In the early stages of degeneration often a minimally invasive spine surgery procedure can be done to relieve pain or remove disc herniations. However, while these surgeries may be considered successful, it is understood that they are temporary solutions and symptoms will likely reoccur.
Minimally Invasive Spine Surgery (MISS)
These techniques use tiny incisions, less disruption to muscles and tissues, faster recovery, and often an endoscope or microscope for visualization.
Common procedures:
• Microdiscectomy: Removal of a small portion of a herniated disc pressing on a nerve.
• Endoscopic discectomy: Using a camera and very small tools through a tube to remove disc fragments.
• Percutaneous vertebroplasty/kyphoplasty: Cement injection into fractured vertebrae (from osteoporosis or trauma).
• Minimally invasive laminectomy: Small removal of bone to decompress the spinal cord or nerves.
Decompression Surgeries
Focused on relieving pressure on the spinal cord or nerves due to herniated discs, bone spurs, or thickened ligaments.
Main types:
• Laminectomy: Removing part/all of the lamina (roof of the vertebra) to open the spinal canal.
• Laminotomy: Partial removal of lamina (smaller opening than laminectomy).
• Foraminotomy: Widening the foramen (where nerve roots exit the spine).
• Discectomy: Full or partial removal of an intervertebral disc that is compressing nerves.
Moderate to Severe Degeneration
As the degeneration increases, minimally invasive procedures become less indicated and may even be recommended in error.
Often surgeons who do minimally invasive surgeries exclusively will offer a surgical option that is not the best long term solution.
In cases of moderate to severe degeneration, we now are considering, is the spine stable enough that motion preserving options like disc replacement can be the best solution.
Conditions like spondylolisthesis or facet arthritis can be seen as indications that fusion is the only option, yet advanced disc replacement options can be done when these conditions are not advanced.
It is critical that your surgeon has extensive experience with fusion, disc replacement options. and hybrid disc replacement/fusion solutions.
Motion-Preserving Surgeries
Designed to maintain flexibility in the spine, rather than fusing bones together.
Examples:
• Artificial disc replacement: Damaged cervical or lumbar discs are replaced with synthetic devices.
• Dynamic stabilization: Implanting flexible devices (instead of rigid fusion) to stabilize segments but still allow movement.
Spinal Fusion Surgeries
Again, surgeons who have extensive experience with spinal fusion may recommend it without considering disc replacement, or may not consider disc replacement due to insurance issues or inexperience with motion preserving options.
Spinal Fusion, intended to permanently connect two or more vertebrae, eliminating motion at that segment, should be used for cases with instability, or severe degeneration.
Types of fusion approaches:
• Posterior lumbar interbody fusion (PLIF): Fusion through the back.
• Transforaminal lumbar interbody fusion (TLIF): Similar to PLIF but from a slightly off-center (lateral) angle.
• Anterior lumbar interbody fusion (ALIF): Fusion through an incision in the abdomen.
• Lateral lumbar interbody fusion (LLIF): Fusion through the patient’s side (minimally invasive).
• Posterolateral fusion: Bone graft placed between transverse processes (no disc space involvement).
• Cervical fusion (ACDF): Anterior cervical discectomy and fusion — common for neck issues.
Materials used:
• Bone grafts (autograft, allograft, synthetic)
• Metal implants (rods, screws, cages)
It is critical that your surgeon have experience and competence with the entire spectrum of surgical options available, and be free from influence from non-medical restrictions.