Lumbar discectomy is one of the most common spine procedures performed today. After a small incision over the lumbar segment that has the herniation, a small opening is made in the bone of the spine (called a laminotomy). The spinal sac and nerve are visualized, gently retracted, then the disk herniation is located and removed.
Lumbar Laminotomy/foraminotomyand removed.
Bone spurs (ie spinal stenosis) can be removed by doing a laminotomy and foraminotomy. This involves resection of the medial lamina and the facet joint.
Laminectomy is a commonly performed procedure to treat spinal stenosis. The procedure involves resection of the spinous process, lamina, and medial (most midline portion) facet joints. In addition, foraminotomy is also performed. If required, a discectomy can be simultaneously done to treat a disk herniation. Laminectomy can also be done when spine tumors need to be removed. Although an excellent procedure to treatment of certain disorders, Laminectomy does carry the risk of facet injury and spinal instability.
Lumbar fusion means fusing across the disk space and facet joints of the lumbar (or thoracic) vertebra. Fusion across the disk space is accomplished by either a TLIF, XLIF, or PLIF approach. Then, instrumentation (titanium rods and pedicle screws) is inserted in order to stabilize the spine while the fusion heals over 2-3 months. Often the hardware can be inserted through a minimally invasive percutaneous approach as described in the attached animation of the Longitude pedicle screw system.
Direct lateral interbody fusion (DLIF)
DLIF or XLIF (Lateral Interbody Fusion) is another way to do a lumbar fusion. Instead of inserting a PEEK allograft via a posterior approach (like in TLIF or PLIF), the allograft is implanted laterally (through the right or left side of the disk space). After the discectomy and placement of the DLIF or XLIF graft, instrumentation is then usually put in (either via a lateral titanium plate or posterior pedicle screws).
Anterior lumbar interbody fusion (ALIF)
As opposed to TLIF and XLIF, ALIF fusions are done from the front (anterior through an abdominal incision). After making an incision at or below the belly button, the abdominal contents (intestine, ureters, iliac arteries and veins) are moved to the side and the disk space removed. Then, an allograft or autograft are inserted. Often a titanium plate and screws are then put in or posterior pedicle screws are inserted through another incision (a 360 degree fusion).
Posterior lumbar interbody fusion (PLIF)
Trans-Foraminal Interbody Fusion (TLIF) or Posterior Lumbar Interbody Fusion (PLIF) are both posterior methods to do a lumbar fusion. Both procedures require a laminotomy (or laminectomy), discectomy with subsequent insertion of an allograft (either cadaver or PEEK) and/or autograft (bone from the patient’s own body) into the disk space. Over time, the 2 lumbar segments fuse and become one segment. Instrumentation (usually titanium pedicle screws) is often inserted to help stabilize the segment while the fusion heals.
Artificial disk replacement
ADR is placed through an exposure similar to the ALIF. Instead of putting in a graft for fusion, an artificial disk is implanted. The two currently FDA approved ADRs are Charite and ProDisc. Both of these artificial disks have the potential to maintain motion at the implanted segment.
Kyphoplasty is a procedure used to treat painful fractures of the lumbar and thoracic spine. Typically, compression fractures are due to osteoporosis, but tumor induced fractures can also be treated using this procedure. The procedure is usually done as an outpatient and involves injection of PMMA cement into the fractured vertebral body. Vertebroplasty is a competing technology that also is used to treat similar fractures. However, many published studies have shown a lower rate (and hence safer profile) of cement leakage out of the injected vertebra with kyphoplasty.
Anterior cervical discectomy and fusion (ACDF)
Disk herniations of the cervical spine can be treated by either ACDF or posterior foraminotomy/discectomy. ACDF involves making an incision in the front of the neck, dissecting down to the spine, removing the entire disk and disk herniation, then fusing the disk space using allograft (either donated bone from a cadaver, PEEK, or titanium) or autograft (bone taken from patient’s own body).
Posterior cervical foraminotomy (PCF)
Foraminal stenosis in the cervical spine can be treated with an incision in the back of the neck then removing the bone spur compressing the nerve. A discectomy (removing the herniated portion of the disk) can also be performed. Typically a fusion is not performed. However, a fusion also can be done in selected circumstances.
Artificial disk replacement (ADR)
ADR has been approved for the lumbar spine and cervical spine. ADR is an alternative to fusion of the lumbar or cervical spine. However, only certain types of patients are candidates for this surgery.
Laminoplasty is also used to treat cervical stenosis with myelopathy. However, instead of discarding the lamina like done in Laminectomy, the lamina are re-attached to the spine using metal plates and mini-screws.
Laminectomy (removing the lamina of the spine) is done to decompress the central spinal canal. The procedure is most commonly performed to treat myelopathy due to spinal cord compression. Laminectomy can be accompanied by a fusion in selected cases.
Posterior cervical fusion
This procedure involves fusion of the facets of the cervical spine. Fusion is often done with instrumentation. Some type of decompression (laminectomy, foraminotomy) is typically performed with the fusion.