When to Turn to Spine Surgery When Nothing Else Will Do

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Article featured on Brigham Health Hub

For many years, Diane Daigneau of Woburn, MA, was able to successfully manage her back and neck pain. Through occasional chiropractic treatments and mild pain relief medications, she was able to continue to work and play.

A few years ago, however, she discovered that circumstances can change dramatically, to the point where even the best non-surgical care fails to provide adequate relief. Such was the case during the summer of 2013, when the pain radiating through Diane’s back, neck, and arms had become so debilitating and persistent that no physician was recommending anything other than cervical spine (neck) surgery.

From Manageable to Intolerable

Diane likes making things pretty. More than that, it’s her job.

She often spends several hours hovering over a single piece of furniture while meticulously applying delicate gold or silver leafing, or some other type of elegant exterior. It’s a mentally and physically demanding job, particularly for someone who has struggled with back and neck pain. But Diane’s pain was never so bad that she ever worried about not being able to do her job or any other enjoyable pursuits. That changed suddenly during a family vacation at the end of July 2013.

Diane woke up on the second morning of her vacation with a new kind of pain. “The pain was unbearable,” says Diane. “It was something like I had never experienced before. There was nothing I could do.”

Along with intense pain, she had limited range of motion in her neck and numbness throughout her neck, shoulder, arms, and chest.

She ultimately headed back home for an MRI, which revealed that two herniated (bulging) discs were crushing nerves in her cervical spine.

A Surgical Solution

Through a colleague, Diane was referred to a spine neurosurgeon for a consultation. Based on her condition, the doctor recommended a two-level anterior cervical discectomy (disc removal).

The doctor started the procedure by approaching Diane’s spine through the front of her neck instead of through her back. There are two distinct advantages to this method. The most important is a significantly reduced risk of damaging the spinal cord. The other is less cutting of muscle, which helps to reduce postoperative pain.

Once the affected area of the spine was reached, the doctor completely removed both bulging discs to take the pressure off of the nerves. Next, to maintain the integrity of the spine, he snugly inserted a graft into each area where a disc had been removed.

The carbon fiber cages used for Diane’s surgery are now the standard of care for discectomy and fusion in the doctor’s practice, and a significant advance from the combined use of grafts (natural or synthetic) and titanium plates. A multi-center study, in which the doctor participated, demonstrated that using a carbon fiber cage alone provides the same strength and functionality as provided by a graft and titanium plate. However, the comparative simplicity of the carbon fiber cage – less material, fewer parts – decreases operation time, reduces the impact on surrounding tissue, and minimizes manipulation of the esophagus.

No Surprises

Diane admits that her recovery hasn’t been easy, but neither has it been a surprise. “I knew all along, step by step, how things were going to be for me,” she explains. “It’s not fun, but at least you’re feeling confident that things are going in the right direction.”

The doctor is similarly confident about the progress of Diane’s recovery. He told Diane that the carbon cages and fused vertebrae eventually will make her neck so strong and stable, as strong as it was before, that she could participate in extreme sports within a year.

Although she finds that claim to be reassuring, Diane doesn’t plan on jumping out of any airplanes in the near future. She’s quite happy to simply be walking, jogging, working – or waking up – without the fear of back and neck pain.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

Cervical Disc Surgery: Disc Replacement or Fusion?

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Article featured on WebMD, medically reviewed by Sabrina Felson, MD

The vast majority of people — more than 90% — with pain from cervical disc disease will get better on their own over time with simple, conservative treatments. Surgery, however, may help if other treatments fail or if symptoms worsen to the point that weakness in your arms and or legs develop. This is called a cervical myelopathy and surgery is recommended.

Cervical disc disease is caused by an abnormality in one or more discs — the cushions — that lie between the neck bones (vertebrae). When a disc is damaged — due to degenerative disc disease (or DDD) or an unknown cause — it can lead to neck pain from inflammation or muscle spasm. In severe cases, pain and numbness can occur in the arms from pressure on the cervical nerve roots or spinal cord.

Surgery for cervical disc disease typically involves removing the disc that is pinching the nerve or pressing on the spinal cord. This surgery is called a discectomy. Depending on where the disc is located, the surgeon can remove it through a small incision either in the front (anterior discectomy) or back (posterior discectomy) of the neck while you are under anesthesia. A similar technique, microdiscectomy, removes the disc through a smaller incision using a microscope or other magnifying device.

Often, a procedure is performed to close the space that’s left when the disc is removed and restore the spine to its original length. Patients have two options:

  • Artificial cervical disc replacement
  • Cervical fusion

In 2007, the FDA approved the first artificial disc, the Prestige Cervical disc, which looks and moves much like the real thing but is made of metal. Since then, several artificial cervical discs have been developed and approved. Ongoing research has shown that the artificial disc can improve neck and arm pain as safely and effectively as cervical fusion while allowing for range of motion that is as good or better than with cervical fusion. People who get the artificial disc are often able to return to work more quickly as well. The surgery to replace the disc, however, does take longer and can lead to more blood loss than with cervical fusion. It’s also not known how the artificial discs will last over time. People who get an artificial disc can always opt for cervical fusion later. But if a patient has cervical fusion first, it’s not possible to later put an artificial disc in the same spot.

The Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What Is Spinal Fusion?

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From WebMD

 

Spinal fusion is surgery to join two or more vertebrae into one single structure. The goal is to stop movement between the two bones and prevent back pain. Once they’re fused, they no longer move like they used to. This keeps you from stretching nearby nerves, ligaments, and muscles that may have caused discomfort.

Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bonelike material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit. Read more

What is Spinal Stenosis?

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From WebMD

Cervical Spinal Stenosis

Spinal stenosis is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems.

Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. It protects your spinal cord, a key part of the central nervous system that connects the brain to the body. The cord rests in the canal formed by your vertebrae.

For most people, the stenosis results from changes because of arthritis. The spinal canal may narrow. The open spaces between the vertebrae may start to get smaller. The tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso. Read more

How The Spinal Cord Works

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Article shared from ChristopherReeve.org

What is the central nervous system?

The central nervous system (CNS) controls most functions of the body and mind. It consists of two parts: the brain and the spinal cord.

The brain is the center of our thoughts, the interpreter of our external environment, and the origin of control over body movement. Like a central computer, it interprets information from our eyes (sight), ears (sound), nose (smell), tongue (taste), and skin (touch), as well as from internal organs such as the stomach.
Read more

Common Disk Injuries and How to Treat them

Understanding Spinal Disk Problems — the Basics

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Article Featured on WebMD

What Are Spinal Disk Problems?

Anybody who has experienced a damaged spinal disk understands how painful it is. Every movement seems to make it worse. This pain is a warning signal that you should heed. If you take appropriate action, the discomfort usually stops, and the problem can be corrected.

Read more

Lumbar Spine Surgery

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Article Featured on Spine Health

Lumbar surgery refers to any type of surgery in the lumbar spine, or lower back, between one or more of the L1-S1 levels. There are two general types of lumbar spine surgery that comprise the most common surgical procedures for the lower back:

Lumbar Decompression

The goal of a decompression surgery is usually to relieve pain caused by nerve root pinching. There are two common causes of lumbar nerve root pressure: from a lumbar herniated disc or lumbar spinal stenosis.

This type of pain is usually referred to as a radiculopathy, or sciatica.

A decompression surgery involves removing a small portion of the bone over the nerve root and/or disc material from under the nerve root to relieve pinching of the nerve and provide more room for the nerve to heal. The most common types of decompression surgery are microdiscectomy and laminectomy.

There are also a few alternatives available to the above two standard procedures, such as an X-STOP which is a possible option instead of a laminectomy for lumbar spinal stenosis.

Lumbar Fusion

The goal of a lumbar fusion is to stop the pain at a painful motion segment in the lower back. Most commonly, this type of surgery is performed for pain and disability caused by lumbar degenerative disc disease or a spondylolisthesis.

A spinal fusion surgery involves using a bone graft to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. Spine surgery instrumentation (medical devices), bone graft procedures, and a bone stimulator are sometimes used along with spinal fusion.

There are also many surgical approaches to performing spinal fusion, such as ALIF, PLIF, XLIF, TLIF, posterolateral gutter fusion, anterior/posterior fusion, and certain minimally invasive approaches.

In addition to the above conditions, decompression and/or spinal fusion may be performed to address other types of lumbar spine pathologies, such as infection or tumors.

Lumbar Spine Surgery Alternatives

In addition to the traditional one-level fusion or decompression surgery that is done for lumbar degenerative disc disease or spinal stenosis, respectively, there are a number of surgical alternatives available. Several of the most common ones include:

Artificial Disc Replacement

Artificial disc technology can be used in specific cases of lumbar degenerative disc disease.

Motion Preservation Technologies

It should be known that while spinal fusion has been a classical treatment for ongoing pain and disability from the lumbar spine, alternatives to fusion do exist for posterior conditions (problems in the back of the lumbar spine) such as spinal stenosis. Inserting an interspinous process spacer, such as the X-STOP device, can actually preserve motion as opposed to stopping it via fusion.

Vertebral Augmentation

A surgery called vertebral augmentation may be done to treat pathological fractures from tumors or osteoporosis.

Multilevel Lumbar Fusion

Lumbar spine fusion surgery for symptomatic degenerative disc disease is typically done on one level of the spine (most commonly toward the bottom of the spine, at L5-S1 or L4-L5). In certain cases it may be done on two levels, and only very rarely would it be considered on 3 or more levels. Multilevel spine fusion may be indicated in cases of scoliosis.

There are only two things that surgery can do. Surgery can decompress a nerve root or it can stabilize a painful motion segment. So we have to identify a nerve root that’s pinched or we have to identify a painful motion segment. And if we can do that, that would make you a candidate for surgery. Just having pain and having failed conservative treatment is not an indication for surgery if there is no pathological cause of the pain – it doesn’t mean there’s not pain, but we have to identify the cause of pain in order to be able to correct it. The only thing surgery can do is actually correct an anatomical defect, so we have to be able to identify it.

Orthopedic & Sports Medicine Center of Oregon is an award-winning, board-certified orthopedic group located in downtown Portland Oregon. We utilize both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Our mission is to return our patients back to pain-free mobility and full strength as quickly and painlessly as possible using both surgical and non-surgical orthopedic procedures.

Our expert physicians provide leading-edge, comprehensive care in the diagnosis and treatment of orthopedic conditions, including total joint replacement and sports medicine. We apply the latest state-of-the-art techniques in order to return our patients to their active lifestyle.

If you’re looking for compassionate, expert orthopedic surgeons in Portland Oregon, contact OSM today.

Phone:
503-224-8399

Address
1515 NW 18th Ave, 3rd Floor
Portland, OR 97209

Hours
Monday–Friday
8:00am – 4:30pm

What Is Degenerative Disc Disease?

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By Brian McHugh, MD | Featured on Spine Health

Degenerative disc disease is one of the most common causes of low back and neck pain, and also one of the most misunderstood.

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Bone Grafts in Spine Surgery

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Article Featured on AAOS

Spinal fusion is one of the most common surgeries done in the neck or back. The basic idea is to fuse together painful bones in the spine so that they heal into a single, solid bone. In order for bones to fuse or heal together, additional bone is needed. This additional bone is called a bone graft.

There are many bone graft options today. They are often combined together. The graft that is best for your problem will depend upon which section of your spine needs to be fused, your age, and your general health.

Read more