Advanced spine surgery focuses on finding the root cause of your spine pain and discomfort while reducing the degree of impact on your lifestyle. Typically, surgery is the last resort after exhausting all non-surgical treatment methods when issues like damaged vertebrae or herniated discs fail to respond to non-surgical treatment options. Dr. George Rappard has a skilled Los Angeles practice that can relieve your pain and improve the function of your spine and nerves. Our clinic uses state-of-the-art surgical techniques and can offer follow-up care and collaborate with rehabilitation therapists to ensure you have the best outcome possible. Read on to learn more about our various advanced spine surgical and minimally invasive procedures and how to prepare for the process.
Lumbar Disk Replacement
Your spine consists of vertebrae (bones stacked on top of each other). Disks between your vertebrae function as cushions, allowing the vertebrae to move and rotate without your bones rubbing against one another.
Lumbar disc replacement surgery replaces a degenerated or worn disk in your spine’s lower part with another disc.
Your surgeon will conduct diagnostic tests like an x-ray, computed tomography (CT) scan, discography, or magnetic resonance imaging to determine whether you qualify for this treatment.
Eligible candidates should have the following characteristics:
- Back pain caused by arthritic intervertebral disks in your lumbar spine.
- No facet joint condition or bony compression on your spinal nerves.
- The patient should not be obese.
- No scoliosis (spine deformity).
- No osteoporosis (weak bones).
Here is what to expect during the procedure:
- A medical assistant will put an intravenous line in your arm or hand to administer anesthesia. The medication will put you into a deep sleep and prevent you from feeling pain during your surgery.
- While lying on your back, your doctor will make a tiny incision in the abdomen and move your blood vessels and organs to the side to gain access to the spine. Then they will remove your damaged disc and place your artificial disk.
- Finally, they will put your blood vessels and organs in place before closing the incision.
The medical experts will take you to the recovery room for monitoring until you wake up. You will still have an intravenous and a bladder catheter to make urination easier. You will remain admitted to the medical facility for a couple of days.
Since the procedure does not require your bone to recover, the healing duration will be quicker than other advanced spine surgeries.
Laminectomy is an advanced spine surgery that removes tissue and bone spurs linked to spine arthritis, creating space. The decompression surgery enlarges your spinal canal and relieves pressure on the nerves or spinal cord.
Your healthcare provider can recommend the procedure if:
- Conservative treatment options like physical therapy or medication fail to improve your symptoms.
- Muscle numbness or weakness that makes walking or standing challenging.
- Loss of bladder or bowel control.
What to Expect During Your Laminectomy Surgical Treatment
Your surgeon will perform the procedure using general anesthesia, and you will be unconscious. They will also monitor your oxygen level, blood pressure, and heart rate throughout the surgery.
Your doctor will make an incision in your back and move your muscles away from the spine. They will use small medical tools to remove your bone spurs and the least amount of lamina. The size of your incision will vary depending on your body size and condition.
If the surgery is part of surgery for a herniated disk, your doctor will also remove the herniated disk and any broken pieces.
If a vertebra has slipped over another, your surgeon will use spinal fusion to stabilize your spine.
Interlaminar Lumbar Endoscopic Discectomy
Interlaminar lumbar endoscopic discectomy is a minimally invasive surgical procedure for treating pain stemming from a disc herniation irritating or compressing spinal nerves.
Endoscopic means your surgeon performs the procedure via a channel in the endoscope while watching with the camera.
Before the surgery, the surgeon will make a tiny incision in your lower back’s skin. Then the doctor will place a tiny tube through your skin. They will advance the tube into interlaminar space with X-ray guidance and an endoscopic camera.
A ligament covers the effaces. The physician opens your ligament, permitting them to carefully place an endoscopic camera and tube in your spinal cord. Your spinal canal is the opening in your spine’s back, running from top to bottom, and all your spinal nerves travel to it. Using the endoscopic camera, the doctor carefully moves your nerves to the side, exposing your injured disc. Finally, they will remove the injured disc and close the incision.
The doctor will observe you for a couple of hours before discharging you.
A foraminotomy is a surgery performed to relieve pressure on spinal nerves that exit your spine via the foramen. When a doctor performs this surgical procedure in the neck region, it is called a cervical foraminotomy. It is a minimally invasive treatment that widens the space where your spinal nerve roots leave your spinal column.
The surgical procedure is ideal for patients with herniated discs resulting in cervical nerve root compression or bone spurs. Some of the symptoms of root compression include the following:
- Weakness or tingling in your arms and hands.
- Needles and pins.
- Pain in shoulders and neck.
The surgical option is recommended if conservative treatment options have failed to relieve your pain.
The cervical foraminotomy procedure involves the following steps:
- Incision — The surgeon will administer general anesthesia. The doctor will make a small incision at your neck’s rear. They will retract your soft tissues and skin, exposing your spine's bony roof.
- Spinal bone removal — The physician will remove and clear away bones from your spine’s posterior arch. It assists the doctor in accessing your herniated disc and pinched nerve root in the spine.
- Removing herniated discs — The healthcare provider will remove your thickened ligament, herniated disc, and bone spur to relieve pressure and tension in your nerve roots.
- Closure — Finally, the surgeon will put your soft tissues and muscles in place before closing your wound with medical glue or stitches.
Cervical Laminoplasty involves repositioning or reshaping bones to relieve stress on your spinal nerves in the spine’s cervical section. Lamina is the roof of bone over your spinal cord, while plastos means molding. Unlike laminectomy, the lamina is not removed but reshaped or repositioned.
Patients with cervical stenosis qualify for the procedure. Spinal stenosis happens when your spinal cord narrows, exerting pressure on the spinal cord. Intervertebral disc and joint degeneration can result in spinal canal narrowing. Bone spurs forming in the spinal cord and connecting ligaments thickening can also cause the ailment.
The procedure involves the following steps:
- Incision — The surgeon will administer general anesthesia and ensure you are in a position that allows the medical expert to access your neck’s rear. They will make an approximately three-inch-long incision. They will dissect your tissues and neck muscles to expose your lamina and cut one side of your cervical vertebrae, making a hinge.
- Cutting bones on your other side — Your doctor will cut through the adjacent side of your cervical vertebrae. They will then cut the spinous tips.
- Opening your vertebrae’s back — The physician will open your vertebrae’s rear to relieve pressure on the nerve roots and spinal cord.
- Placing bone wedges — The surgeon will place tiny wedges made of your bones in the gap. Then they will close your bone door. The wedges will stop it from closing.
- Closure — The surgeon will finally restore soft tissues and muscles in their place before closing the wound by stitching your skin together.
Arthroplasty (Cervical Artificial Disc)
Arthroplasty replaces the damaged or diseased disc with a steel device tailored to preserve motion. The medical device has two linking components: a trough on the bottom and a ball on top.
Not every patient with radiculopathy or neck pain is eligible for the procedure. The surgeon will determine whether you need the procedure depending on your neck anatomy, symptoms, and diagnosis. Typically, ideal candidates have:
- Severe spinal cord injuries stenosis.
- Cervical kyphosis.
- Facet arthritis.
Here is what happens during the surgical procedure:
- The surgeon will make an incision in your neck from the front. They will move your blood vessels and veins aside to see your damaged disc clearly and access the spine.
- Then they will remove your damaged disc from between your vertebrae. They will also remove bone spurs and affected disc fragments.
- The surgeon will raise your disc space to the standard height to relieve stress on your nerve roots. Next, they will clear the surfaces of your vertebrae from your disc tissues and shape them to accept the medical implant.
- Using X-ray guidance, the doctor will implant the medical device in the prepared space and secure it with screws. Your implant is tailored to preserve motions like side bending, rotation, extension, and flexion. It also keeps your cervical spine well-aligned.
- Finally, the surgeon will close the wound with medical glue or stitches, clean the wound, and apply the bandage.
How to Prepare for Your Advanced Spine Surgery
You are probably worried and anxious if you are scheduled for a spine surgical procedure. Luckily, there are different ways to make the process successful.
Depending mainly on your general health condition and age, your doctor can request that you undergo a clearance (checkup) with a general doctor or any physician you visit regularly, like a cardiologist.
The doctor can also request a blood test.
Stop Smoking or Using Tobacco
If you use tobacco or smoke, you should quit months before this advanced spine surgery.
A nicotine user is at an increased risk for serious complications and risks following your procedure, like a delay in the bone recovery required for fusion surgery and wound infection.
It is wise to notify your doctor about your tobacco usage before the surgical procedure, so you and your doctor can determine your quitting plan.
You should stop taking specific supplements and medications, including diabetic, rheumatoid, blood thinners, hypertension, and osteoporosis medications. They can result in complications during the procedure.
Your medical care team should guide you on when to stop taking your medication and when to restart.
Adult Fasting Skin Preparation Guidelines Before Treatment
Start preoperative bathing as directed by the surgeon. The process will significantly reduce the chances of developing postoperative infections.
Avoid eating after midnight on the day of the medical procedure. On your surgery day, you can drink a clear liquid two (2) hours before arriving at the medical facility. The clear liquids can include the following:
- Apple juice without pulp.
However, you should stop drinking clear liquids at least six (6) hours before your surgery if you are:
- With end-stage kidney disease.
- A gastroparesis patient.
What to Carry and Wear to Your Surgery
Bringing essential items like toiletries and a bathrobe is advisable. Your medical facility can offer you a gown and towel.
Do not carry personal valuables like money, glasses, dentures, electronic devices, jewelry, or clothing. The healthcare provider is not liable for your belongings' loss or damage.
Put on loose, comfortable clothes. Avoid wearing jewelry like body piercings, earrings, and rings. You will remove them before surgery. Also, do not apply makeup or use oils, perfumes, or lotions.
You do not have to donate blood for advanced spine surgery. Nevertheless, you can experience blood loss during the treatment.
Your surgeon should discuss with you the benefits and disadvantages of using someone else’s blood versus donating your own. If you use your blood, the doctor will recommend taking iron supplements to increase your blood capacity before the treatment.
While you can walk home after your advanced spine surgery, you will need assistance with activities and chores, including shopping, laundry, grooming, cleaning, and washing. Before the surgery, make practical arrangements to get assistance for the first few weeks.
Your physician can recommend that you avoid operating your car or any machine for a specific duration. You should arrange transportation to work, school, or the medical facility in advance.
Find an Experienced Spine Surgeon Near Me
Sometimes surgery is the last resort, particularly if you suffer from spinal fractures, scoliosis, or a herniated disc. At Dr. George Rappard's facility, we use advanced spine surgery after non-surgical options fail and use minimally invasive techniques. We can also diagnose your spine issue and recommend the best surgical options to alleviate your spine and back pain based on your condition and symptoms. Our facility is a state-of-the-art practice where you can count on receiving compassionate treatment and comprehensive care unmatched by any Los Angeles clinic. Please contact us at 424-777-7463 to learn how we can help you.