Dr Kenneth P Burres says....

Spinal Procedure

What it is intended to be used for

Expectations-- good and bad

Lumbar Laminectomy

Complete decompression of that portion of the spine-- unroofing so to speak

This is a procedure that goes back to the 1890s when surgeons would do this to explore the inside of the spine. Significant downsides include future instability, long rehab, and too much surgery

Lumbar Discectomy

Initiated in 1938, this spinal surgery is “oldish” and utilizes standard spinal instrumentation to remove a disk

This is an older technique and often includes stabilizing elements setting up the patient for more surgery, later-- especially a fusion

Lumbar Laminectomy with Posterolateral Fusion

The aim is nerve root and more decompression`

This operation has been around since the 1940s and especially popular in the 1950s and 50s; it may or not include instrumentation and was fairly successful. Problems included instability later including more disc levels.

Disc replacement with a synthetic device

Removal of a pathological disc through the abdomen and insertion of a disc device (ProDisc, Charitie, others)

This operation is formidable and has a long list of complications

Disadvantages

1. It is not a disc replacement but a version of a fusion with instrumentation in the disc space
2. This replacement is NOT natural and will need to be replaced in the future like a hip replacement
3. Confines the patient to a sedentary life for the most part
4. Now available for cervical and lumbar
5. A lot of surgery for a simple disc problem

Lumbar spinous process spreader device for stenosis

The devices attempts to reduce stenosis by spreading the interlaminar space.

Very controversial and simplistic approach that leaves a lot of pathology behind. Is this a fusion-like device under another name?

Lumbar Laminectomy with Anterior AND Posterior Fusion (360)

Stabilization of one or more spinal segments via two operations-- through the abdomen fusing in the disc space and another surgery through the back with or without hardware to FURTHER stabilize those segments

This is a huge surgery attempting to fuse the front and back of the spine reducing the chance of a failure or ANY instability at those segments. Problems include the scale of the surgery for a disc herniation. Seeming overkill

Lumbar MicroDiscectomy

Lumbar discectomy as described above but using the microscope for the discectomy portion.

A refinement of lumbar discectomy using the microscope and micro-instruments for disc removal. Problem was inadequate removal of the offending disc.

Posterior Lumbar Interbody Fusion (PLIF)

Invented by Ralph Cloward MD, a famous neurosurgeon, this procedure involved removal of a disc and replacement with bone blocks that would later fuse across the disc space

This is not an easy procedure to master and the problem of shifting bone blocks complicating the outcome. If fusion occurs, the problem is above and below the PLIF level-- more disc herniations, etc

Cage fixation spinal fusion

removal of a disc and replacement of the disc with a titanium cage filled with bone-- usually two cages per level

Plagued by low fusion rates and hence instability, cage fixation is not a commonly recommended solution

Anterior trans-abdominal Lumbar Interbody Fusion (ALIF)

Removal of a disc through the abdomen and fusion across the disc space done from in front of the spine. Usually includes a plate fixator

Plagued by low fusion rates, ALIF also suffers from a problem getting to the herniation around and into the disc space. The fusion rate is usually low thus creating instability.

Trans-thoracic thoracic discectomy

An operation through the chest to remove a thoracic disc herniation or bulge

A huge operation pushing the lungs aside and into the front of the thoracic spine and for a small disc problem. Plagued by complications in a lengthy operation

Anterior cervical discectomy with fusion

A standard operation invented by Ralph Cloward MD in the 40s. It involves removal of the disc and replacement with a bone dowel or plug. Instrumention is often utilized to increase the fusion rate

A :gold standard” operation for decades. Done properly it is usually successful, but creates accelerated degeneration at levels above and below the fused level, including arthritic changes, disc problems, more

Posterior cervical discectomy with partial laminectomy and possible fusion

A operation through the back of the neck including removal of part of the roof of the spine followed by spinal fusion of that segment(s)

A fairly painful operation moving the muscles at the back of spine resulting in a segment that is stable and creating problems above and below that

Thoracic costotransvesectomy for thoracic disc

This exposure and surgery involves removing part of the rib and nearby boney structures to decompress the nerve and nearby disc

Done as originally described, this is a fairly extensive surgery and has many possible complications including pneumothorax, extensive bleeding, and instability

Implantation of a Dorsal Column Stimulator {DCS)

Usually for failed surgeries ONLY-- involves implantation of electrodes on the spinal dura and attached to an implanted computer pack programmed to block pain impulses in the spinal cord

Very expensive and only 60% effective. It may be the only thing to offer a patient who has failed “usual” spine surgery. When implanted it is expected to be lifelong. 

Implantation of a Morphine Pump or other drug delivering pumps

This is a temporizing measure that treats symptoms only and not actual probems

Very expensive and requires life-long maintenance. Often fails at 2 years. It is only 60% effective in large studies.