Anterior Cervical Discectomy and Fusion
- This procedure, called an ACDF for short, is very common and is performed when a nerve(s) are compressed by a disc herniation or bone spurs. It is performed through the front of the neck (anterior). The surgery involves removing the disc and or bone spurs compressing the nerves and replacing it with banked bone (cadaver bone) or a synthetic spacer filled with bone graft. A plate is used to secure the vertebrae that are being fused. You may or may not be required to wear a cervical collar. This is determined by the surgeon.
Anterior Cervical Corpectomy and Fusion
- This is a similar surgical approach to the ACDF. The additional component of this procedure is removal of one or more vertebrae in addition to the removal of disc material. A plate is also used to secure the remaining bones above and below the resection area. Some of these procedures additionally may require a separate posterior approach for further stabilization in select cases.
Posterior Cervical Laminectomy with or without Fusion
- This surgery is performed from the back (posterior) or neck and involves removing the arch of bone on the back of the spine (lamina) to allow space for the nerves and spinal cord. In addition, it may be necessary for your surgeon to fuse the vertebrae together with the use of screws and rods. This surgery will sometimes be done in combination with the anterior approach which would allow for a circumferential fusion, or 360 degree fusion of the neck.
Thoracic Laminectomy with or without Fusion
- Similar to the Posterior Cervical laminectomy described above or the Posterior Lumbar laminectomy below except that this occurs in the middle portion of the spine from the shoulders to approximately the bottom of the ribcage area.
Posterior Lumbar Laminectomy
- This procedure involves removing the lamina portion of the vertebrae in the lower portion of the spine from the rib cage to the tailbone areas to allow for more space for the nerves thereby relieving pressure on the nerves. The lamina is the arch of bone over the spinal canal.
- A lumbar discectomy involves the removal of the piece of disc that is bulging and putting pressure on the nerve. This is the standard for treatment of a herniated disc. A discectomy can be performed anywhere along the spine: cervical, thoracic, or lumbar. Any associated bone spurs (osteophytes) are removed to insure the path of the nerve root is free as well. Removal of a small “window” of bone may be necessary for your surgeon to gain exposure during the removal of the disc or ensuring the decompression of the nerve root(s).
- A fusion may be performed in addition to a decompression procedure (i.e. Laminectomy) to relieve the pressure off the spinal nerves, while restoring spinal stability and alignment. There are many different types of fusion and approaches for this. Spinal fusion involves using bone grafting products to cause two vertebral bodies to cement together forming one bone. Bone graft can be taken from the patient’s hip (autograft bone) during surgery, harvested from cadaver bone (allograft bone), harvested through stem cell technologies, or manufactured (synthetic bone fusion products). Rods and screws and/or plates with screws are placed to help fixate the fusion. This can be accomplished by a posterior (back), anterior (front), or lateral (side) approach.
The hardware used is a high technology metal alloy and therefore unlikely to “set off” security alarms in airports or other venues. However depending upon the level of security sensitivity or if you have other hardware in your body (such as a total knee replacement), security agents may need to perform a further examination to verify that you have had surgery. Some surgeons require you to wear a brace for a period of time after surgery.
Your surgeon will discuss with you the approach options they feel will give you the best outcome. Here are some examples of lumbar spine approaches:
1. Anterior Lumbar Interbody Fusion (ALIF)
- This approach utilizes an incision through the anterior side (abdomen) to fuse the bones together. As with the other interbody fusions, a portion of the disc is removed and replaced with bone or a spacer filled with bone creating materials.
2. Posterior Lumbar Interbody Fusion (PLIF):
- This approach is through the middle of the back and achieves a fusion by inserting a bone graft and/or spinal implant (cage) directly into the disc space. Pedicle screws affixed to rods are typically used to secure the fusion.
3. Transforaminal Lumbar Interbody Fusion (TLIF):
- Similar to the PLIF except the disc is removed through the side of the spinal canal instead of the back of the canal like with the PLIF. This can be performed either with traditional open technique or with less invasive methods.
4. Extreme Lateral Interbody Fusion (XLIF):
- This technique provides access to the spine through the side or “lateral” approach. This approach involves minimal disruption to your nerves and other nearby structures, therefore is referred to a “minimally invasive” technique.
5. Interlaminar Lumbar Interbody Fusion (ILIF)
6. Posteriolateral Fusion (PLF)
7. Anterior/posterior Lumbar Fusion (360)
- A procedure (ALIF, XLIF, PLIF, TLIF) may be combined with a posterior instrumented fusion to obtain a more rigid fusion. This approach is commonly referred to a 360 degree approach.