New Jersey Spinal Medicine & Surgery

Leader in Minimally Invasive Spine Surgery Led by Dante Implicito, M.D., F.A.A.O.S.

Dante A. Implicito, M.D., F.A.A.O.S.

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Conditions
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Herniated Disc
A Herniated Disc (also known as a Bulging Disc) occurs when a disc in the cervical or lumbar spine ruptures. Soft material from inside the disc can form a bulge that presses against the spinal cord and nerve roots, causing pain in the neck, back, arms or legs.
Spinal discs are the durable, elastic pads that act as shock absorbers for the vertebrae. They cushion the vertebrae and allow the spine to twist and bend. Each disk has a tough, fibrous outer wall and a softer inner nucleus.

Symptoms:
Depending on the location of the herniation a variety of symptoms can occur. If the herniation is located in the cervical spine it can cause sharp pain in the neck and shoulders. Also, pain, numbness or tingling can be felt down the shoulders and into the arms and hands.
If the herniation is located in the lumbar spine it can cause pain through the mid and lower back. Also, pain, numbness or tingling can be felt into the buttocks, legs, and feet. In severe cases, bowel or bladder dysfunction may occur. If this thus has occurred, consult a physician immediately.

Causes:
A herniated disc can be caused by the normal wear and tear of aging, or it can be caused by traumatic injury to the spine. Those whose lifestyle includes repetitive movements and heavy lifting are susceptible to disc herniations. Typically, small cracks or tears form in the discs outer wall resulting in a weak spot.

A herniation occurs when the nucleus of the disc pushes through the weakened disc wall. The bulging disc material can push into the spinal canal, pressing against the spinal cord and nerve roots.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Degenerative Disc Disease (DDD)
Degenerative Disc Disease (DDD) is a broad term describing the normal changes that affect a person’s spinal discs. These changes take place and develop in everyone, to some degree. It is not necessarily a disease, but a medical condition in which the discs of the spine have deteriorated due to age, genetics, trauma or injury to the back.

Degenerative Disc Disease is a weakening of one or more vertebral discs, which normally act as a cushion or “shock absorber” between the bones of the spinal column. This condition can develop as a natural part of the aging process. A loss of water absorption and proteoglycan (molecules in the body that attract water) as the body ages can cause damage to the center of discs (the pulpous) resulting in inflexibility or rigidness. When the vertebral discs are unable to act as a cushion, the center collapses, resulting in damaged vertebrae above and below the damaged disc. This improper alignment causes the facet joints (the areas where the vertebral bones touch) to twist into an unnatural position. Frequently, patients describe a “grinding bone-on-bone” feeling. In time, this awkward positioning of the vertebrae may create bone spurs. If these spurs grow into the spinal canal, they may pinch the spinal cord and nerves (a condition called Spinal Stenosis).

Degenerative Disc Disease generally begins when small tears appear in a damaged disc wall, called the annulus. These tears can cause pain. As the tears heal, the scar tissue created is not as strong as the original disc wall. If the back is repeatedly injured, the process of tearing and scarring may continue, weakening the disc wall further.

Symptoms:
Degenerative Disc Disease may result in neck or back pain. There are some common symptoms that are fairly consistent in people with degenerative disc disease, including arm pain or low back or leg pain. The site of the injury may be painful, and may severe or constant. It is possible for people to feel different degrees of severity of pain, but it tends to come and go. Bending, twisting and sitting may make the pain worse, whereas lying down seems to relieve the pressure on the spine.

Some people experience pain, numbness or tingling in the arms or legs due to compression of the nerve roots. Patients who are diagnosed with nerve root damage can experience lower extremity weakness and symptoms of Sciatica.

Causes:
The cause of DDD is typically the normal wear and tear that occurs in the discs as a person ages. However, it can also be caused by injury or repetitive lifting. The affected disc becomes thinner and loses its cushioning ability. These changes affect the way the vertebrae in the spine move and bone spurs can result as well as bulging or disc leakage and spondylitis, all of which can cause pain when they contact the spinal nerves. Smoking, obesity, heavy lifting, and hereditary factors also lead to advanced degeneration.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Kyphosis
Kyphosis is characterized by a misshaping of the spine and often appears as a curve or “hump” in the spine. This unnatural curving of the spine is a deformation caused by disease or damage to the vertebrae.

Symptoms:
In most instances, the only symptom may be the appearance of a hump in the upper back. If the kyphosis is severe enough, the person may have pain or aching in the neck or lower back.

Causes:
Kyphosis can have several causes. In some instances, bad posture can loosen the spine’s ligaments over time causing a curve to develop. Also, disease or physical trauma to the bones of the spine can weaken resulting in collapse the vertebrae. Diseases that often contribute to Kyphosis include Osteoporosis, Scheuermann’s Disease, Pott’s Disease or Spinal Tumors.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Pinched Nerve
A Pinched Nerve in the spine is often the result of another underlying spinal condition. Spinal nerves become entrapped or “pinched” after they are compressed by another part of the spine.

Symptoms:
Pain associated with pinched nerves often manifests as sharp localized pain in the neck or lower back.

This pain may also extend down into the extremities causing radicular pain. Sudden movements or certain positions may increase this pain.

Causes:
Some of the most common causes of pinched nerves in the spine include:

  • Herniated Discs
  • Spinal Stenosis
  • Osteoarthritis
  • Bone Spurs

Pinched nerves in the spine are often a common cause of Sciatica, as well.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Radiculopathy
Radiculopathy is a word often used to describe the pain that radiates through the extremities or muscles in the spine. Radiculopathy itself is not a spinal condition but rather the result of another underlying spinal condition. Radiculopathy is classified into two categories- cervical and lumbar.

Cervical Radiculopathy is damage or irritation to the nerve roots between the vertebrae in the cervical spine (neck). Injury of the nerve roots may cause the vertebral bones above and below to touch, pinching the nerve root, which results in chronic pain in the cervical spine, shoulders, arms or fingers.

Lumbar Radiculopathy (Sciatica) is damage or irritation to the nerve roots between the vertebrae in the lower spine. Injury of the nerve roots may cause the vertebral bones above and below to touch, pinching the nerve root, which results in chronic pain in the lower back and legs.

Inflammation of a nerve or the compression of nerve roots can lead to numbness or tingling, and over time, pain associated with this condition usually increases in frequency and severity.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Sacroilitis
Sacroilitis is an inflammation of one or both of the sacroiliac joints. The Sacroiliac Joints are the mechanisms that connect your lumbar spine to your pelvis. Sacroilitis often manifests as pain in your lower back and into your buttocks and hips. In some cases, this pain may radiate down one or both legs. This pain is often more noticeable after a period of standing or after routines that utilize the hips, such as walking, climbing stairs or rising from a sitting position.

Symptoms:
The pain that is often associated with Sacroilitis is confined to the lumbar spine region and the buttocks. However, this pain can also be transmitted through the legs, groin and, in some cases, the feet. Sacroilitis pain can be aggravated by:

  • Prolonged standing
  • Bearing weight more on one leg than the other
  • Stair climbing
  • Running or jogging
  • Awkward postures

Causes:
Sacroilitis is prevalent in many athletes and those who engage in repetitively concussive activities. The strain and repetitive impact on these joints often cause inflammation and deterioration. As the joint is impacted more and more the deterioration of the joint begins to cause pain and inflammation. It is also common in those with pre-existing arthritis of the joints or spine.

Another common cause is pregnancy. The Sacroiliac Joints must loosen and stretch to accommodate childbirth. The added weight and altered pronation during pregnancy can cause additional stress on these joints and can lead to increased deterioration. In other cases, women who have had a child have Sacroiliac Joints that never return to their natural position. This unnatural positioning creates stress on the joints and accelerates the degenerative process.

If you, or someone you love, has been suffering from neck or back pain for more than 30 days New Jersey Spinal Medicine and Surgery can help! Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle!

Sciatica
Sciatica describes an irritation of the sciatic nerve, which is the largest single nerve in the human body. The Sciatic Nerve begins from several nerves in the lower lumbar vertebrae and the sacrum at the bottom of the spine. These nerves combine to form the Sciatic Nerve, which travels through the buttocks and down each leg. Sciatic Nerve irritation can result from compression of the Sciatic Nerve roots or from inflammation.

Symptoms:
The primary symptom of Sciatic Nerve irritation is pain felt in the lower back or buttocks that travels down one leg, frequently to the foot. The pain can vary from a mild ache to a sharp, shooting pain and may sometimes feel like an electric jolt traveling down the leg. Muscular weakness, numbness or a tingling sensation down the leg and into the foot may also be symptoms. Pain in the leg is usually worse when sitting.

Causes:
Sciatica can be caused by a variety of conditions that cause inflammation or pressure on the nerve roots connected to the Sciatic Nerve. The most frequent cause of Sciatica is the degeneration and rupture of a lumbar disc. The ruptured disc may herniate and push against a nerve, causing pain in the low back, leg, or both. Occasionally, trauma or an episode of heavy lifting causes sudden rupture of the disc and symptoms. Sudden twisting can also cause herniations.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Scoliosis
Scoliosis is an abnormal curvature of the spine and a condition known as “Idiopathic Scoliosis” is most common in young adolescents. This form of Scoliosis sometimes progresses slowly and may not be detected until a person is an adult. Scoliosis has a genetic component and frequently runs in families. Certain neuromuscular disorders such as Muscular Dystrophy can also cause Scoliosis. Additionally, Asymmetric Degeneration of the discs between vertebrae can cause Scoliosis, particularly in adults.

Symptoms:
A typical spine, viewed from the side, has an elongated S-shape with the upper back curved outward and the lower back curved inward. The principal symptom of Scoliosis is an abnormal curvature viewed from behind, most frequently in the upper back. One hip may be higher than the other, the shoulders and hips may be uneven, and one shoulder blade frequently appears more prominent than the other. The spine may also be rotated in from its normal position, causing the ribs on one side to be more prominent. The extensive curvature may cause back pain, breathing problems, and severe deformity.

Causes:
The cause of Idiopathic Scoliosis is unknown, but a family history of Scoliosis increases the risk. Adult onset Scoliosis is typically caused by Asymmetric Disc Degeneration where one side of the spine experiences degenerative conditions more than the other.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Spinal Fractures
A Spinal Fracture or Spinal Trauma is often the result of a physical injury to the spine. A sudden fall or injury can lead to a compression of one or more vertebrae and/or injury to the spinal cord or nerves. Spinal Fractures are often seen in slip and fall accidents, motor vehicle accidents and traumatic sports injuries. Another common cause of a Spinal Fracture is weakened vertebrae as a result of Osteoporosis.

Symptoms:
The most common symptom of Spinal Trauma is the sudden onset of pain following a traumatic episode or sudden injury. In many cases, the fractured bone is pushed into the spinal canal or spinal cord and begins to damage the nerves. This damage manifests as sharp pain, weakness, burning, tingling or paralysis in the area of the injury and/or extremities.

Causes:
Spinal Trauma is typically caused by a violent force applied to the spine. This sudden force can exert an extreme directional force onto the vertebrae causing them to fracture. Spinal Fractures may occur anywhere along the spine but are most common in the middle and lower back. The sudden onset of back pain following an injury is suspicious for a fracture. Treatment of Spine Fractures will depend on the symptoms and extent of the damage.

Those who suffer from Osteoporosis or bone density conditions are also at a higher risk for Spinal Fractures. As our bones lose density they become more porous and thus, more brittle. This decreased density means less force is required to damage the vertebrae and cause fractures.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Spinal Stenosis
Spinal Stenosis is the narrowing of the spaces in the spine, caused by a deficiency of the spinal canal. The spaces of the spine included three main areas: the center of the spine, in which the spinal cord passes through, the spinal canals, in which the nerves branch out and the spaces between the vertebrae. When the nerves or spinal cord are compressed, they can become inflamed, causing Spinal Stenosis related symptoms.

The narrowing of these spaces occurs when:

  • Pressure is placed on the spinal cord or nerves
  • The tissue becomes thick or hardened
  • Bones or joints grow
  • Bone spurs develop

Most cases of Spinal Stenosis occur in the lumbar (lower back) region of the spine, but can also affect the cervical (neck), as well. When Spinal Stenosis of the thoracic (mid-back) region is affected, it is almost always in conjunction with Lumbar Stenosis.

Although Spinal Stenosis is a condition that can occur congenitally (at birth), due to an abnormally formed spine, it is usually due to the aging process as well as everyday activities. As we age, our ligaments thicken and calcify, thus creating a narrower opening for the nerves and spinal cord.

Statistics show that Spinal Stenosis is most common in men and women over the age of 50 unless it has occurred at birth, by trauma or as a result of the growth of a tumor.

Symptoms:
A patient with Spinal Stenosis may or may not show signs/symptoms for many years. The symptoms of Spinal Stenosis can vary, depending on a person’s pain tolerance, the severity of the condition and where the narrowing is located along the spine. As the narrowing between the spaces of the spine become more confined, symptoms may begin to present themselves, initially with small amounts of pain that a person would normally brush off as common back pain, while treating the pain with anti-inflammatories. After days/weeks/months pass, the area may become more narrow due to the aging process and daily activities, and their pain may increase due to irritation or inflammation of the nerves and can result in a person experiencing stenosis symptoms when standing or walking. Cervical Stenosis pain can affect the neck, arms or hands as well as hand coordination. Lumbar Spinal Stenosis pain can radiate from the lower back to the buttocks, leg and/or foot of the affected side of the body, as well as affect a person’s balance and ability to walk.

Causes:
There may be several causes of Spinal Stenosis and, although the leading cause is due to the normal aging process or injury to the spine from an accident, there are several other factors that can contribute to this condition.

The most common causes of spinal stenosis are:

  • Osteoarthritis: Also known as degenerative joint disorder, osteoarthritis is the most common, disabling, painful joint disorder. It is the wearing out of the joints and affects approximately 30 million Americans, mostly women.
  • Rheumatoid Arthritis: An autoimmune disease, which leads to severe damage of the joints. Most common in the cervical (neck) region of the spine.
  • Degenerative Disc Disease: One of the most common causes of lower back pain, Degenerative Disc Disease is a condition caused by the loss of cushioning between the vertebrae, due the breakdown on inter vertebral discs. The discs become stiff and rigid, causing movement to be limited. Degenerative Disc Disease is usually age/injury related, progressing gradually and often leads to loss of function unless diagnosed and treated properly.
  • Paget’s Disease: The abnormal wear of bone tissue followed by abnormal bone growth, such as bone spurs. The vertebrae are the second most commonly affected area of the body.
  • Trauma: Results caused by vehicle accidents, sports injuries or falls. These external forces can create nerve compression and symptoms of sciatica.
  • Tumors: In rare instances, abnormal growths can develop, causing compression of the sciatic nerve.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Spondylolisthesis
Spondylolisthesis is a condition that occurs when one vertebra of the spine slips forward over another vertebra above or below it. It can occur anywhere along the spine but is most often seen in the Lumbar Spine.

Symptoms:
Symptoms resulting from Spondylolisthesis can be varied depending upon the location of the injury. The most common symptom is a pain in the area of the injury. If the forward slippage causes a compression of a nerve root the nerve can become inflamed and irritated. This will result in pain the lumbar or cervical spine and leg pain or arm pain. In the more advanced cases, a deformity may become visible as the curvature of the spine is increased. This often results in more complex problems such as mobility and breathing.

Causes:
Spondylolisthesis can be caused by several factors. The majority of cases occur when the joints that allow the spine to bend forward (facet joints) wear over time and with age causing them to become weaker. This weakness will allow one vertebra to slip over another.

In other cases, subjecting to the spine to a sudden or repeated force may cause Spondylolisthesis. Adolescent athletes that perform repetitive hyperextension may be at increased risk for Spondylolisthesis. Furthermore, athletes whose sport requires shock absorption by the legs and feet may also develop this condition. Those involved in gymnastics, cheerleading and other acrobatics often have a higher risk for this injury.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Spondylosis
Spondylosis is a term that describes a reduction in the space between two spinal discs. This decreased space often leads to the exiting nerve root becoming irritated or impinged. In more severe cases, the shock absorbing inter vertebral discs will completely wear away causing bone on bone contact. This can often lead to spinal fractures and bone spurs.

Causes:
The intervertebral discs between the spinal vertebrae serve as the shock absorbers of the spine. These discs absorb the heavy loads our bodies demand of our spine. These discs are composed of mostly water and a gelatinous protein. In many instances, these discs can wear out or become desiccated (dry out) and become incapable of performing their functions.

Spondylosis is very common and can also be a result of the aging process. Studies also show that there may be a genetic component involved because some families will have more of these changes over time, while other families will develop less. Spondylosis is often seen in athletes or those whose job involves manual labor. This process is often accelerated by repetitive incidents of high impact collision, heavy forces being exerted on the spine and sports that involve concussive actions anywhere on the body.

Symptoms:
Because Spondylosis can occur both in the cervical and lumbar spine the symptoms may vary depending on the location of the condition.

Cervical Spondylosis may result in localized pain, pain that radiates throughout the neck, tingling in the shoulders, arms, hands, and fingers. In more severe cases, numbness in the shoulders, arms, hands, and fingers may occur. You may also experience a decreased range of motion when raising your arms or a sharp pain when you attempt to raise your arms.

Lumbar Spondylosis may result in localized pain, pain that radiates through the middle and lower back, tingling in the thighs, legs or feet. In more severe cases, numbness in the thighs, legs or feet may occur. You may also experience decreased strength and mobility and legs and an inability to walk more than a short distance.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Spondylitis
Ankylosing Spondylitis is an inflammatory disease that, in some cases, can cause the vertebrae in the spine to fuse together. In some of the more severe case, it may become extremely difficult to lift your head high enough to see forward and cause a permanent hunched position of the spine.

Symptoms:
Early signs and symptoms of Ankylosing Spondylitis may include pain and stiffness in your lower back and hips. This pain may be most noticeable in the morning and after a period of sitting or standing.

Symptoms may be gradual at first often manifesting as mild discomfort or pain. This pain usually will increase in severity over time but often will be dormant for a few days before rising again.

Causes:
Ankylosing Spondylitis specific cause has yet to be identified. Recent research suggests that there may be a certain genetic factor involved. In particular, people who have a gene known as the HLA-B27 gene seem to be at a significantly increased risk of developing this condition.

As Ankylosing Spondylitis becomes more severe and inflammation accelerates the body will attempt to heal by forming new bone. The purpose of this bone is to fill the gaping segments between vertebrae. The body uses this bone in an attempt to fuse sections of vertebrae together. However, because of this irregular and unnatural fusion, those areas of the spine will be rendered stiff and inflexible. This fusion can also cause constriction in the rib cage. This restriction can impair your lung capacity and result in an ability to breathe naturally.

If you, or someone you love, have been suffering from neck or back pain, New Jersey Spinal Medicine and Surgery can help. Contact us today to discuss treatment options. Our goal at New Jersey Spinal Medicine and Surgery is to get you back to a healthy and active lifestyle.

Procedures
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Minimally Invasive Spinal Fusion
Minimally Invasive Spinal Fusion is a procedure performed to alleviate the pressure on the lumbar spinal nerves as a result of lumbar disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulpous) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the back, buttocks, legs or feet. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

The type of approach (ALIF, PLIF, TLIF, XLIF) will vary based on your condition and it is best to discuss with your surgeon which of these procedures may be right for you. All of these approaches are carried out through a Minimally Invasive technique and serve to alleviate spinal conditions and radicular pain.

Minimally Invasive Approach:
In this procedure, a small incision is made in the lumbar spine, depending upon the location of the disc(s). Using a muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and onto the offending spinal disc(s). Specialized instruments are used to remove the herniated disc or bone spurs entirely and the surgeon is able to visualize the spine real-time using a fluoroscope. After disc material is removed, a bone graft is placed in the empty disc space. Over time, this bone graft will knit together with the vertebrae above and below to form one larger and more stable vertebra.

A small stabilization plate and surgical screws are also placed between the vertebrae to provide stability to the spine as well as ensure the bone graft maintains its proper position.

Many people with chronic back pain have avoided Spinal Fusion Surgery due to the perceived lack of mobility and lengthy recovery time associated with Spinal Fusion Procedures. However, with New Jersey Spinal Medicine and Surgery’s Minimally Invasive Techniques, lengthy recoveries are avoided and spinal mobility is maintained.

Minimally Invasive Discectomy
A Minimally Invasive Discectomy is a procedure designed to relieve pain as a result of a herniated disc in the cervical or lumbar spine. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulpous) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the neck or back as into extremities. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

The Minimally Invasive Discectomy procedure is often referred to by many different names:

  • Percutaneous Discectomy
  • Endoscopic Discectomy
  • Microscopic Discectomy

It is best to discuss with your surgeon which of these procedures may be right for you.

Minimally Invasive Approach:
All of the above procedures are carried out utilizing a Minimally Invasive Technique. In this procedure, a small incision is made in the area of the offending disc(s). Using a muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and into the spinal space. Using fluoroscopic guidance, the surgeon will then identify the herniation(s). Specialized instruments are used to remove the only the herniated portions of the disc or any bone spurs that may have formed and the surgeon is able to visualize the spine real-time using a fluoroscope. This removal of disc material allows for the spinal nerves to be decompressed and results in the relief of cervical or lumbar pain as well as the radicular pain associated with the herniation.

Anterior Cervical Discectomy
Anterior Cervical Discectomy and Fusion (ACDF) is a procedure performed to alleviate the pressure on the cervical spinal nerves as a result of cervical disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulpous) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the neck, shoulders, arms or fingers. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

Minimally Invasive Approach:
In this procedure, a small incision is made in the neck, depending upon the location of the disc. Using a muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and onto the offending spinal disc(s). Specialized instruments are used to remove the herniated disc or bone spurs entirely and the surgeon is able to visualize the spine real-time using a fluoroscope. After disc material is removed, a bone graft is placed in the empty disc space. Over time, this bone graft will knit together with the vertebrae above and below to form one larger and more stable vertebra.

A small stabilization plate and surgical screws are also placed between the vertebrae to provide stability to the spine as well as ensure the bone graft maintains its proper position. As a result of these Minimally Invasive Techniques, the chances of reduced mobility is the cervical spine is diminished and the cervical spine will continue to flex and extend freely after this procedure.

Interspinous Process or Inter-Laminar Decompression
An Interspinous Process Decompression or Inter-Laminar Decompression are Minimally Invasive surgical procedures designed to alleviate the painful symptoms of Lumbar Spinal Stenosis. A small device is placed into the back of the spine and prevents the spine from bending too far backward at the area of the lumbar spine that has been narrowed due to Spinal Stenosis. For patients with Spinal Stenosis, this backward position is often a position can cause pain in the back and into the extremities.

Minimally Invasive Approach”
In this procedure, a small incision is made at the levels of the lumbar spine where the Spinal Stenosis is present. Using a muscle-sparing technique, small surgical instruments and a surgical camera are slipped between the muscle fibers and into the spinal space. Using fluoroscopic guidance, the surgeon will then identify the bony protrusions at the back of the spine (spinous processes) and use a small surgical instrument designed to create a larger space between the spinous processes. Next, an implant is inserted into this space that allows for continuous decompression of the spine.

The design of the implant prevents the spine from bending too far backward at the segments that are treated. However, this procedure still maintains the ability of movements like bending forward (flexion) and rotating the lower back.

Artificial Disc Replacement
Cervical Disc Arthroplasty is similar to a Joint Replacement procedure. When the old natural cervical disc material is removed, a new, artificial one is put in the intervertebral disc space. An Artificial Cervical Disc is a prosthetic device that helps to maintain motion in that segment of the spine. Therefore, it allows for rotation, side bending, flexion, and extension. An Artificial Disc Replacement of the cervical spine is performed when normal mobility and function of the neck is compromised. This often occurs due to pain and stiffness from a herniated or bulging disc

Artificial Disc Replacement Approach:
This procedure is done through the anterior approach (from the front). A small incision is made near the front of the neck. The surgeon will then gently move the muscles, skin, and fat (soft tissues) to the side, in order to access the cervical vertebrae. Next, the surgeon will remove the disc and any bone spurs from the spine to decompress the spinal cord and nerve roots. This part of the procedure is referred to as a discectomy or decompression. The artificial cervical disc prosthesis is then inserted into that space using special instruments. After the prosthesis is secured and tested, the soft tissues are put back into place and the incision is closed with stitches.

Lumbar Laminectomy
The Lamina is the arched part of the vertebra, which forms a protective dome over the spinal canal to protect the nerves that run through it. Laminectomy is a procedure that removes the lamina to create more space and relieve pressure or compression. Pressure, compression, and pain in this area are often caused by the inner portion of the disc (nucleus pulposus) extruding through the outer hard layer of the disc (annulus), often pushing up against nerve roots or structures that cause pain and immobility. Pain and immobility can also be caused by bony overgrowths, or spurs, within the spinal canal, as a result of arthritis of the spine. This procedure’s primary function is to create more space in the spinal canal in order to relieve the pressure that is causing pain and irritation.

Lumbar Laminectomy Approach:
This Minimally Invasive procedure is performed posteriorly (from the back), as that is where the lamina is most easily seen and reached. First, the surgeon will make an incision over the affected vertebra and move the muscles to the side.

Specialized instruments are then used to remove the lamina to create the extra room in the spinal canal for the nerve roots. If a herniated disc is present, the surgeon may remove that portion of the disc, along with any bony materials that could be contributing the compression or pain.

Nerve Root Block
Nerve Roots are the portions of the nerve that runs through the spinal canal and exit at each part of the vertebral segment of the spine. The spine is divided into segments based on the nerve roots that branch from each section. A Nerve Root Block is an injection into the affected segment of the spine. The injection is a steroidal medicine along with a local numbing agent (anesthetic) under the guidance of fluoroscopy (x-ray). When there is a pain in the legs or arms that is the result of nerve pain or compression, a Nerve Root Block may be used to provide relief. The nerve root block can be repeated in a few months if relief is experienced.

Nerve Root Block Approach:
This is an injection based procedure and does not require an incision. First, the injection site is cleaned and prepared with antiseptic soap or iodine, and a sterile drape is placed around the area. A local anesthetic is then applied to the area. Using fluoroscopic guidance, a needle with the steroidal medicine and a local anesthetic is advanced into the affected spinal segment where the medication is then administered. Last, the skin is cleaned and a Band-Aid placed over the injection site. Blood pressure is monitored for about 30 minutes in the recovery area until it is normalized, and then the patient is free to return home.

Posterior Cervical Decompression and Fusion
This procedure is performed to alleviate the pressure on the spinal cord and cervical spinal nerves as a result of cervical disc herniations or other degenerative conditions. When an intervertebral disc becomes herniated the gelatinous disc nucleus material (nucleus pulposus) is forced out from the disc. This herniated disc material then enters the spinal canal where it begins to press against the spinal cord or spinal nerves. This often causes pain both in the area of the herniation as well as pain in the neck, shoulder, and arms. Removing the disc and any bone spurs will alleviate the pressure on the nerves or spinal cord, which relieves the pain.

Posterior Cervical Decompression and Fusion Approach:
Depending on the number of levels involved, a small longitudinal incision is made in the back of the neck in the midline right over the affected segment. The muscles and soft tissues are moved to the side to reveal the spinal bones and processes. Once that is done, the surgeon will determine if a laminectomy (removal of the domed portion of the spinal canal) or a foraminotomy (removal of bone spurs at the spot where the nerves come through the spinal bone hole) is needed. Next, two screws are placed on either side of the bones and held in place by a rod on each side of the spine. The bony surfaces are decorticated and a bone graft is placed, which will fuse the bones together over time. The incision then closed with a stitch and a bandage applied to the area.

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