Neck and Back Treatments

A damaged or diseased disc can put pressure on the spinal cord or spinal nerves, resulting in pain and loss of function. If you have a herniated disc in your neck or degenerative disc disease of the cervical spine that hasn’t responded to non-surgical treatments, your surgeon may recommend you have an anterior cervical discectomy and fusion (ACDF) to relieve the pressure on nerves.

During this procedure, the affected cervical disc is removed and the space between vertebrae is filled with a bone graft and/or implant or cage. The graft may come from your own hip or a donor (cadaver), or the doctor can use an artificial disc. The graft is held in place by a small plate attached to the front of the spine with screws into each of the vertebral bones. It may take up to 12 months or longer for the graft and vertebrae to heal, or fuse together to form one solid piece of bone.

Cervical fusion eliminates movement between damaged vertebrae in the neck. Only a small area is affected, however, so any loss in range of motion is limited.

Your surgeon may recommend cervical disc arthroplasty, or artificial disc replacement, for degenerative disc disease in the neck that does not get better with non-surgical treatments. Candidates for cervical disc replacement typically have symptoms of radiculopathy (pinched nerves that cause pain to radiate into the shoulders, arms, and hands) or myelopathy (spinal cord compression that causes loss of function in the extremities).

Artificial cervical disc replacement is an alternative to spinal fusion surgery (ACDF) that allows more natural motion of the spine. During the procedure, the surgeon will remove the damaged disc, restore normal disc height (diseased discs become thinner), and insert the artificial one. Disc replacement surgery does not require any bone grafting.

Artificial discs are typically made of either metal or plastic-like materials like biopolymers, or a combination of these materials. The top surface is attached to the upper vertebra, while the lower surface is attached to the lower vertebra at the affected disc level.

The main benefit of cervical disc arthroplasty over ACDF is increased motion and flexibility. However, it is important to understand that you will not gain additional range of motion, but rather maintain the range of motion you had prior to surgery.

Lumbar decompression is performed to relieve pain caused by pinched nerves in the lower back as a result of a herniated disc or spinal stenosis. During the procedure, Dr. Rauzzino removes a small portion of the bone over the nerve root and/or disc material from under the nerve root, which relieves pressure on the nerve.

The two most common surgical approaches for decompression are microdiscectomy and lumbar laminectomy.

Microdiscectomy is a minimally invasive spine surgery performed on an outpatient basis. You will be sedated using general anesthesia but will go home the same day. Learn more about this procedure below.

Lumbar laminectomy, or open decompression, is an inpatient procedure that requires a hospital stay of 1 to 3 days. You will be sedated using general anesthesia. This procedure differs from a microdiscectomy in that the incision is longer and there is more muscle retraction. Learn more about this procedure below.

Your surgeon may recommend that you get a lumbar fusion if you haven’t found relief from conservative treatment for your back and leg pain. Lumbar fusions are used to treat back and leg pain as a result of degenerative disc and joints in the spine.

There are times that a lumbar fusion can be done in a minimally invasive manner versus the traditional open approach. As a result, this can mean a shorter hospital stay, less post-op pain, and a quicker overall recovery. To find out if you are a candidate for this type of surgery, you will need to discuss this with your surgeon.

Your surgeon may recommend a lumbar disc arthroplasty, or artificial disc replacement, for degenerative disc disease in the back that does not get better with non-surgical treatments. Candidates for lumbar disc replacement typically have symptoms of back pain without significant leg pain.

Artificial lumbar disc replacement is an alternative to spinal fusion surgery that allows more natural motion of the spine. During the procedure, the surgeon will remove the damaged disc, restore normal disc height (diseased discs become thinner), and insert the artificial one. Disc replacement surgery does not require any bone grafting.

Artificial discs are typically made of either metal or plastic-like materials like biopolymers, or a combination of these materials. The top surface is attached to the upper vertebra, while the lower surface is attached to the lower vertebra at the affected disc level.

The main benefit of lumbar disc arthroplasty over a lumbar fusion is increased motion and flexibility. However, it is important to understand that you will not gain additional range of motion, but rather maintain the range of motion you had prior to surgery. Also, the lumbar disc replacement is only appropriate for a very select patient population, so you will need to discuss with your surgeon if you qualify for the procedure.

A microdiscectomy is a minimally invasive spine surgery performed to alleviate the pain of nerve compression, or sciatica, which results in pain, numbness, or weakness in the leg. Sciatica is typically caused by a herniated disc or spinal stenosis.

Microdiscectomy is considered the gold standard for removing the herniated portion of a disc that is pressing on a nerve. It is performed on an outpatient basis in a surgery center or hospital, which means you will go home just a few hours after the surgery is complete.

During the procedure, Dr. Rauzzino will make a small incision (1 - 1 ½ inches) over the affected disc. He will then insert visualization tools and special instruments to remove the portion of the herniated disc that is compressing the nerve root. This approach reduces injury to your back muscles and surrounding tissues.

Other benefits of microdiscectomy include:

• Smaller incisions and scars
• Less pain
• Decreased blood loss
• Fewer complications
• Shorter hospital stay
• Quicker recovery and return to daily activities

Kyphoplasty and vertebroplasty are minimally invasive surgical procedures used to treat spinal compression fractures resulting from osteoporosis. Both are performed on an outpatient basis and only take about an hour for each vertebra involved, which means you will go home on the same day.

These procedures relieve pain resulting from spinal compression, prevent further collapse of the fracture, and restore normal spinal alignment. They can be performed on both the cervical (neck) and lumbar (low back) spine.

During kyphoplasty, the surgeon inserts a balloon into the fractured vertebra and inflates it to create a space in the area with the fractured bone. This restores the vertebra to its proper height and shape. The balloon is then deflated and removed, and a special type of bone cement is inserted into the vertebra.

Vertebroplasty is a similar procedure except that it does not entail the use of a balloon. Instead, the doctor simply injects the cement directly into the fractured vertebra. The downside is that it does not restore the natural height of the vertebra.

Spinal stenosis is a condition that causes the spinal canal to narrow and put pressure on nerves. This nerve compression can cause symptoms of myelopathy, such as numbness, pain, or weakness in the arms or hands; difficulty using the hands; and balance problems. Spinal stenosis may be present at multiple levels of the cervical spine at the same time.

Dr. Rauzzino might suggest a cervical laminoplasty if you have spinal stenosis in your neck that is causing myelopathy. During the procedure, the surgeon creates an opening in the lamina, the bone lying over the spinal cord. There are a couple of different surgical approaches, and Dr. Rauzzino will decide which is best for you. Both approaches create more space for the spinal cord and remove pressure on the nerves.

After surgery, you will stay in the hospital for 2 to 3 days. You will need to wear a neck collar for several weeks, and you may undergo physical therapy to strengthen the neck muscles. You might initially experience pronounced weakness and shoulder pain as the nerves return to their normal location, but this is normal and temporary. Most patients recover nerve function within several months after surgery, with continued improvement over 6 to 18 months as the spinal cord heals.

Lumbar laminectomy, or open decompression, is performed to alleviate pain caused by compressed nerves. It involves removing a portion of the lamina, the back part of the vertebra that covers the spinal canal. A number of factors can cause nerve root compression, including herniated discs, spinal stenosis, facet joint arthritis, or tumors.

During the procedure, Dr. Rauzzino will make a 2-inch to 5-inch incision over the affected disc(s). After moving muscle tissue away from the spine above and below the affected disc, he will remove a portion of the lamina. This enlarges the spinal canal and relieves compression of the spinal cord. It also allows the surgeon to visualize the spinal canal and nerve roots. Once the compressed nerve can be seen, the cause of compression can be identified and removed.

Lumbar laminectomy is performed under general anesthesia and typically requires a short hospital stay.

Lumbar fusion is performed to eliminate back pain caused by a number of conditions, including:

• Degenerative disc disease
• Spondylolisthesis (slipped vertebra)
• Spinal stenosis
• Scoliosis
• Spinal fracture
• Spinal infection
• Spinal tumor

The procedure fuses together damaged vertebrae to create a single, solid bone. Whenever possible, Dr. Rauzzino will use a minimally invasive technique for lumbar fusion. There are a number of surgical approaches he can use to reach the affected disc or vertebrae. He can make an incision from the front of the spine (anterior), the back (posterior), and/or from the side (lateral).

During this procedure, the surgeon will use bone grafts to fuse the damaged vertebrae together. The graft may come from your own hip or a donor (cadaver), or the doctor can use an artificial disc. The graft is held in place by a small plate attached to the front of the spine with screws into each of the vertebral bones.

In some cases, the disc between two vertebrae may need to be removed. To fill the empty disc space, a device with bone graft is implanted between the vertebral bodies. It may take up to 12 months or longer for the graft and vertebrae to heal, or fuse together to form one solid piece of bone.

Lumbar fusion is performed in the hospital under general anesthesia and typically requires a hospital stay of 3 to 4 days or longer, depending on the extent of surgery.

Lumbar fusion minimizes pain by eliminating movement between damaged vertebrae in the low back. Since most surgeries affect only a small area, any loss in range of motion is limited.

Posterior cervical foraminotomy is a minimally invasive surgery that relieves nerve root compression in the neck. The procedure enlarges the foramen, or the space where the nerve root exits the spinal cord.

There are two minimally invasive approaches. Dr. Rauzzino will first make a small incision (1 to 2 inches) in the back of the neck and move muscles and soft tissue out of the way to access the spine. With a full minimally invasive technique, he will make an even smaller incision and insert a thin tube with a retractor that allows him to access the spine without disrupting the surrounding tissues.

Once Dr. Rauzzino reaches the spinal canal, he will remove a small amount of bone from the foramen to expose the nerve root and relieve pressure. If other factors are causing compression, such as a herniated disc or bone spur, Dr. Rauzzino may also remove the part of the disc or spur pushing on the nerve.

For some patients, a posterior cervical foraminotomy may be a viable alternative to a discectomy or spinal fusion. The procedure is performed under general anesthesia and typically requires a brief hospital stay of 1 to 2 nights.

Front Range Spine and Neurosurgery treats benign and malignant tumors of the brain, spine, and spinal cord. Some of the many tumors we treat include:

• Aneurysmal bone cyst
• Astrocytoma
• Chordoma
• Dermoid, Epidermoid, Teratoma
• Ependymoma
• Gliomas
• Hemangioblastoma
• Hemangioma
• Lipoma
• Meningioma
• Metastatic tumors (lymphoma, lung, breast, prostate)
• Neurofibroma
• Neuroma
• Oligodendroglioma
• Osteoblastoma
• Osteoid osteoma
• Primary lymphoma
• Schwannoma
• Vertebral hemangioma

Dr. Rauzzino has years of expertise surgically removing all types of tumors. The goal is to remove the cancerous tumor entirely or as much of it as possible.

Depending on the type of tumor, surgery may be the only treatment, or it may be combined with other treatments, such as chemotherapy or radiation therapy. The different types of cancer surgeries include:

• Curative: Removes the cancerous tumor or growth from the body.
• Preventive: Removes tissue that does not contain cancerous cells, but may develop into a malignant tumor.
• Diagnostic: Removes a sample of tissue. Also called a biopsy, this procedure confirms if cells are cancerous, identifies the type of cancer, and determines the stage of the cancer.
• Staging: Determines the extent (spread) of cancer in the body.
• Debulking: Removes a portion of a cancerous tumor.
• Palliative: Performed to relieve the discomfort of advanced stages of cancer.
• Supportive: Performed to help other cancer treatments work more effectively, e.g., insertion of a catheter.