COMMON SPINE CONDITIONS:
Osteoporosis typically occurs in postmenopausal women and may contribute to painful vertebral fractures. Surgical procedures such as Vertebroplasty and Kyphoplasty are usually effective treatments if caught early. Physical therapy may also be beneficial to strengthen muscles, reduce pain and return the patient to their prior mobility level.
Spondylolisthesis
A slippage of one vertebra over the one below it, most commonly in the lumbar (lower back) area. It may develop in a weakened area of the vertebra during childhood or the adolescent years, or it could occur later in life as a result of degeneration, or a stress fracture in a vertebra.
Spinal Stenosis
Narrowing of the spinal canal, nerve root channel, and/or intervertebral foramen. Spinal stenosis may be inherited, but most often it is caused by the normal aging process.
Sciatica
Pain radiating from the back and down the leg.
Ruptured Disc/Bulging Disc/”Slipped Disc”
Age or injury may cause discs to dry out or degenerate.
As this happens, the jelly-like nucleus in the disc may bulge into the annulus, causing pain and pressure. If a sudden movement or injury causes a rupture of the annulus (torn annulus), the nucleus squeezes out and irritates the nerves.
Radiculopathy
Most often referred to as a pinched nerve; it may cause pain in the upper extremities, thorax, or legs.
Spinal Instability
As a disc degenerates and flattens, vertebrae may become unstable, slipping back and forth and irritating facet joints and nerves.
Degenerative Disc Disease
Over the human life span, the discs naturally wear out.
Sports, injury and everyday activities contribute to the degeneration of the discs.
Scoliosis
This sideways curvature of the spine causes it to resemble a letter “S” or “C” rather than a straight “I”.
Scoliosis can occur at any age in children or teen-agers. It can run in families, but in many cases its cause is not known.
TREATMENT:
MINIMALLY INVASIVE LUMBAR DISCECTOMY
A minimally invasive discectomy is a procedure performed to treat conditions like a bulging or herniated disc in the neck or back. The goal of the procedure is to remove a small portion of the damaged disc in order to decompress a pinched nerve root in the spinal canal.
CERVICAL DISC REPLACEMENT
Artificial disc replacement (ADR), or total disc replacement (TDR), is a type of arthroplasty. It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial disc implants in the cervical (upper) spine. The procedure is used to treat cervical pain resulting from degenerative disc disease or a herniated disc caused by accident. Cervical disc replacement is also an alternative intervention for symptomatic disc herniation with associated arm and hand symptoms.
Artificial disc replacement has been developed as an alternative to spinal fusion, with the goal of pain reduction or elimination, while still allowing motion throughout the spine. Another possible benefit is the prevention of premature breakdown in adjacent levels of the spine, a potential risk in fusion surgeries.
ANTERIOR CERVICAL DISCECTOMY WITH FUSION (ACDF)
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure to treat nerve root or spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine with a discectomy, followed by inter-vertebral fusion to stabilize the corresponding vertebrae. This procedure is used when other non-surgical, conservative treatments have failed.
LUMBAR LAMINECTOMY
Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral lamina. This helps ease pressure on the spinal cord or the nerve roots that may be caused by injury, herniated disk, narrowing of the canal (spinal stenosis). A laminectomy is considered only after other conservative medical treatments have not worked.
ANTERIOR LUMBAR INTERBODY FUSION (ALIF)
Anterior lumbar interbody fusion (ALIF) is a spine surgery that involves approaching the spine from the front (anterior) of the body to remove a herniated disc from in between two adjacent vertebrae in the lower back (lumbar spine), then fusing, or joining together, the vertebrae on either side of the remaining disc space using bone graft, a PEEK or Titanium spacer, and titanium screws.
OPEN-POSTERIOR LUMBAR INTERBODY FUSION (PLIF)
Open PLIF Procedure
A typical PLIF procedure involves an open incision (approximately 4-6 inches long) in the middle of the lower back followed by removing the paraspinous muscles away from the spine. Bone removal (laminectomy) and lumbar discectomy are performed to remove pressure from affected spinal nerve roots. When the offending disc is removed, an empty space is left between the upper and lower vertebrae (interbody). This is then filled with bone graft. Implants made of titanium, or PEEK or materials are typically inserted into the interbody space. Finally, pedicle screws are placed into the upper and lower vertebrae and connected with rods or plates.
MINIMALLY INVASIVE POSTERIOR LUMBAR INERTBODY FUSION (MIS-PLIF)
In minimally invasive procedures, the surgical incisions are small, there is no need (or minimal need) for muscle stripping, there is less tissue retraction, and blood loss is minimized. Special surgical tools allow the surgeon to achieve the same goals and objectives as the open surgery while minimizing cutting and retracting of the paraspinous muscles. Therefore, tissue trauma (injury) and post-operative pain are reduced, hospital stays are shorter, and patients can recover more quickly.
TRANSFORAMINAL LUMBAR INTERBODY FUSION
Transforaminal lumbar interbody fusion (TLIF) is a form of spine surgery in which the lumbar spine is approached through an incision in the back.
This technique is a variation of Posterior Lumbar Interbody Fusion (PLIF). In transforaminal lumbar interbody fusion (TLIF), your surgeon approaches the disk space slightly more from the side. The advantage of this approach is that it requires less movement of the nerve roots; thus, theoretically, it decreases the chance of nerve injury.
SI JOINT FUSION
The sacroiliac joint or SI joint is the joint in the pelvis between the sacrum and the ilium, which are joined by strong ligaments. The SI joint is a strong weight bearing joint that holds the pelvis together. There are two joints, one on the right and one on the left. Pain is thought to be caused by sacroiliitis, an inflammation of one or both of the sacroiliac joints. Sacroiliitis may cause pain in the low back, buttock and or in the thigh. SI joint dysfunction is a common cause of sacroiliitis. Sacroiliac joint dysfunction generally refers to abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the SI joint, or sacroiliitis. Sacroiliitis can also be due to a prior lumbar fusion (failed back surgery), or trauma from an accident.
KYPHOPLASTY:
During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy (XRAY) to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
Using the X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the vertebral body to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
The balloon is removed, and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the material hardens quickly, stabilizing the bone.
The goals of a kyphoplasty surgical procedure are designed to stop the pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.
POSTERIOR CERVICAL SPINE FUSION
A posterior cervical spine fusion surgery may be recommended to stop motion between two or more vertebrae, to straighten the cervical spine from a spinal deformity, or to stabilize the cervical spine after a fracture.
Unlike in an anterior cervical fusion, there is no place to wedge bone graft, so the bone graft is simply laid on top of the lamina. The goal of surgery is for the lamina to eventually fuse. To improve fusion, spinal hardware or wires may be used to hold the graft tightly in place while the fusion heals.
A posterior cervical fusion surgery (done from the back of the neck) provides stabilization of the neck. It may be performed to supplement an anterior fusion of the neck or without any other fusion on the neck, by itself or in conjunction with a cervical laminectomy. The procedure is done through a vertical incision in the neck using a microscope to provide excellent visualization of the nerves.
MINIMALLY INVASIVE POSTERIOR FACET JOINT FUSION
A minimally invasive posterior facet joint fusion using “DTRAX” is an advanced procedure used to treat nerve root compression and to assist with cervical spinal fusion.
Performed through a small incision, Dr. Greenwald enters the affected area, through the back of the neck, utilizing real time fluoroscopy (X-RAY) to guide the procedure.
Once Dr. Greenwald has located the affected area, he will insert the DTRAX device. The DTRAX device is an implant used to help alleviate neck and arm pain, providing indirect decompression of the compressed nerve roots and stabilizing the cervical area through fusion.