
In some patients, the cervical spinal canal can be narrowed by bone spurs arising from the back of the vertebral body or the ligament behind the vertebral bodies. Because the area of compression cannot be addressed by an anterior cervical discectomy alone, it may be necessary to remove one or more vertebral body and the discs above and below to adequately decompress the spinal cord and/or nerve roots.

What happens afterward?
Most patients experience only mild discomfort at the operative site, which is generally well controlled with oral pain medicines. A mild sore throat is not uncommon and is usually short lived. Most patients are discharged from the hospital in 24-48 hours. Patients may notice immediate improvement in some or all of their symptoms, however, some symptoms may improve only gradually. A successful outcome will depend on your compliance with the health care provider's recommendations, and a realistic expectation for meeting the goals of surgery (which depend on one's condition preoperatively).

Since cigarette smoking dramatically impairs bone healing, smoking cessation will significantly improve the likelihood for a successful fusion.

The Operation

Incision
The patient is positioned on their back. If using the patient's own bone, an incision is made over the hip to harvest bone from the iliac crest. For the corpectomy, a small incision is made on either side of the neck. (A longer "up and down" incision may be required for multiple corpectomies).

Decompression
The cervical spine is widely exposed by separating the spaces between the normal tissues. The discs above and below the vertebrae involved are removed. The middle portion of the vertebrae is removed (some of which is saved for use in the fusion) using special cutting instruments and drills to decompress the underlying spinal cord and nerve roots.

Reconstruction

A strut of bone is placed to span the bony defect and provide support to the front of the spine. The bone is incorporated (fused) into the remaining vertebrae over time. Bone from the bone bank (allograft) may be substituted for the patient's own bone. A metal plate and screws are often used to provide extra support and facilitate the fusion process.

Closure
Absorbable sutures and sometimes skin staples are used to close the incisions. A cervical collar may or may not be required for use after surgery. The doctor will follow the fusion with periodic X-ray exams after the operation.

Laminoplasty

Prestige Cervical Disc System

The PRESTIGE® Cervical Disc is an artificial disc replacement that gives patients suffering from the symptoms of degenerative cervical disc disease or acute unresolved cervical disc herniation a chance to maintain their pre-operative physiologic function and preserve motion in their necks.

The PRESTIGE® Cervical Disc offers patients with radiculopathy and myelopathy related to degenerative cervical disc disease (DDD) in the cervical spine an alternative to spinal fusion surgery. Constructed of stainless steel in a unique, two-piece ball-and-trough configuration, the device is designed to preserve spinal mobility and alignment at the treated vertebral segment.

Each vertebra in the spine is separated by a shock absorbing disc, which is made up largely of water. As discs lose water content because of disease, injury or age, they compress, or lose height, which causes the vertebrae to move closer together. This reduces the disc's shock absorbing qualities, which may lead to bone spurs and narrowing of the nerve openings. If a disc ruptures, it can place pressure on the surrounding nerve roots and the spinal cord, resulting in pain, numbness and/or weakness.

Your doctor may recommend surgery if non-surgical treatment fails to provide relief from these symptoms. Traditionally, a procedure called an anterior cervical discectomy with fusion (ACDF) has been the "gold standard" for surgically treating DDD in the cervical spine. Using bone grafts and instrumentation such as metal plates and screws, this procedure fuses, or creates a bond between, two or more adjacent vertebrae, ideally stabilizing the segment and providing relief. Many patients have achieved excellent results with ACDF; however, a potential disadvantage associated with spinal fusion is the loss of motion and flexibility in the treated vertebral segment.

Artificial disc replacement with the PRESTIGE® Cervical Disc offers the potential for preserved neck mobility at the treated vertebral level.

The PRESTIGE® Cervical Disc replaces a diseased or damaged disc and is designed to preserve motion. Made of stainless steel, the device has two articulating components (a ball on top and a trough on the bottom) that are inserted into the disc space and attached to the vertebral bodies on either side. These components function like a joint, replicating the physiological motion (flexion, extension, side bending and rotation) and alignment (height and curvature) of a natural intervertebral disc.

The PRESTIGE® Cervical Disc is available in a variety of sizes that allow surgeons to closely match a patient's anatomy.

While many factors contribute to the longevity of an artificial disc, the PRESTIGE® Cervical Disc has undergone significant testing to verify the safety and adequate durability of the device.

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