Cervical Spine Surgical Treatmentneck treatments

If the cervical spine condition cannot be treated by conservative measures (e.g. anti-inflammatory medications), oral steroids (e.g. Predisone) can be prescribed for greater pain relief. Patients however are discouraged from taking oral steroids for long term use.  

If cervical spine pain lasts more than 8 weeks and the patient’s quality of life is compromised, surgery may be an option.  Cervical spine surgery has a high success rate.  The success rate of surgery for a cervical herniated disc, for example, is 95-98%.

There are three types of cervical spine surgery:

  • The first is the anterior cervical discectomy and spine fusion. For cervical herniated discs, this surgery is the most popular and is preferred by spine surgeons. The surgeon makes a one-inch incision in the front of the neck. The disc is removed and the space where the disc used to be undergoes fusion. The surgeon will add a plate over the operated area to stabilize it.
  • The second type is anterior discectomy without spine fusion. It is the same procedure as the first except that no fusion takes place, because when the disc is removed, the space remains open. The space will eventually fuse although the healing process is longer, and a deformation might occur.
  • The third type is called posterior cervical discectomy. It resembles a lumbar discectomy and it is the approach recommended when the discs are in lateral position in the foramen. Surgeons agree that this is a more difficult procedure due to numerous veins in this area. Bleeding can occur, and the spinal cord also needs to be manipulated.

Thoracic Spine Treatment

Most thoracic disc conditions can be treated without surgery. Some of the more popular approaches include a prolonged period of rest, strengthening exercises, anti-inflammatory agents, spine manipulation, medications and analgesics. Thoracic surgery is recommended only when there’s a strong possibility of a spinal cord dysfunction or acute chronic pain.

Depending on the location and position of the herniated disc, one procedure is an open thoracotomy which is done using a front approach crossing into the thoracic spine. This means the spine is reached via the chest. Minimal invasive surgery is possible; the surgeon makes small incisions.

Another procedure is called costotransversectomy usually recommended for lateral herniated discs. The spine is reached from behind or from the side, and involves the removal of a rib.  

Based on a study carried out among surgery patients, most surgeons now agree that the trans-thoracic approach appears to be the preferred method.

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Lumbar Spine Treatment

herniated discLower back pain is common and in many cases, people obtain relief by adopting one or a combination of these conservative approaches:

  • Rest
  • Anti-inflammatory agents
  • Exercise
  • Narcotic or non-narcotic medication (discouraged for long term use)
  • Heat application
  • Muscle relaxers

Lumbar spine surgery is, of course, an option but only if conservative treatments have been exhausted and lower back pain persists to a point that it begins to erode the patient’s quality of life.

There are at least five known types of surgeries for chronic and severe low back pain but only your doctor and specialist can help you decide which is the most suitable surgery for you, taking into account certain factors.

The following is a general description of lumbar spine surgeries:

  • Discectomy – this procedure involves removing part of the affected disc. The most common problem is a herniated disc, a condition that puts extreme pressure on the nerves, causing pain.
  • Foramenotomy – this procedure is used when pressure on the nerve is being caused not just by a herniated disc but also by bone or tissue that pinches or pushes the nerve. 
  • Laminectomy – this procedure is aimed to provide relief for the spinal cord. It is a common surgery to correct conditions like spinal stenosis and spondylolisthesis. Parts of the bone is removed, and may require spinal fushion to stabilize the spine.
  • Spine Fusion – this procedure is intended to prevent movement between vertebrae. It is performed to treat an unstable spine (a condition called spondylolisthesis).  
  • Spinal Disc Replacement this is a relatively new type of surgery and its purpose is to treat specific cases of lumbar pain.
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Minimally Invasive TLIF

Minimally Invasive Transforaminal Lumbar Interbody Fusion (or TLIF for short) is a type of procedure performed on the spine.  It covers four fundamental aspects:

  1. The surgery is done through the foramen (a foramen is an opening that allows a nerve to pass in between bones);
  2. It involves the lower back (lumbar);
  3. Bone grafts are placed between two vertebrae;
  4. Fusion is carried out to stabilize the spine

As the name of the procedure suggests, it is a surgery that is not invasive. This means that the surgeon makes tiny incisions and dilates the muscles that surround the spine and gently separates them. In aTraditional TLIF, the surgeon has to cut or remove the muscles from the spine. This can cause scarring and other complications. Minimally invasive TLIF, however, keeps the muscles and the vascular function intact.

How it’s Done

The surgeon makes a 3-cm incision in the skin of the back directly over the vertebra(e) requiring treatment. Muscles around the spine are then dilated so that the spine can be reached and stabilized. After the spine is reached, the lamina (or vertebral “roof”) is taken out so that the nerve roots become visible. 

The nerve roots are moved to one side while the surgeon lifts the disc material from the front of the spine, after which he inserts a bone graft into the space formerly occupied by the disk. This bone graft stimulates bone growth. To stabilize the spine, screws and rods will be inserted, until fusion takes place. The purpose of the surgery is for the spine to be stable again.

Is Minimally Invasive TLIF for You?

If you have been diagnosed with spinal instability in the lower back (e.g. degenerative disc disease, spondylolisthesis or spinal stenosis) and your body has not responded well to conservative treatment (e.g. rest, physical rehabilitation, or prescription medication), you may be a candidate for minimally invasive TLIF. Discuss this matter with your doctor as he will determine the suitability of this surgery for you. He will need to consider the condition requiring treatment, your lifestyle, age, and overall health.

Post Surgery

Most people can leave the hospital the next day following the procedure. Some need to stay in the hospital for a few days. Patients will notice improvements after surgery while others will notice a gradual improvement of symptoms.

The desired outcomes will depend on the patient’s attitude, compliance with doctor’s instructions, and realistic expectations. People can usually assume their daily routines after several weeks.

Please Note:  The information provided here serve only as guidelines and must not replace your doctor’s advice. If you need more information on any of the surgeries related to the neck, mid back and lower back, please contact us.

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Minimally Invasive XLIF

The XLIF Procedure; Turning Spine Surgery on Its Side

When performing XLIF back surgery, your surgeon will approach your spine from the side of your body. You will be positioned on your side on the surgical table and two small incisions will be made. One of the incisions will be made on your side – this is the incision from which most of the surgery will be performed. Another incision will be made slightly behind the first, toward your back.

After you have been positioned, an x-ray will be taken to help your doctor precisely locate the operative space. Next, your skin will be marked at the site where the two small incisions will be made. Your surgeon will use the latest instrumentation to access the spine in a minimally disruptive manner. Disc preparation is the next step. This is done by removing the disc tissue, an action which allows the bones to be fused together. Several x-rays will be taken during this stage to ensure the preparation is correct. Once the disc has been prepared, the surgeon will then place a stabilizing implant into the space to restore the disc height and enable the spine to once again support necessary loads. Once in position, a final x-ray will be taken to confirm correct implant placement. In the event that further stabilization is necessary, the surgeon may choose to insert additional screws, rods, or plates into the vertebrae.cells that bridge the space between the vertebrae and allow the bone to grow together. Increased stability and restoration of disc height often result in significant pain relief.


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Anterior Cervical Discectomy & Fusion (ACDF)

neck treatmentsACDF is a surgical procedure intended to remove a herniated or diseased disc which provides relief to neck and arm pain. The pain is caused by the disc pressing on nerve roots.

How it’s Done

The word “discectomy” means cutting out the disc. By removing the disc, pressure on the nerves is eliminated. The surgery is a four step process:  the surgeon makes an incision on the front of the neck, removes the diseased disc, creates a clearing above and below the removed disc, and then prepares it for a bone graft. The bone graft is placed between the vertebrae. To hold it in place, the surgeon screws in a metal plate over the treated area to hold the bones in place. During the healing process, the bone graft forms a new bone mass called a fusion.

Is ACDF for You?

ACDF is recommended to individuals who:

  • Have a herniated or damaged disk
  • Suffer from chronic weakness of the neck and arm
  • Feel more intense pain in the arm than in the neck
  • Have not improved despite traditional treatment and medication

ACDF can provide relief for herniated and protruding discs and degenerative disc disease (resulting from the formation of bone spurs and inflammation of facet joints).
If you are seriously considering the ACDF procedure, speak to your neurosurgeon. He will examine you and make the necessary assessments and discuss the different types of bone grafts.

Post Surgery

Some patients can go home right after surgery, but if any significant pain or discomfort is felt, or if any medical complications arise (e.g. difficulty in breathing), they may have to stay in the hospital for a few days. The doctor will provide clear and detailed instructions regarding prescription medication. Patients may also need assistance in walking or bathing during the first few days.

Recovery time takes 4-6 weeks, but patients must consult with their physician two weeks after the surgery. They may be asked to increase their physical activity (like walking for longer distances).

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About Dr. Kareh

Neurosurgeon Dr. Victor Kareh, founder of Brain & Spine Surgery Associates in Houston, Texas, offers specialized centers for diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous systems and peripheral nerves.

Learn More about Dr. Kareh

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