Lumbar Spine

 

Electrothermal Surgery

Intradiscal Electrothermal Therapy (IDET) is a minimally invasive procedure for treatment of contained lumbar herniated discs with annular disruption. IDET is a minimally invasive procedure, which uses a heated catheter in attempts to stabilize a painful disc and disable the associated nerve. This is performed to alleviate the effects of low back pain caused by diseased or small herniations of discs. During this treatment, the physician applies controlled levels of thermal energy (heat) to a broad section of the affected disc wall. This heat contracts and thickens the collagen of the disc wall.

 

Lumbar Microdiscectomy

This surgery is a procedure performed with a small incision and a microscope to remove a herniated nucleus pulposus.

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Pedicle Screw Instrumentation

Pedicle screw instrumentation is the use of internally implanted instrumentation, which is screws, into the pedicles to anchor to the vertebra. They are usually connected by a rod device used to stabilize the spine for all different types of surgical procedures including trauma and fusion procedures.

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Laminectomy

The surgical removal of bone from the back of a vertebra to free the nerves. It allows the surgeon to visualize and free the nerve from behind and to reach the area where the disc is pinching the nerves.

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Lumbar Disc Replacement

The aim of lumbar total disc replacement is to preserve motion in the lumbar spine. It can be considered for patients with low back pain as an alternative to spinal fusion. Currently, one lumbar disc replacement is available and this is the Charité disc distributed by DePuy. The Charité disc is a three-piece disc that has been approved in places in this country since October 2004. We expect the ProDisc®, which is a two-piece disc distributed by Synthes, to be released very soon.

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lumbarfusion

Posterior Lumbar Interbody Fusion with pedicle screws for a Grade 2 spondylolithesis

Anterior Lumbar Interbody Spinal Fusion

This procedure is performed via an incision in a patient's abdomen. The vertebral bodies are approached from the front and a femoral ring (cadaver bone), or cylindrical cage is placed between the two vertebral bodies. The femoral ring or cage instrumentation is filled with bone graft. The bone graft may be obtained from the patient or in the form of bone morphogenic protein to stimulate fusion. Interbody fusion may well be supplemented by a posterior fixation procedure performed at the same time.

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Posterior Lumbar Interbody Fusion

 

It is performed by an incision made posteriorly in the lumbar spine. The posterior lumbar interbody fusion involves placing bone in the interbody between the nerves as well as placing bone on the transverse processes laterally. In a patient with significant scarring, a Transforaminal Lumbar Interbody Fusion may be performed to avoid scar with a similar posterior lateral fusion also involved. It is rare, at this time, to take iliac crest bone graft for a posterior lumbar interbody fusion procedure.

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Direct Lateral Interbody Fusion

The direct lateral approach has been used for many years to approach the spine. Early on, this approach had significant complications because in the lumbar area, it involved going directly through the iliopsoas musculature. This would injure the ilioinguinal nerve and produce thigh weakness with direct iliopsoas muscle damage. The procedure has become popular again due to the fact that it can now be performed through two small incisions with the initial probe containing a nerve monitor to protect from muscle and nerve damage. It allows a direct lateral approach to the spine through two small 1" incisions and removal of the disc or in some cases, possibly a failed total disc replacement. This procedure is not lengthy and has minimal blood loss and much quicker recovery than any other anterior type approach to the lumbar or thoracic spine.

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