When a nerve in the back or neck is irritated, the structure irritating the nerve has to be removed. This is often the case when a spinal disc herniates and pinches the neighboring nerve. This is how a lumbar discectomy is performed: A small incision is made directly over the herniated disc (using an x-ray during surgery helps to localize the disc and make a smaller skin incision). Next, the muscles are gently retracted to allow removal of a small ligament and sometimes a sliver of bone. This gives me the ability to visualized the pinched nerve and herniated disc that is pinching the nerve. The herniated piece of the disc is removed, leaving a majority of the disc (which you need for stability and shock absorption). When the nerve is free, it looks less inflamed and is mobile and happy.
Fusion surgery is the most major of the surgeries that I perform. The word fusion literally means “to make two things turn into one.” The goal of fusion surgery is to make two spinal bones fuse into one spinal bone. This is accomplished by removing the disc between the two bones and replacing it with a block of plastic surrounded by cadaver bone. The plastic serves to maintain the position of the bones and prevent collapse while the bones grow together. If the bones collapse, fusion might not occur. The bones also have to be stabilized to prevent excessive motion. If the bones move too much relative to each other, the fusion might not occur. One way to stabilize the bones is to use small titanium clamps or small titanium rods. There are new techniques to perform these surgeries through small incisions, minimally invasive surgery.
SPINAL CORD STIMULATORS
Spinal cord stimulators (SCS) are great for patients that have epidural fibrosis (scar) or have had “too many back surgeries.” Scar formation is not entirely predictable or preventable. When scar strangles the nerves in the back, an effective way to treat the patient is with a spinal stimulator. When a patient has had multiple back surgeries and still have unbearable pain, spinal cord stimulators are very effective.