Spine procedures: cervical, lumbar and sacroiliac joint surgery, and interventional pain management

  • Minimally invasive
  • Motion preserving
  • Open procedures
A man seen from behind, holding the back of his neck
MIS

ACDFAnterior cervical discectomy and fusion

  • Pinched nerve
  • Spinal cord compression

Anterior Cervical Discectomy And Fusion. Using an approach from the front of the neck, we remove the herniated disc that is compressing your nerve or spinal cord. A spacer is then placed in between the bones where the disc used to be. Over time the two bones fuse together. Additional details about ACDF, anterior cervical discectomy and fusion

MIS

Cervical foraminotomy

  • Pinched nerve

Working from the back of the neck through a small tube, we widen the opening where the nerve leaves the spine to take the pressure off it. The disc is left in place and nothing is fused. Additional details about Cervical foraminotomy

MP

Cervical disc replacement

  • Pinched nerve
  • Spinal cord compression

Using the same approach from the front of the neck, we remove the damaged disc and take the pressure off the nerve or spinal cord. Instead of fusing the bones, we put in an artificial disc that lets the neck keep moving at that level. Not everyone is a candidate, and your imaging decides. Additional details about Cervical disc replacement

Pinched nerve

↑ Treated by the three above

Cervical radiculopathy

A disc or bone spur is pressing on a nerve where it leaves your neck. You may feel pain, tingling or weakness running down into your shoulder, arm or hand. Most cases get better without surgery.

Spinal cord compression

Cervical stenosis and myelopathy

The spinal canal in your neck has narrowed and is squeezing your spinal cord. You may notice clumsy hands, trouble with buttons or handwriting, or poor balance more than neck pain. The spinal cord recovers less well than a nerve, so timing matters.

MP

Cervical laminoplasty

  • Spinal cord compression

Working from the back of the neck, we hinge open the bony roof of the spinal canal to give the spinal cord more room across several levels. This procedure preserves the motion of the spine. It can be used in select cases. Additional details about Cervical laminoplasty

OPEN

Posterior cervical fusion

  • Spinal cord compression

Working from the back of the neck, we take the pressure off the spinal cord and hold several levels still with screws and rods. Over time the bones fuse together. We use it when the problem runs along much of the neck or the alignment needs correcting. Additional details about Posterior cervical fusion

  • Minimally invasive
  • Motion preserving
  • Open procedures
A man seen from behind, both hands pressed to his lower back
MIS

Microdiscectomy and laminectomy

  • Pinched nerve
  • Spinal stenosis

Through a small tube in the lower back, we remove the piece of disc or bone that is pressing on your nerve. The muscle is moved aside without being cut, and nothing is fused. This is the most common spine operation. Additional details about Microdiscectomy and laminectomy

MP

Lumbar disc replacement

  • Pinched nerve
  • Spinal stenosis

Using an approach from the front of the abdomen, we remove the worn disc and put in an artificial one that keeps the level moving. Very few people are candidates, and your imaging decides. Additional details about Lumbar disc replacement

MIS

MIS TLIF

  • Pinched nerve
  • Spinal stenosis
  • Instability

Minimally Invasive Transforaminal Lumbar Interbody Fusion. Through small incisions in the back, we take the pressure off the nerve and remove the worn disc. A spacer goes in where the disc used to be, and screws and rods hold the level still while the two bones fuse together. Additional details about MIS TLIF

Pinched nerve

Lumbar radiculopathy

A disc or bone spur is pressing on a nerve root in your lower back. You may feel pain, numbness or weakness running down your leg, often called sciatica. Most cases get better without surgery.

Spinal stenosis

Legs tire and ache on walking

The spinal canal in your lower back has narrowed and is crowding the nerves inside it. Your legs tire and ache after walking a short way, and feel better when you sit down or lean forward.

Instability – spondylolisthesis

Degenerative spondylolisthesis

One of the bones in your lower back has slipped forward on the one below. When we take the pressure off your nerves at that level, we usually fuse it too, because removing bone from an unstable level can make it worse.

OPEN

Multilevel laminectomy

  • Spinal stenosis

Working from the back, we remove the bone and thickened ligament that are crowding the nerves across three or more levels of the lower back. If the spine is stable, no fusion is needed. Additional details about Multilevel laminectomy

OPEN

Multilevel lumbar fusion

  • Pinched nerve
  • Spinal stenosis
  • Instability

Working from the back, we correct the alignment of the spine and fuse several levels together with screws and rods. We use it for deformity, for revising earlier surgery, and when the spine has lost its balance over the pelvis. We plan it on standing X-rays of the whole spine. Additional details about Multilevel lumbar fusion

MIS

Lateral lumbar fusion (XLIF / DLIF)

  • Pinched nerve
  • Spinal stenosis
  • Instability

Through a small incision in your side, we reach the spine and place a large spacer where the disc used to be. This restores the height of the disc and gives the nerves more room without entering the spinal canal. It cannot reach the lowest level, L5–S1. Additional details about Lateral lumbar fusion (XLIF / DLIF)

MIS

ALIFAnterior lumbar fusion

  • Pinched nerve
  • Spinal stenosis
  • Instability

Using an approach from the front of the abdomen, we remove the worn disc and place a large spacer between the bones, without touching the back muscles. Over time the two bones fuse together. It is the usual choice at L5–S1. Additional details about ALIF, anterior lumbar fusion

Who may benefit from a fusion

The two common reasons for fusion are an unstable spine, where the bones are sliding back and forth, or neuroforaminal stenosis, a type of nerve compression that occurs when nerves become entrapped as they exit the spine through a tunnel called the neural foramen. This is usually due to severe disc collapse.

  • Minimally invasive
The pelvis from behind, with both sacroiliac joints marked in red
A person seen from behind with both hands pressed to the base of the spine

SI joint injectionThe diagnostic block

  • Confirms Sacroiliac joint pain

Using X-ray guidance, we inject numbing medicine into the SI joint. If your pain goes away for a while, that confirms the joint is the source. Most insurers require this before a fusion. Additional details about SI joint injection, the diagnostic block

MIS

MIS SI joint fusion

  • Sacroiliac joint pain

Through a small incision on the side of the hip, we place implants across the SI joint to hold it still so it can fuse. We only consider it after an injection has confirmed the joint is the source and other treatments have been tried. Additional details about MIS SI joint fusion

Sacroiliac joint pain

Sacroiliitis, or disruption after an injury

The joint between your spine and pelvis is causing pain low in your back and off to one side, sometimes spreading into your groin or thigh. It is often worse getting out of a car, rolling over in bed or standing on one leg. It is easy to mistake for a lumbar spine problem, and it is common after a lumbar fusion that ends at the sacrum.

Diagnosing and treating sacroiliitis

First we examine the SI joint using a set of provocative maneuvers. If the physical exam is positive for sacroiliitis, then a diagnostic injection is the next step. If a numbing injection in your SI joint relieves your pain, this confirms that the SI joint is the source. If you fail multiple injections, then you may be a candidate for an SI joint fusion.

How the diagnosis is confirmed →

  • Minimally invasive
The lower spine from the side, with a needle guided to the joint at the back of one level

ESIEpidural steroid injection

  • Pinched nerve
  • Spinal stenosis

Using X-ray guidance, we inject steroid medicine next to the irritated nerve to calm the inflammation. There is no incision. It can relieve the pain and helps confirm which level is causing it. Additional details about ESI, epidural steroid injection

RFARadiofrequency ablation

  • Degenerative back pain

Using X-ray guidance, we use heat to turn off the small nerves that carry pain from worn facet joints in the back. We first confirm those joints are the source with a numbing test injection. Additional details about RFA, radiofrequency ablation

MIS

BVNBasivertebral nerve ablation

  • Vertebrogenic back pain

Through a small needle in the back, we use heat to turn off the nerve inside the vertebra that carries this type of back pain. Nothing is removed or fused. Whether it is right for you depends on specific changes seen on your MRI. Additional details about BVN, basivertebral nerve ablation

Spinal Injections and Ablations

An epidural steroid injection (ESI) involves injecting anti-inflammatory medicine (steroids) around a pinched or irritated nerve to help relieve leg pain. Radiofrequency ablation (RFA) helps relieve back pain by using heat to turn off small sensory nerves that innervate the spinal facet joints. Basivertebral nerve ablation (BVN), known as Intracept, targets the sensory nerves that travel to the vertebral endplates next to degenerative discs, which is another common cause of back pain. Intracept is a permanent solution that does not need to be repeated.