OutPatient Surgery

What is Laminectomy?

A laminectomy is typically performed to alleviate pain from lumbar spinal stenosis.

Spinal stenosis is caused by degenerative changes that lead to enlargement of the facet joints in the back of the vertebrae.

The enlarged joints and related degenerative changes place pressure on the nerve roots as they exit the spine.

Each vertebra has two portions of vertebral bone over the nerve roots in the back of the spine. These small flat bones are called the lamina.

The lamina functions as a protective covering of the spinal canal. In the lower back, they protect the cauda equina, the nerve roots that branch off of the spinal cord, as well as the nerve roots as they exit the spine.

What to expect during the procedure?

• Our doctors will make an incision in your back over the affected vertebrae and move the muscles away from your spine as needed. Small instruments are used to remove the lamina. The size of the incision may vary based on your condition and body size. Minimally invasive surgery.
• If laminectomy is being performed as part of the surgical treatment for a herniated disk, the surgeons will also remove the herniated portion of the disk and any pieces that have broken loose (discectomy).
• If one of your vertebrae has slipped over another or if you have curvature of the spine, spinal fusion may be necessary to stabilize your spine. During spinal fusion, the doctors will permanently connect two or more of your vertebrae together using bone grafts and, if necessary, metal rods and screws.
• Depending on your condition and individual needs, our team may use a smaller, minimally invasive incision and a special surgical microscope to perform the operation.

What results should I expect?

Most people report measurable improvement in their symptoms after laminectomy, particularly a decrease in pain that radiates down the leg or arm. But this benefit may lessen over time if you have a particularly aggressive form of arthritis. Laminectomy is less likely to improve pain in the back itself.

A follow-up appointment with our doctors will provide a better assessment of your procedure, as results can vary from patient to patient.

What is a Coflex^TM procedure?

The coflex^TM device can be used to treat LSS and is a single-piece titanium implant that is stable, strong, and flexible enough to give your spine the support it needs. It provides spinal stability without the invasiveness and loss of mobility associated with spinal fusion. If you or a loved one is recommended for the coflex^TM procedure, the spine surgeon may choose to perform the procedure in an outpatient setting where patients can experience better outcomes, lower infection rates, cost savings, and more personalized service.

What to expect during the procedure?

The coflex^TM procedure can be performed in an outpatient setting. However, you should arrange for someone to drive you, and to help during the first few hours of your recovery after surgery.

Decompression surgery involves removing the pressure on the nerves that causes pain. After undergoing decompression surgery, our doctors will insert the coflex^TM device through the incision made for the decompression. The coflex^TM device is positioned on your lamina, which is the strongest bone in the back of your spine. On average, the entire procedure, including decompression and implantation of the coflex^TM device, usually takes less than 2 hours.

What results should I expect?

When you wake from recovery, you may be encouraged to get up and walk almost immediately, taking into consideration your overall health at the time of surgery. Since there is no fusion, and therefore no healing bone to wait for, you’ll most likely be able to do this right after your procedure. You’ll notice that your pain has been significantly relieved, and your spine should feel stable and strong. Most patients do need to wait several days following the surgery for the incision wound to heal.

In the weeks and months following surgery, your recovery depends on a number of factors, including the degree of your stenosis and the extent of the decompression that was performed. Most patients are able to return to normal activity, and even expanded activity such as golf, cycling, or gardening, within weeks of the surgery. Some patients may require physical therapy to help with mobility and flexibility.

What is a Microdiscectomy?

Typically performed for a herniated disc, a microdiscectomy relieves the pressure on a spinal nerve root by removing the material causing the pain.

A microdiscectomy is generally considered the gold standard for removing the herniated portion of a disc that is pressing on a nerve, as the procedure has a long history and many spine surgeons have extensive expertise in this approach. A microdiscectomy is generally considered a minimally invasive surgery, as there is minimal disruption of the tissues and structures in the lower back.

What to expect during the procedure?

A microdiscectomy is performed through a 1 to 1½-inch incision in the midline of the low back.

First, the back muscles (erector spinae) are lifted off the bony arch (lamina) of the spine and moved to the side. Since these back muscles run vertically, they are held to the side with a retractor during the surgery; they do not need to be cut.

The nerve root is gently moved to the side.

Our surgeons use small instruments to go under the nerve root and remove the fragments of disc material that have extruded from the disc.

In a microdiscectomy, only the small portion of the disc that has herniated—or leaked out of the disc—is removed; the majority of the disc is left as is.

What should I expect after surgery?

The total procedure takes about 1 hour to complete. Patients are generally permitted to go home the same day, but they will be advised by physical and occupational therapists on proper in-home techniques before discharge. Patients should avoid bending too much at the waist and refrain from lifting heavy objects for the first couple of weeks. This, along with proper techniques for getting in and out of bed and using the restroom, will help prevent straining the injury. Additionally, patients should avoid sitting for extended periods during the first couple of weeks after surgery.

Our surgeons may recommend a back brace or a soft lumbar corset to provide additional lumbar support after the procedure. The wound area is left clean and open, with no surgical dressing or bandages required. Patients can return to bathing within a day or two after the procedure, and resuming other routines such as driving and returning to work is typically possible within a few days to a week. Our surgeons will schedule a follow-up appointment about 2 weeks after surgery to assess the progress of recovery.

What is Spinal Cord Stimulation?

Spinal cord stimulation is used most often after nonsurgical pain treatment options have failed to provide sufficient relief. Spinal cord stimulators may be used to treat or manage different types of chronic pain, including:

• Back pain, especially back pain that continues even after surgery (failed back surgery syndrome)
• Post-surgical pain
• Arachnoiditis (painful inflammation of the arachnoid, a thin membrane that covers the brain and spinal cord)
• Heart pain (angina) untreatable by other means
• Injuries to the spinal cord
• Nerve-related pain (such as severe diabetic neuropathy and cancer-related neuropathy from radiation, surgery or chemotherapy)
• Peripheral vascular disease
• Complex regional pain syndrome
• Pain after an amputation
• Visceral abdominal pain and perineal pain

Spinal cord stimulation can improve overall quality of life and sleep, and reduce the need for pain medicines. It is typically used along with other pain management treatments, including medications, exercise, physical therapy and relaxation methods. Several kinds of spinal cord stimulation systems are available. The units that are more commonly used are fully implanted and have a pulse generator, which is like a battery. Most of the newer devices feature a rechargeable pulse generator system that can be easily charged through the skin. There are also some pulse generators that are fully implanted that do not require recharging, but last a shorter time before they need to get replaced. Another system includes an antenna, transmitter, and a receiver that relies upon radio frequency to power the device. In these systems, the antenna and transmitter are carried outside the body, while the receiver is implanted inside the body. Spinal cord stimulation is recommended when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed. Spinal cord stimulation, also called neurostimulation, directs mild electrical pulses to interfere with pain messages reaching the brain. A small device implanted near the spine generates these pulses. The implanted generator used in spinal cord stimulation has similarities to a cardiac pacemaker, leading some to call the device a pacemaker for pain.

What to expect during the procedure?

During spinal cord stimulation, a device that delivers the electrical signals is implanted in the body through a needle placed in the back near the spinal cord. A small incision is then made to place the pulse generator in the upper buttock. The patient may turn the current off and on or adjust the intensity of the signals. Some devices cause what’s described as a pleasant, tingling sensation while others do not. Research shows that newer devices may change the sensation of pain by potentially altering the balance of cells that deliver pain in the spinal cord. During the permanent implantation procedure, the generator is placed underneath the skin and the trial electrodes are replaced with sterile electrodes. Unlike the trial electrodes, these will be anchored by sutures to minimize movement. The implantation can take about 1-2 hours and is typically performed as an outpatient procedure.

After administering the local anesthesia, your surgeon will make one incision (typically along your lower abdomen or buttocks) to place the generator, and another incision (along your spine) to insert the permanent electrodes. Each incision is about the length of a credit card. Once the electrodes and generator are connected and functioning, our team will close the incisions.

What results to expect?

Generally, the pain relief provided by spinal cord stimulators allows patients to do much more than they could before surgery, but there are certain restrictions to be mindful of.

MRIs are not always safe for those with spinal cord stimulation devices!! Some newer devices are compatible with certain MRI machine models and scan locations, but your doctor will need to evaluate the specifics of your stimulator first. If your device is not MRI compatible, MRIs can cause serious injury. You should power off your stimulator when you’re driving or operating heavy machinery, as sudden changes in stimulation levels could cause distraction. Swimming is fine with a permanent, implanted generator, but you cannot get your temporary stimulator wet. You will need to avoid baths and showers during that short trial period. A spinal cord stimulator can be removed safely if you are unsatisfied with the level of pain relief it provides or if there is an infection or mechanical problem with your system

What is Cervical Disc Replacement?

The natural cervical intervertebral disc is a remarkable mechanical structure from an engineering perspective. It has the ability to absorb a large compressive load while still providing an impressive range of motion between the bones in the neck. Duplicating the natural disc's form and function with an artificial disc is challenging. However, several artificial cervical discs have been developed and are available as a surgical option to treat cervical disc problems that cause chronic neck pain and other symptoms, such as arm pain or weakness.

• Confirmed cervical disc disease. An MRI or CT scan with myelography can show soft tissues—such as discs, nerve roots, and the spinal cord—in addition to bones. If imaging shows degeneration of one or more discs, the next step is to determine if any of the degenerating discs correlate to the pain or other symptoms experienced by the patient.
• Radicular pain and/or neurological deficits caused by a problematic disc. Most commonly, an inflamed cervical nerve root corresponds to problems with pain, tingling, numbness, and/or weakness that radiate down into the arm and/or hand. If the spinal cord is compressed within the cervical spine, cervical myelopathic symptoms and/or myelopathy may be experienced anywhere below the level of compression, such as pain that goes into both hands and/or legs, hand weakness/numbness, leg weakness/numbness, trouble with coordination or walking, or difficulty with bladder/bowel control.
• Nonsurgical treatments have been tried. Cervical degenerative disc disease symptoms typically can be managed with nonsurgical treatments, such as rest, ice, heat, medications, physical therapy, and/or therapeutic injections. If the symptoms persist at least 4 to 6 weeks despite nonsurgical treatments, a surgical solution is more likely to be needed for pain relief.1
• Surgery would be well tolerated. Candidates for cervical ADR must be in generally good health and capable of recovering well from the surgery. The candidate needs to have reached full skeletal maturity (with no more bone growth left) but still be in good enough health for the procedure’s benefits to outweigh the risks. Candidates for cervical ADR are typically between ages 20 and 70.

What to expect during surgery?

Before having cervical disc replacement surgery, the surgeon typically requests the following of the patient in the weeks leading up to the procedure:

• Quit smoking and/or other tobacco products. Smoking is known to raise the risk for surgical complications, such as infection, as well as have a detrimental effect on bones and the healing process.

A single-level cervical ADR surgery commonly involves the following steps:

• The patient lies face up on a table. General anesthesia is applied so the patient goes to sleep (becomes unconscious) and does not feel pain or discomfort during the procedure.
• A 1- to 2-inch incision is made in the front of the neck.
• The affected disc is removed, as are any disc fragments or osteophytes (bone spurs) that are pressing on a nerve root or the spinal cord .
• The disc space is restored to its normal disc height to help relieve pressure on the surrounding nerves.
• Using live x-ray imaging (fluoroscopy) for visual guidance, the artificial disc device is placed in the prepared disc space. More than one artificial disc size may be tried before the surgeon decides on the best fit. The specifics of how the artificial disc is implanted can vary depending on the type of disc.
• After the artificial disc is placed and attached to the 2 adjacent vertebrae (above and below), the incision is sewn up.

What to expect from the procedure?

After cervical artificial disc replacement surgery, most patients go home the same day whereas others spend a night in the hospital. During this short stay in the hospital, the patient receives:

• Pain medication
• Clear liquid diet before transitioning to solid foods
• Education about managing pain and incision care at home
• Assistance with walking and stairs

What is a Kyphoplasty Procedure?

A Kyphoplasty procedure is an outpatient surgical procedure that treats small breaks and fractures in the vertebra that make up the spine. Without treatment or surgical procedures, these fractures can curve and shorten the spine.

Our doctors are able to complete this complex procedure, designed to stop the pain caused by a spinal fracture, without the need for a hospital setting. In addition to relieving pain, they will stabilize the bone and restore some of the lost vertebral body height due to compression and spinal fractures. This minimally invasive surgery is performed through a small skin puncture rather than a larger incision and typically takes 1 to 2 hours.

What to expect during the procedure?

During the kyphoplasty procedure, the back is cleaned and prepped for the placement of the needle to puncture the skin. Local anesthesia and mild sedation are applied, although the patient will remain awake during the procedure. Once the small incision is made in the back, a tube is inserted through the path created in the vertebra and into the fractured area.

A specialized ballon will then be inserted throughthe tube and into the fractured vertebra to be inflated. The inflating ballon creates a soft inner bone support for the fractured vertebra allowing it to return to normal height. Once the ballon is removed, the cavity of the damaged vertebra will be willed with a cement like material that will quickly harden and mimic the natural bone structure.

What to expect after the procedure?

After a kyphoplasty procedure, our team will monitor the patient in the recovery area for a few hours. If there are no complications, the patient is typically allowed to go home with the assistance of someone. Patients are advised not to drive themselves. While most patients may experience immediate relief, others might notice a gradual reduction in pain over time.

This outpatient procedure allows patients to return to their normal routines almost immediately, but they should be limited to non-strenuous activities for 4 to 6 weeks. Our team will follow up with the patient through a virtual or in-person appointment a few weeks after the procedure to assess their recovery.