Other Procedures
- Microdiscectomy
- Lumbar laminectomy
- Cervical laminectomy
- ACDF
- Spinal fusion
- Interbody fusion
- Spinal arthroplasty and artificial disc
- Surgery for spinal fracture
- Surgery for a spinal tumor
- Surgery for tethered cord
Microdiscectomy
The lumbar microdiscectomy procedure is designed to remove herniated disc material that compresses on a spinal nerve and relieve the radicular symptoms. When a disc herniates in the lumbar spine, it compresses a spinal nerve and typically produces pain, numbness or tingling in that nerve distribution to one leg. If the disc herniates more centrally, both legs can be affected and the spinal cord may be compressed. When this occurs, bladder and bowel function may also be affected. The microdiscectomy procedure is done through a small incision in the lower back with a minimally invasive approach. The operating microscope is used to achieve optimal visualization. Once the disc is accessed through the surgical approach, the herniated disc material is removed and the spinal nerve is decompressed. When the nerve is decompressed, the pain will improve. There is still healthy disc material that will remain in the disc space. Usually the small incision is closed with absorbable sutures and able to be covered with a band-aid.
Click Here to Download an Educational Packet About Microdiscectomy.
This video will show Dr. El-Kadi removing a large disc fragment through a small incision. As the fragment is removed, you will notice that it releases pressure from the nerve. This will alleviate the pain radiating down into the leg. Finally, you can see the closed incision which can be covered with a small bandaid. This is a live video taken during surgery.
Lumbar laminectomy
Spinal stenosis results in the narrowing of the spinal canal in which the spinal cord and nerves are contained. This narrowing and pressure on the nerves can result in pain, numbness and/or weakness of one or both legs. These symptoms are usually aggravated by walking and standing. The lumbar laminectomy procedure is designed to relieve this pressure on the nerves by partial or complete removal of the back portion of the vertebrae called the lamina. A 2 to 4 inch incision is made in the lumbar region and the lamina, with its surrounding ligaments, is removed. The spinal cord and nerves are then decompressed. This bony removal generally does not affect the mobility or stability of the spine. When the nerves are decompressed, symptoms will improve.
Click Here to Download an Educational Packet About Laminectomy.
Cervical laminectomy
Spinal stenosis results in the narrowing of the spinal canal in which the spinal cord and nerves are contained. This narrowing and pressure on the nerves can result in pain, numbness and/or weakness of one or both arms. Severe cervical stenosis can also cause weakness or discoordination of the legs. The cervical laminectomy procedure is designed to relieve this pressure on the nerves by partial or complete removal of the back portion of the vertebrae called the lamina. This bony removal generally does not affect the mobility or stability of the spine. When the nerves are decompressed, symptoms will improve. Patients may have to wear a collar after surgery for a short period of time.
Some patients who undergo cervical laminectomy also require fusion.
ACDF
Herniated discs in the cervical spine can compress the nerves that affect the arms and hands. Typically this compression causes pain, numbness or tingling in the arms and hands. If the herniation is more central, the spinal cord can be compressed and cause symptoms down the entire length of the spine which may include difficulty walking or impairment of bladder and bowel function. The anterior cervical discectomy procedure is designed to remove this herniated material from the nerves and relieve the symptoms. This procedure is done through a small incision in the front of the neck. There is minimal trauma to the neck tissues with this approach. Since the disk and bone spurs are removed anterior to the spinal cord there is minimal spinal nerve or cord traction with this procedure. A small piece of bone graft from the bone bank is placed in between the vertebral bodies to occupy the disk space, and a titanium plate is secured on the front of the vertebrae to provide stability and minimize the need for collars after surgery. Spinal stabilization
Click Here to Download an Educational Packet About ACDF.
This video will show clips of Dr. El-Kadi performing the anterior cervical discectomy and fusion with plating. By removing the disc and placing bone graft from the bone bank, the pressure on the nerves can be released. This will alleviate the pain symptoms in the arm. With the application of the plate at this one level, the patient will not need to wear a cervical collar. Finally, you can see the incision which is closed with absorbable suture. This is a live video taken during surgery.
This lateral xray shows a cervical plate and screws with placement of interbody graft.
Spinal fusion
In some cases, patients that have spinal stenosis also have a condition called spondylolisthesis, or slippage, of one vertebral body over another. This slippage contributes to the nerve compressions and radicular symptoms. Spinal instability my accompany spondylolisthesis and a spinal fusion must be done at the same time your stenosis is surgically addressed. Patients with scoliosis may also have fusion done in order to correct the abnormal curvature or prevent it from getting worse. The surgeon reaches the lumbar region through an incision in the lower back. After the laminectomy, fusion is performed to stabilize this area. Titanium screws and rods are placed into the bone, and bone graft from the bone bank is situated around the screws to secure the area. After surgery, patients wear a lumbar brace to stabilize this area as it is healing. There are a small number of patients who have only bone graft placed without the titanium screws. This decision is made by your surgeon before the operation.
Click Here to Download an Educational Packet About Lumbar.
This xray shows a front view of scoliosis in one of Dr. El-Kadi’s patients.
This xray shows the postoperative correction of scoliosis with fusion.
Interbody fusion
In some cases, patients require additional fusion techniques. Interbody fusion is performed by placing a cage or bone graft between the vertebral bodies. This method creates support along the front of the spinal column. The approach for placing the cage can be done from the front, side or back.
The interbody fusion device can be seen on this lateral x-ray. It is located in the disc space between the lower two levels of the fusion. It is marked by vertical metallic markers.
Spinal arthroplasty and artificial disc
Some patients with cervical disc herniation may be a candidate for artifical disc replacement. Patient selection is crucial for this procedure, and if you are interested in spinal arthroplasty you should discuss this option with your surgeon. In spinal arthroplasty, the entire disc is removed and corresponding nerves are decompressed. Instead of fusion with bone at this level, the artificial disc is used to preserve motion at this segment. In this case, titanium plates are not used. Patients do not need a cervical collar after this operation.
From this lateral xray view, you can see the titanium edges of the artificial disc.
Surgery for spinal fracture
- osteoporotic
- traumatic
- malignant
Surgery for spinal fracture is dependent on the type of fracture and whether it is stable or unstable. Thoracolumbar compression fractures can often be managed conservatively with bracing and pain medications, but patients with persistent pain can consider surgical intervention. Kyphoplasty and vertebroplasty involves percutaneous injection of cement into the vertebral body to regain some of the height of the bone and shorten the duration of pain. If patients have developed compression fractures secondary to osteoporosis, the treatment plan must also include addressing the underlying osteoporosis. This is often accomplished through coordination with the primary care physician. Unstable fractures may require more aggressive surgical stabilization such as spinal fusion. When there is radiculopathy or neurological compromise, patients are considered for surgical intervention sooner than if these findings are not present.
Surgery for a spinal tumor
- primary
- metastatic
Treatment for primary spinal tumors involves surgical resection of the lesion. Although spinal cord tumors are rare, they can leave patients neurologically and functionally impaired. Advanced diagnostic tools allow earlier detection of tumors, and intervention can proceed sooner. Microsurgical techniques and other specialized treatments can help to minimize the potentially devastating effects of these types of tumors. With any type of tumor surgery, the goal of surgical resection is to remove as much of the tumor as is safely possible and spare functional neural tissue. Radical resection can often be achieved in benign tumor types. A limited resection or biopsy combined with multidisciplinary medical treatments may be recommended for malignant tumors. Metastatic tumors are treated with surgery and/or radiation therapy. Decision making about optimal treatment is done through coordination between neurosurgeons and oncologists.
This large intramedullary tumor was found in a young patient who had an unsteady gait and was falling frequently. You can see the area of tumor circled with a red mark.
This MRI shows the patient with the intramedullary tumor. Compare it to the view below. The area for the spinal cord is being completely occupied by the tumor.
The following video shows Dr. El-Kadi removing the intramedullary tumor from this patient. It is a live video from surgery, and therefore it does contain somewhat graphic coverage. You will see the opening of the spinal cord and removal of the tumor. Finally, the spinal membrane is closed.
Surgery for tethered cord
When patients present with symptoms related to tethered cord in adulthood, surgical intervention can be performed to alleviate pain. Laminectomy is performed to expose the area. The dural sac is carefully opened, and the tethered cord is released from its attachments. The dural sac is repaired before the remainder of the incision is closed. Pain relief is generally good, but the patient will have a slower recovery of bladder function.