Treatments - Crozer-Keystone Health System - PA

Treatments

Crozer-Keystone's board-certified neurosurgeons perform the following procedures, most of which can be performed with minimally invasive and image guided techniques.

Artificial Disc Replacement

An alternative to spinal fusion surgery, artificial disc replacement is a procedure that involves replacing a painful disc that is causing chronic back pain with an artificial disc that provides pain relief without compromising the spine's natural anatomical structure. Artificial disc replacement surgery may be performed on the lower back (lumbar spine) or the neck (cervical spine). Artificial discs are structurally similar to the damaged discs that are replaced and share similar functions, including acting as shock absorbers in the back or neck.

Cervical Disc Replacement Surgery

During cervical disc replacement surgery, the affected disc is completely removed, including any impinging bone spurs. The disc space is increased to its prior normal disc height to help relieve pressure on the nerves. Using X-rays or fluoroscopy, the artificial disc is implanted into the prepared disc space. Typically, patients can go home within 24 to 48 hours with minimal activity limitations. 

Cervical Spondylosis Surgery

If cervical spondylosis compresses the spinal cord or nerve roots, this may cause neurological problems and deterioration. To treat this problem, surgery is performed to remove compression from the nerve tissue (spinal cord and/or nerve roots) and to stabilize the cervical spine. After relieving the spinal cord and/or nerve compression, the spine is reconstructed by placing bone between the involved vertebra and performing a spinal fusion. Special implants may also be placed to restore the stability of the spinal column and to help heal the spinal fusion.

Discectomy/Partial Discectomy

Surgery is performed to stop a herniated disc from pressing on and irritating the nerves, which causes pain and weakness. The most common procedure is called a discectomy or partial discectomy, in which part of the herniated disc is removed. 

Discectomy can be done under either local, spinal or general anesthesia. The patient lies face down on the operating table, generally in a kneeling position. A small incision is made in the skin over the herniated disc and the muscles over the spine are pulled back from the bone. A small amount of bone may be removed so the surgeon can see the compressed nerve. The herniated disc and any loose pieces are removed until they are no longer pressing on the nerve. Any bone spurs are also removed so that the nerve is free of pressure.

Fusion for Cervical, Thoracic and Lumbar Spine Trauma

Fusion is a surgical technique in which one or more of the vertebrae of the spine are fused together so that motion no longer occurs between them. During spinal fusion surgery, bone grafts are placed around the spine. The body then heals the grafts over several months,which joins the vertebrae together.

Cervical Spinal Fusion: If conservative treatments fail to control pain, a neurosurgeon may recommend a cervical fusion. There are two types of cervical fusion procedures:

Anterior cervical fusion is performed through an incision in the front of the neck. This technique is used to:

  • Remove pressure from nerve roots or the spinal cord caused by bone spurs or a herniated disc
  • Stop the motion between two or more vertebrae

Removing pressure from the nerve roots or spinal cord can ease arm pain. Problems from pressure on the nerves, such as numbness or weakness in the arm or difficulty walking, may also improve. Fusion of the problem vertebrae reduces mechanical pain caused from too much motion in the spinal segment.

Posterior cervical fusion is performed through an incision in the back of the neck. This technique is used to:

  • Stop the motion between two or more vertebrae
  • Restore the normal curve of the cervical spine and keep a spinal deformity from getting worse
  • Stabilize the spine after a fracture or dislocation of the cervical spine

Thoracic Fusion: In some cases, neurosurgeons may perform thoracic fusions using minimally-invasive surgery.

In a conventional thoracic spinal fusion procedure, surgeons must often perform a thoracotomy, or incision into the chest wall, then remove a rib to reach the spine for operative repair. The thoracotomy sometimes requires an incision up to 20 inches long. Using minimally-invasive techniques, surgeons can completely skip the thoracotomy and rib removal, instead performing their surgery through small incisions. Using a tiny, high-tech endoscopic camera, they can view the surgical site on a high-resolution television monitor, while doing their work with long-handled instruments. Using small incisions instead of big ones offers another benefit to the patient, small scars only, and better outcomes.

Minimally invasive surgery may not be ideal for all patients, so be sure to discuss this option with your neurosurgeon.

Lumbar Fusion: A lumbar fusion is major surgery, which requires the use of screws that are placed between the vertebrae to be fused. The bone graft is then placed around these. The screws that are used during this operation are made of titanium, and usually stay in for life.

Lumbar fusions involve greater risks than simple laminectomies or discectomies. Recovery is longer after this procedure. However, most patients undergoing this operation do well. Since these are longer operations, there is more blood loss and blood transfusion is sometimes required. The risks of general complications are slightly higher than those for a simple laminectomy. Typical operating time can be anywhere from four to eight hours. Every operation is different. Most patients note that the first week after surgery is difficult, but by six weeks and 12 weeks after surgery most are very glad they had the surgery done.

Herniated Cervical Disc Surgery

Surgery should be considered when compression of the spinal cord causes spinal cord dysfunction since these symptoms can become permanent. Symptoms may include decreased balance, difficulty walking, feeling of clumsiness in the legs, loss of coordination and fine movement skill of the hands, and problems with urination.

Surgical treatment for herniated cervical discs varies according to the severity of the injury. One method is known as a foraminotomy and microdiskectomy. It involves the open removal of the part of the herniated disc that puts pressure on the nerve root. The entire disc is not removed.  This is usually an outpatient procedure, meaning that the patients usually goes home the same day of surgery.

The most common surgical method used to treat a cervical disc herniation is known as anterior cervical decompression and fusion. Like a foraminotomy and microdiskectomy, this operation involves an open incision, dissection of muscle and tissue. Unlike a foraminotomy and microdiskectomy, this procedure involves removal of the entire disc, placement of a bone graft, plate and screws. This procedure results in a fusion at the involved level of the cervical spine. Many patients may be up walking the same evening or the next morning after surgery. Most patients stay overnight in the hospital and then go home the next day.

Kyphoplasty

Kyphoplasty is an outpatient procedure used to treat painful compression fractures in the spine. In a compression fracture, all or part of a spine bone collapses.

A common cause of compression fractures of the spine is thinning of your bones, or osteoporosis. Your doctor may recommend kyphoplasty if you have severe and disabling pain for two months or more that does not get better with bed rest, pain medicines, and physical therapy.

During surgery, you may have local anesthesia  or general anesthesia. You lie face down on a table and a healthcare provider applies medicine to numb the area. The neurosurgeon places a needle through the skin into the spine bone. Real-time x-ray images guide the neurosurgeon to the correct area of your back. A balloon is placed through the needle, into the bone and then inflates. This restores the height of the vertebrae. Cement is then injected into the space to make sure it does not collapse again.

Kyphosis Surgery

Spinal instrumentation and fusion are surgical procedures that may be used to correct spinal deformity and to permanently stabilize the spinal column. These procedures join and solidify the level where a part of the spine has been damaged or removed (e.g. intervertebral disc). Medically designed hardware such as rods, bars, wires, and screws hold the spine straight during fusion.

Lumbar Laminectomy

Lumbar laminectomy is a surgical procedure performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. Stenosis occurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs form. Spondylolisthesis (the slipping of one vertebra onto another) can also lead to compression.

The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.

Lumbar Micro Discectomy

Lumbar micro discectomy is an operation on the lumbar spine performed using a surgical microscope and microsurgical techniques. A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc which is "pinching" one or more spinal nerve roots. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery. In fact, many patients go home on the same day as surgery.

Lumbar microdiscectomy surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:

  • Leg pain which limits your normal daily activities
  • Weakness in your leg(s) or feet
  • Numbness in your extremities
  • Impaired bowel and/or bladder function

Minimally Invasive Spine Surgery

Many spinal disorders can now be corrected with minimally invasive spinal surgery.

Minimally invasive spinal surgery is a collection of surgical techniques that allows the spinal problem to be corrected using small surgical incisions. Compared to traditional spine surgery, minimally invasive spinal procedures are less damaging to the muscles and other soft tissues around the spine. Also, a quicker recovery from surgery is anticipated with minimally invasive surgery. Other advantages of minimally invasive spinal surgery include less bleeding, shorter hospital stay and a lower rate of postoperative infection compared to traditional spinal surgery.

Minimally Invasive Spinal Surgery Techniques

Minimally invasive spinal procedures may be done with general, spinal, or local anesthesia depending on the specific type of surgery being performed. Many minimally invasive spinal procedures can be performed in an outpatient setting while more complex minimally invasive operations may require postoperative hospitalization.

During minimally invasive surgery, small incisions are made to perform the surgical procedures. To perform spinal surgery through a small incision, the surgeon must use special equipment that is not routinely used with traditional spinal surgery. To access the spine through a small incision, the minimally invasive spinal specialist uses a specialized tubular retractor or port to access the spine.

Neuro-oncology

Neuro-oncology is the treatment of cancers of the brain and nervous system. Crozer-Keystone's team of experienced, skilled and dedicated physicians take a multi-disciplinary approach to treating neurological cancers. Our team of oncologists, neurosurgeons and psychologists treat brain and spine tumors, meningiomas, glioma and glioblastoma multiforme, including astrocytoma, oligodendroglioma, and ependymoma, as well as brain or spinal cord tumors brought on by lymphoma, acoustic neuroma, and secondary tumors of the brain. In addition, tumors in the pituitary region, including pituitary macroadenoma, pituitary microadenoma, Rathke's Cleft cycs, and craniopharyngioma are also treated.  Most tumor surgeries are performed with minimally invasive techniques.

Peripheral Nerve Surgery

Peripheral nerves are the nerves outside your brain and spinal cord. Peripheral nerve disorders interrupt the messages traveling between the brain and the rest of the body. Peripheral nerve surgery is performed to relieve the symptoms of conditions of the nervous system such as carpal tunnel syndrome, ulnar neuropathy and peripheral nerve tumors.

Shunt Insertion for Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus (NPH) is the abnormal buildup of cerebralspinal fluid in the ventricles or cavities of the brain. NPH occurs when the flow of CSF in the brain and spine are blocked, causing swelling in the brain. The treatment is to surgically insert a shunt in the brain to drain the excess fluid into the abdomen, where the fluid can be absorbed naturally into the circulatory or blood system.

Spinal Fusion

See Fusion for Cervical, Thoracic and Lumbar  Spine Trauma above.

Spinal Tumors Surgery

See Neuro-oncology

Treatment of Syringomyelia

Syringomyelia is a disorder that causes a cyst to form in the spinal cord. Over time, the cyst gets bigger and longer and damages the spinal cord. Syringomyelia may result from a skull abnormality called  a Chiari malformation. A tumor, meningitis or trauma may also cause syringomyelia. Surgery is the main treatment for this condition, although some people also need to have the cyst drained.