Spine Care Treatments

Anterior Lumbar Interbody Fusion

Anterior Lumbar Interbody Fusion (ALIF) is a surgical procedure used to alleviate pain and instability in the lumbar spine. It involves removing an intervertebral disc from the lower back through an incision made in the abdomen and then inserting a spacer or bone graft in its place. This fusion procedure aims to promote the growth of new bone, creating a solid bridge between adjacent vertebrae.

ALIF is commonly recommended for conditions such as degenerative disc disease, disc herniation, spondylolisthesis, and instability in the lumbar spine. It can be an effective treatment option when non-surgical methods like physical therapy, medications, and rest have failed to provide relief.

Diagnosing the need for ALIF typically involves a thorough examination by a spine specialist. The process may include a review of medical history, physical assessment, imaging studies (such as X-rays, CT scans, or MRIs), and potentially non-surgical treatments to confirm the diagnosis. The surgeon can only determine if ALIF is the appropriate course of action after a comprehensive evaluation.

Various factors can contribute to the need for ALIF. Degenerative disc disease, which occurs when the discs between the vertebrae break down, leading to pain and instability, is a common cause. Disc herniation, when the inner jelly-like substance of a disc protrudes and irritates nearby nerves, can also lead to ALIF. Additionally, spondylolisthesis, a condition where one vertebra slips forward over another, can necessitate ALIF to stabilize the spine.

Once ALIF is determined to be the appropriate treatment option, the surgery is typically performed by an orthopedic surgeon. During the procedure, the surgeon will remove the damaged disc, clear space for the spacer or bone graft, and secure it with screws or metal plates. Over time, the body will naturally fuse the vertebrae together, creating stability and reducing pain.

Following the surgery, patients may need to stay in the hospital for a few days for monitoring. Recovery time can vary but typically involves restricted activities, physical therapy, and pain management. Patients must follow post-operative instructions, attend follow-up appointments, and engage in regular exercise to aid in the healing process.

It's important to note that ALIF, like any surgery, comes with risks and potential complications, including infection, bleeding, nerve damage, or failure to relieve symptoms. Therefore, it is essential for patients to have open and honest discussions with their healthcare providers to fully understand the procedure, risks, benefits, and anticipated outcomes.

Basivertebral Nerve Radiofrequency Ablation (Intracept)

Basivertebral nerve ablation is a minimally invasive procedure used to treat chronic back pain caused by vertebral endplate fractures or diseased vertebral bodies. During the procedure, a special needle or catheter is guided into the affected area of the spine, usually using imaging techniques such as X-ray or fluoroscopy. Radiofrequency energy is then delivered through the needle to selectively ablate or destroy the basivertebral nerves responsible for transmitting pain signals. By interrupting the pain signals, the procedure aims to provide relief from chronic back pain.

Discectomy

A discectomy is a surgical procedure performed to remove a portion of an intervertebral disc, typically in the spine, causing pain or other symptoms. This procedure aims to relieve pressure on the nerves and restore normal function in the affected area.

Discectomies are commonly used to treat conditions such as herniated discs, which occur when the soft cushion-like material inside a spinal disc pushes through a weak area in the outer layer, irritating nearby nerves. Other conditions like degenerative disc disease or spinal stenosis, where the spinal canal narrows and puts pressure on the nerves, may also require a discectomy.

To diagnose the need for a discectomy, a thorough evaluation by a spine specialist is essential. This may involve a review of the patient's medical history, physical examination, and diagnostic tests like X-rays, CT scans, or MRIs. These imaging tests help identify the exact location and severity of the disc herniation or other spinal abnormalities, enabling the surgeon to make an accurate diagnosis.

The procedure may be performed using different techniques, such as traditional open surgery or minimally invasive approaches. During an open discectomy, a small incision is made in the back, and the surgeon removes the portion of the disc causing the compression. In minimally invasive discectomy techniques, smaller incisions are made, and specialized surgical instruments are used to access and remove the herniated disc material.

Post-surgery, patients may need to stay in the hospital for a short period of time for observation. Recovery times vary depending on the patient and the specifics of the surgery, but most individuals can expect a period of restricted activities, ample rest, and physical therapy to aid in the healing process. Follow-up appointments are essential to evaluate progress and ensure the best possible outcome.

It is important to note that discectomy, like any surgical procedure, comes with risks and potential complications. These can include infection, bleeding, nerve damage, or failure to alleviate symptoms. As with any medical treatment, discussing the risks, benefits, and expected outcomes with a qualified healthcare professional is vital.

Remember, this is a general overview, and it's crucial to consult with a spine specialist or orthopedic surgeon to receive personalized information and recommendations based on your specific condition.

Disc Replacement or Total Disc Replacement

Disc replacement, also known as artificial disc replacement or total disc replacement, is a surgical procedure designed to alleviate pain and restore function in the spine by replacing a damaged or degenerated spinal disc with an artificial disc.

During the disc replacement procedure, the surgeon removes the problematic disc and inserts an artificial disc made of metal or a combination of metal and plastic. This artificial disc is designed to mimic the natural function of a healthy disc, allowing for normal spine mobility and cushioning between vertebrae.

Disc replacement surgery is typically recommended for individuals with degenerative disc disease, herniated discs, or other conditions that cause chronic back or neck pain. It is often considered an alternative to traditional spinal fusion surgery, as it aims to retain spinal motion and flexibility while addressing the underlying issue.

Diagnosing the need for disc replacement involves a comprehensive evaluation by a spine specialist. This may include a review of medical history, physical examination, and diagnostic tests such as X-rays, CT scans, or MRIs. These imaging studies help determine the extent of disc degeneration or damage and guide the decision-making process regarding the suitability of disc replacement.

The surgical procedure itself can be performed using different approaches, including anterior (from the front), posterior (from the back), or lateral (from the side), depending on the patient's specific condition and the surgeon's preference. Your healthcare provider will determine the best approach for your situation.

Following disc replacement surgery, patients may need to stay in the hospital for a few days for monitoring. Recovery time can vary but typically involves a period of restricted activities, physical therapy, and pain management. The artificial disc allows for more normal spine movement compared to fusion surgery, potentially leading to a quicker return to regular activities.

As with any surgical procedure, disc replacement carries risks and potential complications, such as infection, bleeding, ongoing pain, or spinal nerve damage. It is essential to have thorough discussions with the experts at the MarinHealth Spine Institute to carefully weigh the benefits and potential risks before making a decision.

Dorsal Root Ganglion Stimulation

Dorsal Root Ganglion (DRG) Stimulation is a form of neuromodulation therapy used to manage chronic pain. The dorsal root ganglion is a small structure located near the spinal cord, and it contains clusters of nerve cell bodies. In this therapy, mild electrical pulses are delivered to the dorsal root ganglion using implanted devices to help alleviate pain.

DRG stimulation works by interrupting or altering pain signals before they reach the brain. It is often used when other treatments have been unsuccessful in providing relief. By stimulating the dorsal root ganglion, it can modulate the activity of the nerves involved in transmitting pain signals, thus reducing the sensation of pain for the individual.

The procedure involves the surgical implantation of electrodes near the targeted dorsal root ganglion. These electrodes are connected to an implantable pulse generator that delivers the electrical pulses. The strength and frequency of the electrical signals can be adjusted based on the individual's specific needs.

Epidural Steroid Injections

Epidural steroid injections use numbing agents and strong anti-inflammatory medicines to control back pain, allowing patients to move comfortably and return to their regular routines faster. Back pain can make everyday activities painful and difficult, especially when the pain extends to your legs and other parts of the body. ESIs are becoming increasingly popular for treating sciatica, lumbar spinal stenosis, other spinal conditions, and some arm and leg pain.

Our specialists at the MarinHealth Spine Institute are experts at diagnosing spinal conditions and helping patients find nonoperative treatment options like epidural steroid injections. Injections may be a part of a larger treatment plan that includes physical therapy, medication management, or other treatments to improve the condition of your spine.

How do epidural steroid injections work?
Sciatica and lumbar spinal stenosis are conditions that cause pain (or tingling and other sensations) in the lower back, buttocks, and legs. The pain usually radiates across nerves that extend from the lower back into the legs. This occurs because of excess pressure and inflammation around the roots of the nerves. When spinal bones and joints deteriorate, they can start to squeeze together or rub the wrong way, irritating the roots of these important nerves around the lower spine.

Epidural steroid injections reduce swelling and inflammation around the spine, relieving pressure around the irritated nerves. The medicines in the injection also help block pain signals, relieving patients with severe pain. The effects of the injection are usually temporary, but this reduction in pain may make it easier for patients to finish other treatments, such as exercise plans to help relieve pressure on the lower back.

Indirect Lumbar Decompression Procedure (Vertiflex)

Indirect lumbar decompression is a minimally invasive spinal surgery procedure that relieves pressure on pinched nerves in the spine without removing the compressing tissue. It can help reduce pain and inflammation in the spinal joints and surrounding tissue, and improve mobility.

Intradiscal Therapies

Intradiscal therapies, also known as intradiscal treatments, are medical procedures that target specific spinal discs to provide relief from pain and other related symptoms. These therapies are typically used to treat conditions such as herniated discs, degenerative disc disease, and chronic low back pain.

There are different types of intradiscal therapies, including:

• Intradiscal Injections: Drugs such as corticosteroids or local anesthetics are injected directly into the affected spinal disc to reduce inflammation and provide pain relief.
• Intradiscal Electrothermal Therapy (IDET): This procedure involves inserting a heated catheter into the damaged disc to cauterize and seal the nerve endings, thereby reducing pain signals.
• Intradiscal Radiofrequency Thermocoagulation: In this therapy, radiofrequency energy is used to generate heat and destroy specific nerve fibers causing pain within the disc.
• Intradiscal Biologic Therapies: These therapies involve injecting biological substances, such as stem cells or platelet-rich plasma, into the disc to promote healing and repair damaged tissue.
• Intradiscal therapies are typically reserved for patients who have not responded to conservative treatments like physical therapy, medication, or other non-invasive approaches. However, the specific choice of treatment depends on the individual patient's condition and is best determined by consulting with a doctor.

Lateral Sacroiliac Joint Fusion

Lateral sacroiliac (SI) joint fusion is a minimally invasive surgical procedure that uses a lateral approach to stabilize the SI joint with titanium implants. This technique is used to treat low back pain caused by degenerative sacroiliitis or SI joint disruption that is not controlled by other methods.

Minimally Invasive Decompression

Minimally invasive decompression (MID) is a medical procedure used to relieve pressure on the nerves in the spine. It involves using small incisions and specialized instruments to remove bone spurs, herniated discs, or other tissue that may be compressing the nerves. The goal of minimally invasive decompression is to reduce pain and improve function without the need for open surgery, resulting in smaller incisions, less tissue damage, and quicker recovery compared to traditional open procedures. MID techniques are typically performed by orthopedic surgeons or neurosurgeons and are chosen based on the individual patient's condition and needs.

Various procedures can be performed to provide indirect or direct decompression of the lumbar spine with different profiles of anesthesia, risk, and invasiveness. Dr. Naidu offers the mild procedure and the Vertiflex procedure. Dr. Su offers minimally invasive surgical decompression techniques such as unilateral laminectomy for bilateral decompression (ULBD)

Minimally Invasive Lumbar Decompression (Vertos)

Minimally invasive lumbar decompression (MILD) is a type of spine surgery that treats lumbar spinal stenosis, a common condition that causes pain in the lower back and legs. The procedure involves making smaller incisions than traditional surgery and using specialized tools to remove small pieces of bone and thickened ligaments from the spinal canal. This restores space in the spinal canal and relieves pressure on the nerves, which can help improve mobility. MILD is an outpatient procedure that doesn't require implants and can be a safe, effective, and cost-effective alternative to traditional surgery. Patients typically experience a faster recovery time and less pain than with traditional surgery, and some studies have shown significant improvements in function and pain over a two-year follow-up period.

Minimally Invasive Lumbar Discectomy

Minimally invasive lumbar discectomy is a surgical procedure used to treat herniated or bulging discs in the lower back. It is a less invasive alternative to traditional open back surgery. During the procedure, a surgeon makes a small incision near the affected disc and uses specialized instruments to remove the damaged disc material that may be pressing on nerves and causing pain or other symptoms. The minimally invasive approach typically involves smaller incisions, less muscle and tissue disruption, and a faster recovery time compared to open surgery. It can be an effective treatment option for certain cases of lumbar disc herniation.

Minimally Invasive Spinal Fusion

Minimally invasive spinal fusion is a surgical procedure used to treat various spinal conditions that cause instability or pain. Unlike traditional open surgery, which requires larger incisions and muscle dissection, minimally invasive techniques utilize smaller incisions and specialized tools to access the spine.

During the procedure, small incisions are made, and a series of tubes or dilators are inserted to create a path to the affected area of the spine. Through these tubes, surgeons use tiny instruments and a camera (endoscope) to perform the fusion. The surgeon removes damaged discs or bone spurs, corrects spinal alignment, and inserts implants or bone grafts to fuse the vertebrae together.

There are several potential benefits of minimally invasive spinal fusion compared to traditional open surgery. These include more minor scars, less tissue damage, reduced blood loss, shorter hospital stays, and faster recovery times. However, not all patients are suitable candidates for this approach, and the decision to use minimally invasive techniques depends on factors such as the type and complexity of the spinal condition, the surgeon's expertise, and the patient's overall health.

Nonoperative Treatments for Spine Conditions

When you suffer from back pain and other spine-related problems, everyday activities can become difficult or even impossible. Our spinal experts can work with you to find conservative options to manage pain and correct issues with your muscles, joints, bones, and nerves. Below are a few of the conservative management methods your doctor might recommend for back pain or other orthopedic problems:

• Physical therapy and other exercises. Our office often refers patients to physical therapists who can help with rehabilitation and other restorative measures.
• Lifestyle changes. Sometimes weight loss, diet changes, improving posture, wearing proper shoes or supportive gear during work, and other changes can significantly affect your overall health.
• Holistic options. Acupuncture, chiropractic appointments, and other holistic options can be very effective in helping patients control pain and improve mobility.
• Pain management. Our team works with Pain Psychologists in the community to help our patients manage their pain.

Our orthopedic specialists will work with you and your other doctor/physical therapists to form your treatment plan. Your specific condition and goals will always be taken into account before treatments are considered. Whether your goal is as simple as being able to stand without pain or as big as running a marathon, our team wants to help you live an active and healthy life.

Peripheral Nerve Stimulation

Peripheral nerve stimulation (PNS) is a medical technique that involves the application of electrical impulses to nerves located outside the brain and spinal cord. It is a form of neuromodulation used to alleviate chronic pain and treat other nervous system disorders. PNS works by targeting specific nerves with electrical stimulation, which can help control pain, restore function, or manage symptoms associated with various conditions. This technique is often used when conservative treatments are unsuccessful in managing a patient's pain or symptoms.

Posterior Sacroiliac Joint Fusion

Posterior sacroiliac joint fusion (SI joint fusion) is a minimally invasive surgical procedure that treats pain and dysfunction in the sacroiliac (SI) joint. During the procedure, a surgeon makes a small incision above the buttock and places a threaded device packed with bone graft material into the joint. The graft material can be autograft or allograft, which is tissue taken from a donor. The device promotes bone growth and stabilizes the joint, which can help end pain.

Posterolateral Sacroiliac Joint Fusion

Posterior/lateral sacroiliac joint fusion (SI joint fusion) is a surgical procedure that stabilizes the sacroiliac joint, which is located in the pelvis between the sacrum and ilium. It's often recommended for people with sacroiliac joint dysfunction, a condition that causes pain and instability in the lower back and buttocks.

Radiofrequency Ablation

Radiofrequency ablation (RFA), also known as rhizotomy, is one of the newest pain control techniques. In this nonsurgical procedure, radiofrequency waves are delivered to certain nerves, with the goal of interrupting pain signals to the brain.

RFA typically targets pain from the facet joints, which can contribute to chronic pain in the neck or lower back, and the sacroiliac joints, which can contribute to chronic low back pain. RFA is considered for long-term pain conditions, especially of the neck, lowerback or arthritic joints that haven’t been successfully treated with other methods:

• Facet joint pain
• Knees
• Hips
• Other

Regenerative Medicine

Regenerative medicine is a branch of medicine that focuses on developing methods to repair, replace, or regenerate damaged or diseased cells, tissues, or organs in the body. It aims to stimulate the body's own healing mechanisms or provide new tissues and organs through various approaches such as stem cell therapy, tissue engineering, and gene therapy. The ultimate goal of regenerative medicine is to restore normal function and improve the quality of life for individuals with injuries or chronic conditions that are currently difficult to treat.

Sacroiliac Joint Fusion

Sacroiliac joint fusion is a surgical procedure that aims to alleviate pain and instability in the sacroiliac joint. The sacroiliac joint is located in the lower back and connects the sacrum (the triangular bone at the base of the spine) to the iliac bones of the pelvis.

During the fusion procedure, the surgeon may use various techniques to stabilize and fuse the sacroiliac joint. This fusion limits the movement of the joint, which can help reduce pain caused by inflammation or abnormal joint motion. The fusion may involve the use of bone grafts, implants, or different types of stabilization devices.

Sacroiliac joint fusion is typically recommended for individuals who have failed to find relief from conservative treatments such as physical therapy, medications, or injections.

Spinal Cord Stimulation

Spinal cord stimulation (SCS) is a medical procedure that involves the use of a device to alleviate chronic pain. It works by delivering low-level electrical signals to the spinal cord, which helps to mask or interfere with the transmission of pain signals to the brain. The device consists of an implanted electrode that is placed near the spinal cord and connected to a small generator that produces electrical impulses. This technique is commonly used for managing chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, and certain types of neuropathic pain. It can help improve pain control and reduce the reliance on pain medications for some individuals.

Vertebral Augmentation

Vertebral augmentation is a minimally invasive surgical procedure used to treat compression fractures within the vertebral column, specifically in the spine. Compression fractures usually occur due to conditions like osteoporosis, trauma, or tumors.

The two common types of vertebral augmentation are:

• Vertebroplasty: During this procedure, a special medical-grade cement is injected directly into the fractured vertebra. The cement hardens quickly, stabilizing the bone and providing immediate pain relief.
• Kyphoplasty: Kyphoplasty involves the use of a balloon-like device called a bone tamp. A small incision is made, and the bone tamp is inserted and inflated inside the fractured vertebra. This helps restore the height and shape of the vertebra. Once the space is created, the bone tamp is deflated, and the space is filled with the cement-like material to provide stabilization.

Vertebral augmentation procedures are aimed at relieving pain, stabilizing the spine, and improving overall function. They can help restore the normal alignment of the vertebral column, reduce spinal deformity, and allow patients to regain mobility. These procedures are typically performed by orthopedic or neurosurgeons who specialize in spine surgeries. If you suspect a compression fracture or are experiencing severe back pain, it's important to see a doctor to find a treatment plan that works best for you.