Neurosurgical Associates, P.C.
Practice Areas
Spinal Surgery
Neurosurgical Associates, P.C.

Instrumentation on Spine Universe
Surgery for the spine involves a variety of approaches and techniques. The purpose of this discussion is to briefly explain what those procedures are and why the surgeon might chose one or several in attempting to help you.

First know that a laminectomy is not a discectomy is not a fusion is not an instrumentation.

A laminectomy is a removal of the roof of bone over the surface of the spinal cord and involves an incision on the back or back of the neck. A laminectomy is performed to either decompress the underlying nerve or spinal cord or to gain access to the inside of the spinal column so that the surgeon can remove disc or tumor. A laminectomy can sometimes be combined with a removal of a portion of the facet to further decompress the nerve or to gain further surgical access for the rest of the procedure.

The disc material is the wafer like cushion that is in between the round blocks of vertebral bodies. With degeneration or injury, the covering around the discs can tear and disc material exudes out and presses upon the nerve. Even in the absence of this herniation, there can be significant degeneration of the disc and the edges of the vertebral body to create severe episodes or even constant spinal pain. Discectomy can be accomplished in several ways. If there is a herniated fragment, the surgeon can perform a small laminectomy (laminotomy) and remove the fragment. Many times the surgeon can chose to remove more disc material within the disc space in an effort to prevent more material from herniating out later. Not all discectomies require an approach from the back however. The approach that a surgeon chooses for the disc problem is tailored to the anatomical location of the herniation (cervical, thoracic, or lumbar), whether the degeneration or herniation is central or lateral, and the degree that the disc is pressing upon the spinal cord. After carefully reviewing everything, your surgeon may choose to bring in another surgical specialist such as a thoracic surgeon or a vascular surgeon to assist him or her in the approach to the disc. This would be more likely if the approach to the disc or the vertebra was being made from the front (anterior) or the side (lateral) in the chest or abdomen.

A fusion is the placement of bone in a joint space to prevent that joint from moving. This is done when it is felt that the movement is counterproductive or even dangerous for the patient. In these cases the patient can have severe degeneration of the disc and vertebral body such that movement in the particular area constantly elicits pain or neurological deficit. A fusion can also be necessary in the face of major spinal cord trauma. With fracture of the major supporting bone of the spinal column and tearing of the ligaments, instability of the spine and associated endangerment of the spinal cord and nerve roots can require surgical stabilization to include fusion. Fusion can also be required when a large amount of bone and joint has been destroyed by infection or tumor. In many of these cases removal of that bone will result in instability to the spine unless new bone is placed within or over the defect to fuse that segment. The bone used for fusion can be taken from the patient by taking a graft of bone from another part of the body (e.g. hip, rib, tibia) or from a cadaver donor (allograft). More recently, surgeons have found that fusion can augmented and accelerated by using synthetic compounds (hydroxyapitite) or special proteins (bone morphogenic protein) from the patient's blood.

Instrumentation is a surgical process that many times goes hand in hand with fusion. Instrumentation is a general term indicating that some form of metal was applied to the spine during the surgical procedure. The metal is generally titanium because it is lightweight, very strong, and better able to be visualized in the MRI. The forms that instrumentation takes are diverse and designed to fit any spinal problem that the surgeon faces. It includes metal plates with screws and bolts designed to strut the front of two vertebral bodies, interpedicular screws to bore into the vertebral body and be interconnected with a rod to prevent motion of two segments, and cages that are placed within the disc space and filled with morcelized bone to create a fusion. The decision as to what type of instrumentation to use or whether to use it at all rests with the surgeon and his or her experience when confronting a particular complex spine problem.

Many times one of the abovementioned procedures will require the use of another or perhaps all of the above mentioned spinal procedures. When undergoing a spinal surgery, or any surgery for that matter, have clear understandings of the following: What is wrong and what exactly will be corrected. Is there a limit to what can be corrected (i.e. is back pain that has occurred for 25 years going to disappear after the surgery)? What are the indications for doing this particular surgery that is recommended? What are the goals of the surgery? What are the risks of the surgery? What are the alternatives to the surgery? What is involved with the convalescence? What about return to work, school, and exercise? If you have questions regarding the surgical procedure that is proposed for you, do not hesitate to call your surgeon or make another appointment to clarify any issue that you might have.

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Neurosurgical Associates, P.C. 1000 Asylum Ave., Suite 3208
Hartford, CT 06105
Fax: (860) 244-3516
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