Surgical Treatment

Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion, often abbreviated as ACDF, is a common procedure performed in the cervical spine. It involves an incision along the front of your neck (called the anterior side) in order to remove disc material and access your spinal cord and nerve roots. The procedure involves removing the disc (the discectomy portion of the operation) in between the two bones and placing material in that space which allows those two bones to grow together (the fusion portion of the operation). A plate and screws may also be placed on top of the bones in your neck to hold the 2 together until they can fuse.

The surgery is most commonly done to treat a herniated cervical disk which is irritating a nerve and causing neck, shoulder, arm and hand pain or numbness. The surgery is also done to treat cases where bone spurs are causing tightening around the spinal cord (also known as cervical stenosis).

The procedure itself involves a one to two inch incision skin incision on either the left or right side of your neck, usually placed horizontally in line with a naturally occurring skin crease. The thin muscle underneath is divided and then the plane in between your esophagus and carotid artery developed down to the front of your spine. An x-ray is then taken to ensure we are at the appropriate disc space and then the disc material is removed using a variety of instruments. Any remaining bone, ligament etc… is removed to fully relieve any pressure on the spinal cord or nerve roots. Following this, either bone graft or possibly an implant is placed into the evacuated disk space to allow for fusion of the 2 bones together and to prevent collapse of the disk space. A small plate is then attached to the front of the spine and screws placed to hold the plate in place. This serves to make the construct more rigid and hold the 2 bones together until they have had a chance to grow together.

Approaching the cervical spine from the front allows for a few advantages as compared to the back or posterior approach. It allows for less muscle stripping as compared to approaches from the back side and frequently less incisional pain. It also allows for direct access to any herniated disc fragments which may be causing nerve irritation. There are always potentials risks to each type of procedure and no 2 surgeries are the same, so be sure and speak to your physician about your specific risk profile.

Cervical Artificial Disc Replacement

Cervical Artificial Disc Replacement, sometimes abbreviated ADR, is another commonly performed surgery which involves accessing the spinal cord and nerve roots from the front side of the neck. The approach and its advantages are similar to the anterior cervical discectomy and fusion. The added advantage of artificial disc replacement is the ability to maintain motion at the segment of the spine being operated on and avoid a fusion.

The artificial disc device consists of a device placed into the disc space which allows the spine to maintain motion at that segment. The theoretical advantages include the ability to allow early range of motion of the neck after surgery as well as the hope of minimizing stress at the adjacent levels of the spine. However, artificial disc replacements can only be done in a certain subset of patients, and so it is important to go over your scans with your surgeon to see if you are a candidate for disk replacement. The indications for artificial disc replacement are similar to those for anterior cervical discectomy and fusion and include a cervical herniated disc which is irritating the spinal cord or nerve roots. The incision and approach for artificial disc replacement is also similar to the anterior cervical discectomy and fusion. The only difference is once the disc space is cleaned out, the disc replacement device is placed into the evacuated disc space.

Cervical Foraminotomy

A cervical foraminotomy is an approach to the cervical spine done posteriorly (through the back of your neck) to allow for decompression (making more space) around a nerve in your neck. It may also allow for removal of a herniated disc depending on the location of the disc.

The surgery involves approximately one to two inch incision on the back of your neck. The dissection carried down to the spine and an x-ray taken to confirm we are at the appropriate level. Following that, a series of instruments are used to remove any bone, ligament or disc which may be sitting around a nerve root and causing irritation.

The advantages of this approach include the ability to access a nerve and relieve the pressure on it without having to fuse that segment or remove any of your discs. It also allows you to avoid any of the potential complications associated with anterior cervical approaches. The disadvantages as compared to anterior cervical approaches is that there can be some more neck discomfort with approaches which go through the back of your neck.

Cervical Laminoplasty

Cervical laminoplasty is a technique designed to reduce the pressure on the spinal cord in the neck. It is a procedure used in patients who have cervical stenosis, otherwise known as tightening around the spinal cord. Pressure on the spinal cord can be due to various causes but most commonly is caused by arthritis and disk herniations. When the pressure on the spinal cord increases enough, it can lead to issues including neck, shoulder and arm numbness, tingling or pain, difficulty with fine motor tasks such as buttoning shirts or using zippers and eventually balance trouble and bowel or bladder symptoms.

Laminoplasty involves an approach along the back of your neck. Once the bones on the back of your neck can be seen, a drill is used to partially cut the bone on one side and completely cut it on the other side. This creates a door which is then hinged open to allow the spinal cord more room to expand. The hinged-open bone is then often held in place with a plate.

This procedure, originally invented by Japanese surgeons, provides the ability to expand space available for the spinal cord while at the same time avoiding fusion. Some patients may have neck pain or stiffness but most do not notice a significant loss of motion.

Cervical Laminectomy and Fusion

A cervical laminectomy and fusion is a procedure designed to reduce the pressure on the spinal cord on the neck. It is a procedure used in patients who have cervical stenosis, otherwise known as tightening around the spinal cord. Pressure on the spinal cord can be due to various causes but most commonly is caused by arthritis and disk herniations. When the pressure on the spinal cord increases enough, it can lead to issues including neck, shoulder and arm numbness, tingling or pain, difficulty with fine motor tasks such as buttoning shirts or using zippers and eventually balance trouble and bowel or bladder symptoms.

Laminectomy and fusion in the cervical spine involves an incision along the back of your neck to expose the lamina, or bones along the back of your neck. Once these are exposed, a combination of a drill and other instruments are used to remove the bones and allow the spinal cord to expand into that space. This is followed by the insertion of rods and screws to hold things in place while the fusion is allowed to heal. The fusion component of the surgery, in its simplest form, involves trying to get the bones in your neck to grow together and fuse.

Lumbar Microdiscectomy

A microdiscectomy is a procedure which uses a small incision and minimally-invasive techniques to access the portion of the lumbar disc which has ruptured and is irritating the nerve roots (link to herniated disc section). The procedure is indicated in patients who have buttock or leg pain due to a disc herniation which has not gotten better with conservative treatment. If the leg pain is so severe that it is difficult to carry on with the basic functions of daily life or if the herniated disk is causing leg weakness, that may be a reason to have the surgery sooner. The results of the surgery do tend to degrade somewhat the longer the nerve has been irritated, so its generally not recommended to allow the symptoms to go longer than 6 months without treatment. Most microdiscectomies can be done as outpatient procedures with patients going home the same day, but again no two surgeries are the same and it is important to discuss your specific situation with your surgeon.

Lumbar Microdecompression

A microdecompression is a procedure which uses a small incision on your back and minimally-invasive techniques to access the lumbar spine and trim away any bone or ligament which can be contributing to nerve compression. The procedure is generally done for lumbar stenosis, which involves compression on your nerve roots from surrounding bone or ligaments. This generally causes buttock and leg pain while walking (see our Common Diagnoses page for Lumbar Stenosis). Depending on the number of levels, patients can be discharged home either same day or early the next morning.

Anterior Lumbar Interbody Fusion (ALIF)

Anterior lumbar interbody fusion, abbreviated ALIF, is an approach to your lumbar spine done through the front of your abdomen. The procedure offers the opportunity to reach the front of the lumbar spine and have direct access to the bones and discs. Once the lumbar spine is exposed, the appropriate disc can be taken out and the disc space prepared for the insertion of bone graft or devices which help with the fusion.
This procedure can be done anytime a lumbar fusion is needed, but is especially common down at the L5-S1 segment (the transition segment between the lumbar spine and sacrum). It allows for direct access of the disk space and preparation of a large surface area for fusion.

Extreme Lateral Lumbar Interbody Fusion (XLIF)

Similar to anterior lumbar interbody fusion, the extreme lateral lumbar interbody fusion allows for minimally-invasive access of the disc space directly for removal of the disc and insertion of a fusion device. The procedure involves a small incision along the side of your abdomen which allows the surgeon to access your lumbar spine through your psoas muscle.
The advantages include preparing a large surface area for fusion as well as the minimally-invasive way in which it accesses your spine. Because the approach goes through your psoas muscle, the thigh on the side of the approach may be sore especially when you lift your leg. However, this tends to subside over the first couple weeks. If you need to have a lumbar fusion done, ask your surgeon if you’re a candidate for the minimally-invasive XLIF procedure.