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Posterior Cervical ForaminotomiesWhen the inter vertebral discs (shock absorbers), that are between the vertebrae (bones) in the neck wear out and are degenerative, or are injured, they can herniated ( bulge outwards) and press against nerves and or the spinal cord. This can cause pain, tingling , numbness, or pins and needles in the neck, shoulders , hands or fingers ,as well as more serious neurologic problems with balance and coordination of the arms and legs. Additionally the individual bones in the neck can thicken with age and produce bony growths called osteophytes that can pinch nerves and cause symptoms. Generally treatment that is provided will include medications, physical therapy and steroid injections ( anti- inflammatory medication). If symptoms progress or the person is unable to participate in activities of daily life then surgery is indicated. |
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The procedure is done under general anesthesia. An incision is made in the back of the neck and the neck muscles are parted along natural planes or separations. to gain access to the back of the spine. A small portion of the bony arch covering the spinal cord is removed so that the surgeon using a microscope and specially designed microinstruments can see the affected nerve and the surrounding bone and tissues. The bony tunnel or "foramina" that the nerve travels through as it leaves the spine and goes to the arms and hands is inspected and trimmed with a special high speed drill. Any herniated disc tissue or bony osteophytes are also removed and inspected by the surgeon. When the surgeon is satisfied with the result the overlying muscles are returned to their original places and sutured together again. The skin is closed together with a plastic surgery technique to make them less visible and the patient goes home from the hospital to recuperate 1 -2 days after the surgery. Patients return to work quickly depending on the physical demands of their jobs with manual laborers taking 2-3 months and clerical or administrative professionals returning in about a months time. Follow up is done in the surgeon's office at regular intervals for about 4-6 months. Physical therapy is often prescribed to assist in the healing process.
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Thoracoscopic DiscectomyAs with the cervical (neck) and lumbar (low back) areas of the spine the upper back also called the "thoracic" region can develop worn out discs that herniated ( bulge out) and press on nerves or spinal cord. Traditionally patients who have this problem have aches in the upper back with either pain that radiates along the ribcage towards the front of the person or they have problems with their balance and walking with heaviness and sluggishness in the legs and sometimes problems controlling their bladder or bowels. |
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Surgery is done to remove the offending disc bulge and relieve the pressure on the nerves,spinal cord, or both. The procedure used to be done through an incision in the back of the spine. However, with the progress of technology we are now able to use a computer in combination with special tubular instruments called endoscopes to do this through 2 -3 small incisions approximately 3/4 inches long in the side of the chest. Surgery takes 2 to 3 hours and the patient stays in the hospital about 3 days. Thereafter the patient may go home to recuperate and follows up with their surgeon at 2 weeks, 1 month and 3 months after their surgery. Physical therapy is often prescribed to assist in the healing process.
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Thoracoscopic Sympathectomy
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The surgery- called a Thoracoscopic Sympathectomy, the patient is placed under general anesthesia and small incisions are made in the side of the chest. An computer in combination with special tubular instruments called endoscopes allows the surgeon to enter the chest of the patient and snip a small section of the "sympthetic chain" or nerves that control the sweaty palm symptoms. The surgery takes approximately 3 hours and the incisions are closed with a few stitches and small bandages are applied. The patient is discharged to home to recuperate 2-3 days later. Follow up in the surgeon's office is at 2 weeks and 1 month after the surgery and in general the patient may return to school or work soon after the surgery and will not need physical therapy. Results of the surgery are permanent and include dry palms, and often dry armpits, and occasionally dry feet as well. The sweating no longer done by the palms is taken up by the body diffusely.
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Lumbar FusionsLumbar degenerative disc disease is the natural process by which the discs or shock absorbing cushions between the vertebrae become dehydrated or flattened. As this process occurs there is increased back pain, buttocks pain and leg pain as the nerves become squeezed by the bones in the spine. Symptoms include but are not limited to muscle pain, spasms, tingling, burning, weakness and loss of function. Evaluation often requires multiple scans- such as MRI, CT scans and X-rays as well as nerve testing and disc specific testing called "discography". If conservative non-surgical treatment fails to stabilize or improve the patient's condition the surgery may be in order.
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Surgery generally requires an incision in the back of the spine. Some fusions require surgery from the front via the abdomen and through the back to treat severe conditions. Through the incision the surgeon parts the spinal muscles along natural tissue planes using live X-rays or fluoroscopy and removes the bad disc tissue and inserts a bone graft. Or the surgeon can use a variety of metal or synthetic materials- into the old disc space. Special metal screws connected by rods are inserted into the vertebra to create a simple lattice and internal support to stabilize the spine while it heals. While in the hospital the patient participates in physical therapy to enhance healing and ability to be functional at home. Occasionally a brace is given to support and protect the spine while it heals; the brace is worn for up to two months after the surgery. Patients go home 3 to 5 days after the surgery and have activity restrictions for lifting, pushing, bending, twisting and driving for about 2 months. Returning to work is on a case-by-case basis. It is typically dependent upon the physical demands of the job and comfort of the patient. After surgery the patient will have to follow up with their surgeon at 2 weeks, 1 month, 2 ½ months and at 5 months. X-rays in the office will be used to evaluate the fusions progress.
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Lumbar MicrodiscectomyConsidered one of the basic surgical procedures done today in spinal surgery. The lumbar microdiscectomy is performed to remove a portion of an intervertebral disc when it is herniated and pressing against a nerve or nerves in the lower back ( lumbar ) region. Patients often remember a history of a twinge in their back followed by great discomfort sometime after. Typical symptoms include back and leg pain and occasionally bowel and bladder problems. Surgery is done when conservative treatment with medications, physical therapy and steroid injections fail to provide relief or the disc is too large to be expected to heal. |
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The procedure is performed under general anesthesia. The incision is made in the small of the back and is approximately 1 inch long. The surgeon uses special instruments and a high powered microscope to part the spinal muscles and tissues to get to the bony arch that covers the spinal nerves. Using a small drill or other instruments a small notch is taken in the bony arch thereby allowing the herniated disc to come into view. This is removed and the surrounding disc tissue is inspected closely for fragments that can break off later. The nerves and joints of the spine are also inspected and then the tissues are closed with sutures ( stitches) in multiple layers. The skin is closed in a plastic surgery fashion and a small bandage is applied . Patients can go home that night or the morning after the surgery. Recuperation takes about a month and there are some restrictions on driving, lifting, twisting and bending in that time. Return to work is dependent on the physical demands of the job and the patients symptoms at 2 weeks, 1 month and 3 month post operative check ups with the surgeon. Physical therapy may be indicated to improve function and return patient to normal life.
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Lumbar LaminectomyLumbar Laminectomy- is an effective operation performed on the lower back to relieve pressure on the nerve roots. It is effective to decrease pain and improve function for patients with lumbar spinal stenosis. Spinal stenosis is caused by degenerative changes that result in enlargement of the joints. Spine Experts Physicians and Surgeons have the training and expertise to correct physical defects by performing the operation (Laminectomy), your physician and the health care team will support your recovery. Your body is able to heal the nerve, muscle and bone tissues. A full recovery, however, will also depend on your having a strong positive attitude, setting small goals for improvement.
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Lumbar MicrodiscectomySpine Experts Physicians and Surgeons typically recommended microdisectomy spine surgery for patients who experienced leg pain for a t least six weeks and have not found pain relief with normal (conservative) medical treatment (such as over the counter steroids and physical activity). Microdisectomy spine surgery procedure is performed on an outpatient basis with no overnight stay in the hospital. However, depending on the patient you may have to stay overnight in the hospital. Post operatively, patients may return to a normal level of daily activity quickly. A microdiscectomy surgery is actually more effective for treating leg pain than for lower back pain. A small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve and provide more room for the nerve to heal. It may take weeks or months for the nerve root to fully heal and any numbness or weakness to get better, patients normally feel relief from leg pain almost immediately after surgery.
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Anterior Cervical DiscectomyAnterior Cervical Discectomy is a surgical procedure performed to treat a damaged disc in the neck area of the spine. Discectomy is recommended if physical therapy or medication fails to help relieve your neck or arm pain when caused by compressed spinal nerves or inflammation. Discectomy is used to treat: Bulging and herniated disc and degenerative disc disease. Cervical discectomy is a surgical procedure that removes all or some of the disc. "Anterior" means that your doctor reaches the damaged disc from the front of your neck—a more convenient approach than from the back (posterior) of your neck. Depending on your case, one disc or more may be removed. You may be a candidate for Anterior Cervical Discectomy surgery if:
The physicians at Spine Experts may recommend treatment options, but only you can decide whether surgery is right for you. Your surgeon may ask you to stop smoking before scheduling the surgery. It’s important to look at all the risks and benefits before making a decision.
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