Procedures San Francisco
Laminectomy is a workhorse of spine surgery. It has been practiced for more than a hundred years. It is done from the posterior approach (the back of the spine). The goal of laminectomy is to unroof pinches nerves and decompress the spinal canal, either in the middle (central canal) or off to the side (neural foramen) where the nerve comes out. The procedure usually is done under general anesthesia, utilizing a surgical microscope. One-level laminectomy takes anywhere from one to two hours. Sometimes it can be done as an outpatient. Occasionally a surgical drain is utilized. Frequently we expected to get mobilized on postoperative day one. Occasionally, a lumbar corset or brace is utilized to enable the patient to be more mobile at a faster rate.
Lumbar Laminotomy / Microdecompression
Laminotomy is a smaller version of a laminectomy. The difference between laminotomy (microdecompression) and laminectomy is that a smaller part of the lamina (roof of the spinal canal) is removed. At times this is done in a minimally invasive fashion on an outpatient basis. A surgical microscope is normally utilized. Surgery for one level usually takes about one to two hours. The patient is expected to be walking on postoperative day one. Occasionally we do utilize a soft lumbar corset or a semi-rigid lumbar brace.
Lumbar microdiscectomy is one of the most common procedures performed. Sometimes it can be done on an outpatient basis. The goal of microdiscectomy is to remove disc herniation that is pinching the nerve root, resulting in sciatica. A surgical microscope is usually utilized. The procedure can be done in a conventional open fashion or a minimally invasive fashion with smaller incision. Regardless of the approach, the goal of the surgery is the same, which is to decompress the nerve root and remove the disc fragment. Occasionally, the patient may need to stay one or two nights in the hospital for postoperative pain control. We expect most patients to start walking on postoperative day one or the day of surgery. Occasionally, a lumbar brace is utilized.
Sacroiliac fusion is an old procedure that has been done for the past 100 years. It actually predated the use of lumbar microdiscectomy in surgical practice. The modern way of performing sacroiliac fusion is less invasive. Very often, this can be done on an outpatient basis. It involves making a 1″ incision across the buttock and pinning the sacroiliac joint with three titanium implants. Postoperatively, patients usually need to use crutches or a walker for protected weightbearing to allow the joint to solidify before putting full weight. Sacroiliac joint pathology is more common in woman because of hypermobility of the pelvic joints in women. It is also common sequelae of vaginal delivery in women. Quite often, sacroiliac joint pathology is seen after prior lumbar fusion. Also, the sacroiliac joint is commonly affected by trauma—either high-energy trauma such as a motor vehicle accident or fall from a height, or a low-energy trauma such as fall on the buttocks. Sacroiliac fusion’s safety and efficacy have been recently proven in several randomized clinical trials and prospective controlled trials. St. Mary’s Spine Center has been a part of the INSITE clinical trial, which was a surgical multicenter prospective trial demonstrated safety and efficacy of sacroiliac fusions. We also participated in the Lotus retrospective trial of the surgical procedure.
Transforaminal Lumbar Interbody Fusion (TLIF) / Posterior Lumbar Interbody Fusion (PLIF)
Interbody fusion means fusion of two vertebrae across the disc space. This can be accomplished in a variety of different ways. Transforaminal lumbar interbody fusion involves fusing the spine from the back. It involves the placement of pedicle screws above and below on either side, at times utilizing robotic guidance. Also, it does involve placing a cage made out of either titanium or a plastic called PEEK into the disc space. The advantage of interbody fusion is increased fusion rate and improved restoration of normal lumbar contour (lumbar lordosis). Posterior lumbar interbody fusion (PLIF) is a variation of the TLIF and is an older technique that is occasionally still used today.