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Spinal Surgery Approach

Spinal Surgery Techniques

UVNN’s spinal surgery approach varies depending on the individual needs of the patient. Whether open surgery or MISS, the spine can be accessed from different directions. These are referred to as surgical approaches and are explained below:

  • Posterior approach: An incision is made from behind your back or neck
  • Anterior approach: The surgeon accesses the spine from the front of your body, through the neck or the abdomen. 
  • Lateral approach: The pathway to your spine is made from the side.

Spinal Surgery Imaging

UVNN was first in the Upper Valley to use the O-arm™ with neuro-navigation. This is an intraoperative imaging system. Computer-assisted image guidance provides the surgeon with enhanced visualization and accuracy during surgery. The O-arm™ is commonly used during spinal fusions and optimizes the trajectory of implants.

In computer-assisted image guidance, images taken preoperatively (before surgery) are merged with images obtained while the patient is in surgery, yielding real-time views of the anatomical position and orientation of the operative site while the patient is undergoing surgery. 

Common Spinal Surgery Procedures

There are a number of conditions that may lead to spine surgery. All spinal surgery  performed by our surgeons use an operative microscope and minimal invasive techniques. This is known as minimally invasive spinal surgery (MISS). Common procedures include:

  • Discectomy: Our surgeon performs microdiscectomies using a microscope to remove ruptured disc material. Thereby, relieving the pressure on the compressed nerve. Microdiscectomy is a MISS procedure.
  • Laminectomy: Removal of the thin bony plate on the back of the vertebra called the laminae to increase space within the spinal canal and relieve pressure.

Laminotomy: Removal of a portion of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.

Foraminotomy: Removal of bone or tissue involving the passageway where the nerve roots exit from the spinal canal. This exit is known as a foramin (Latin for window).

Disc replacement: As an alternative to fusion, the injured disc is replaced with an artificial one.

  • Spinal fusion: A surgical technique used to join two or more vertebrae. Spinal fusion may include the use of a bone graft and often includes plates, screws or rods (instrumentation). A spinal fusion can be accomplished by different approaches, and all are designed to stabilize the spinal vertebrae and eliminate movement between the bones. The approaches include:
    • Posterior Lumbar Interbody Fusion (PLIF)
    • Transforaminal Lumbar Interbody Fusion (TLIF)
    • Anterior Lumbar Interbody Fusion (ALIF)
    • Lateral Interbody Fusion (LIF)

Spinal instrumentation

Examples of spinal instrumentation include plates, screws, rods, and interbody devices. There are other types of devices your surgeon may recommend in treatment of your spinal disorder. The purpose of instrumentation is to stabilize or fix the spine in position until the fusion solidifies.

  • Pedicle screws help to hold the vertebral body in place until the fusion is complete.
  • An interbody cage is a permanent prosthesis left in place to maintain the foraminal height (eg, space between two vertebral bodies) and decompression following surgery.
  • Interspinous process devices (ISP) reduce the load on the facet joints, restore foraminal height, and provide stability in order to improve the clinical outcome of surgery. An advantage of an ISP is that it can be placed within the spine through a smaller incision as part of minimally invasive spinal surgery.

Some patients are at-risk for their fusion not to heal properly or completely. Your surgeon may refer to this as a non-fusion, pseudarthrosis or a failed fusion. To help avoid fusion problems, your surgeon may recommend a bone growth stimulator. There are different types of stimulators, and our surgeons use those that are worn externally. 

Should surgical treatment be your best option, it may help to understand that minimally invasive spine surgery offers many benefits. Patients who want to return to work and active play, as well as the elderly or those with major spinal problems, often achieve a higher level of function once symptoms are alleviated.