What types of surgery are available for spinal injuries?

Nearly 50% of people diagnosed with a herniated disc in the lower back will recover within six (6) months. This is because inflammation fades over time. Generally, only about 10% of people with a herniated disc have to move forward to a surgical option

Here are several surgical options available depending on the location and severity of your disc damage. The following is a list of the most common types of surgery available for disc injuries and is by no means exhaustive.

Discectomy

A discectomy (also called open discectomy) is a procedure to remove a portion of the disc that rests between each vertebra, and is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord, relieving the pressure on the nerves. This procedure is less invasive that other types of surgery and often utilized in repairing cervical disc injuries. It is also used for bulging discs or ruptured discs. Discectomy may be the most effective type of surgery for people who have tried nonsurgical treatment without success and who have severe, disabling pain.

Percutaneous Discectomy

Percutaneous discectomy is used for bulging discs and discs that have not ruptured into the spinal canal. This procedure inserts a special tool through a small incision in the back. The herniated disc tissue is then removed, thereby reducing the size of the disc herniation. Percutaneous discectomy is considered less effective than open discectomy, and its use is declining. Unless future studies show that this technique is safe and effective, percutaneous discectomy should be considered experimental.

Foramenotomy

A foramenotomy is also a procedure used to relieve pressure on a nerve, but in this case, the nerve is being pinched by more than just herniated disc. A foramenotomy removes a portion of bone and other tissue that may be compressing the nerve as it exits the spinal column.

Laminectomy

A laminectomy is a surgery done to relieve pressure on the spinal cord and/or spinal nerve roots caused by age-related changes in the spine. Laminotomy removes a portion of the thin part of the vertebrae that forms a protective arch over the spinal cord (lamina). Laminectomy removes all of the lamina on selected vertebrae and also may remove thickened tissue that is narrowing the spinal canal, the opening in the vertebrae through which the spinal cord runs. Either procedure may be done at the same time as a discectomy, or separately.

Spine Fusion (BMP). BMP stimulates the body to make bone. A fusion eliminates the flexibility between the vertebrae that are joined, resulting in the two vertebrae becoming one. The spine fusion may be done to treat a problem such as spondylolisthesis (unstable spine), or it may be done because of the extent of other surgery (such as a laminectomy).

Spinal Disc Replacement

Spinal disc replacement is a newer surgery but is becoming more common. The theoretical benefits of disc replacement are to preserve motion and reduce abnormal stresses at the disc above and below the surgery that has commonly been a limitation of disc fusions. A disc replacement benefits the patient by removing the damaged disc between the vertebrae and putting a new, undamaged disc in its place. Traditionally, a cadaver disc has been used to accomplish this type of procedure but more recently there has been a trend towards using artificial disc material. What makes artificial disc surgery so challenging is that unlike a ball and socket joint, such as the hip, the disc is a complex joint with motion in several planes. It is difficult to emulate the natural motion of the disc while maintaining stability.

Spinal instrumentation

Spinal Instrumentation utilizes surgical procedures to implant titanium, titanium-alloy, stainless steel, or non-metallic devices into the spine. Instrumentation provides a permanent solution to spinal instability. Medical implants are specially designed and come in many shapes and sizes. Typically these include rods, hooks, braided cable, plates, screws, and interbody cages. Cages are simply structures that support bones (either between bones or in place of them) while new bone growth occurs through and around them.

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