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SURGICAL PROCEDURES & SERVICES 
Cervical Spine Surgery
Anterior Cervical Decompression and Fusion Minimally Invasive Posterior Cervical Decompression Minimally Invasive Posterior Cervical Fusion
Minimally Invasive Decompression Minimally Invasive Posterior Lumbar Fusion Direct Lateral Interbody Fusion (DILF) Tumor/Mass Biopsy and Resection *Several of our minimally invasive procedures DO NOT require general anesthesia and can be performed under local anesthesia. For more information, please inquire during your neurosurgical consultation. Anterior Cervical Decompression & Fusion (ACDF) An ACDF is indicated for patients with cervical myelopathy (spinal cord injury), cervical radiculopathy (nerve root compression and/or injury) and/or ligamentous instability. The surgery consists of three steps: 1. Decompression of nerves and spinal cord; 2. Fusion of vertebrae and 3. Stabilization of the fusion. The surgery is performed through a small skin incision in the front of a patient's neck. The soft tissue, esophagus and trachea are pushed to the side, allowing direct access to the front of the cervical spine. With the aid of a high-powered microscope and microsurgical instruments, the disc and bone spurs are removed from the disc space. During this process, any pressure on the cervical nerve roots and spinal cord is relieved. Next, the fusion is performed by placing a specially designed cage (hollow spacer) filled with the patient’s own bone marrow and calcium phosphate crystals into the disc space. This spacer maintains disc space height and allows bone cells to grow from one vertebra to another. A titanium plate is placed over the cage and bones to stabilize the spine during the fusion (healing) process. To conclude, the soft tissue and skin are closed using dissolvable sutures. The fusion process can take approximately 3 to 6 months depending on a patient's medical problems, tobacco history and age. After the bone is healed, the plate and screws may be removed.
Cervical Disc Arthroplasty, commonly referred to as cervical artificial disc replacement surgery, is indicated for younger patients with one level of cervical myelopathy (spinal cord injury) and/or cervical radiculopathy (nerve root compression and/or injury) who have failed conservative treatment. The artificial disc cannot be used for candidates with an active infection or allergy to stainless steel. The surgery is performed through a small skin incision in the front of a patient's neck. The soft tissue, esophagus and trachea are pushed to the side, allowing direct access to the front of the cervical spine. With the aid of a high-powered microscope and microsurgical instruments, the disc and bone spurs are removed from the disc space. During this process, any pressure on the cervical nerve roots and spinal cord is relieved. Next, disc space is measured and prepped for the implant (artificial disc). The stainless steel implant is placed in the disc space and fastened down using screws under fluoroscopy (real-time x-rays). To conclude, the soft tissue and skin are closed using dissolvable sutures.
Minimally Invasive Posterior Cervical Fusion The minimally invasive posterior cervical fusion is indicated for patients who have cervical spine instability as well as in conjunction with an anterior cervical fusion (ACDF) for increased stability and improvement in fusion rate for high risk patients. Traditionally, a posterior cervical fusion required a relatively long incision, extensive muscle damage, significant neck pain and a prolonged recovery. We have developed a minimally invasive posterior cervical fusion technique that can be performed through a small 1.5 cm skin incision. This surgical procedure consists of two steps: fusion and stabilization. The minimally invasive posterior cervical fusion is performed through a narrow tube which is inserted from the skin down to the spine using a unique minimally invasive muscle retracting system (METRx). This technique minimizes any damage to the muscles or soft tissue. The fusion is performed through the narrow tube using a high-powered microscope and microsurgical technique. A small amount of the patient's own bone marrow is mixed with calcium phosphate crystals and then placed along the back of the vertebrae. To assist in bone healing (fusion), titanium screws and a rod are placed into the vertebrae through the narrow tube. After the fusion and instrumentation is performed, the tube is removed allowing the retracted muscles to close together undamaged. The fascia and skin are closed using dissolvable sutures. The fusion process can take approximately 3 to 6 months depending on a patient's medical problems, tobacco history and age.
Minimally Invasive Posterior Spinal Decompression A posterior decompression is commonly used for lumbar and thoracic spine conditions; however, can be utilized for certain cervical spine problems. This surgical procedure involves the removal of bone, ligament and/or herniated disc from compressing the nerves and spinal cord using a posterior approach (from the back). Performed through a small skin incision ranging from 1.5 to 2cm in length, a narrow tube is inserted from the skin down to the spine using a unique minimally invasive muscle retracting system (METRx). This technique minimizes any damage to the muscles and soft tissue. The decompression is performed through the narrow tube using a high-powered microscope and microsurgical instruments. After the pressure on the spinal cord and nerves is relieved, the tube is removed allowing the retracted muscles to close together undamaged. The fascia and skin are closed using dissolvable sutures .
Minimally Invasive Posterior Lumbar Fusion The minimally invasive posterior lumbar fusion is indicated for patients who have lumbar radiculopathy (nerve root compression and/or injury), spondylolisthesis, ligamentous instability, spinal stenosis and/or vertebrae fractures. There are many approaches and surgical techniques a neurosurgeon must take into account when choosing the best surgery for his or her patient. A few approaches include the Anterior Lumbar Interbody Fusion (ALIF), the Transforaminal Lumbar Interbody Fusion (TLIF), the Extreme-Lateral Lumbar Interbody Lumbar Fusion (XLIF) and the Posterior Lumbar Interbody Fusion (PLIF). Although Dr Weber has used multiple approaches and microsurgical techniques, he has chosen to refine the posterior approach for his lumbar fusions. However, additional information about other approaches can be provided in the office upon request. The traditional posterior lumbar fusion (PLIF) required a relatively long incision, was complicated by a large amount of blood loss requiring blood transfusions, involved extensive muscle and ligament damage, and required a long recovery and rehabilitation period resulting in a high risk for chronic low back pain after surgery. Dr. Weber has advanced his posterior approach with the development of a Minimally Invasive Posterior Lumbar Fusion that can be performed through two small 3 cm skin incisions. The minimally invasive fusion utilizes the METRx Muscle Retracting System with the SEXTANT™ Percutaneous Rod Insertion System. This minimally invasive surgical procedure consists of three steps: 1. Decompression of nerves and spinal canal; 2. Fusion of vertebrae and 3. Stabilization of the vertebrae and fusion. First, a small 3 cm skin incision is made to insert the narrow tube from the skin down to the spine using the unique minimally invasive muscle retracting system (METRx). This system minimizes any damage to the muscles and soft tissue. With the aid of a high-powered microscope and microsurgical instruments, the decompression is achieved by removing disc, bone and enlarged calcified ligament. Next, the fusion is performed by placing a specially designed cage (hollow spacer) filled with the patient's own bone marrow and calcium phosphate crystals into the disc space. This spacer maintains disc space height and allows bone cells to grow from one vertebra to another. After the decompression and fusion are completed, the tube is removed allowing the retracted muscles to close together undamaged. This technique is followed by the insertion of titanium pedicle screws and rods under fluoroscopy (portable x-ray machine) via the SEXTANT™ Percutaneous Rod Insertion System. The fascia and skin are closed using dissolvable sutures. The result is a marked reduction in blood loss, decreased hospital stay, speedy recovery time and decreased risk of chronic low back pain after surgery. The fusion process can take approximately 3 to 6 months depending on a patient's medical problems, tobacco history and age. After the bone is healed, the titanium screws and rods may be removed.
Direct Lateral Interbody Fusion (DLIF) The direct lateral interbody fusion is a minimally invasive lumbar spine fusion that can be utilized for patients who have lumbar radiculopathy (nerve root compression and/or injury), ligamentous instability and lumbar spinal stenosis. This DLIF is different from other interbody lumbar fusions in that the decompression, fusion and stabilization are done from a direct-lateral approach. First, a small approximately 3 cm skin incision is made on the patient’s left or right side. Next, a narrow tube is gently inserted through the soft tissue and psoas muscle under fluoroscopy using a minimally invasive muscle retracting system. This system minimizes any damage to the muscles and soft tissue and is performed in conjunction with neuromonitoring. With the aid of fiber optics the discectomy can be achieved with microsurgical instruments. The fusion is performed by placing a specially designed cage (hollow spacer) filled with the patient's own bone marrow and calcium phosphate crystals into the disc space. This spacer maintains disc space height and allows bone cells to grow from one vertebra to another (fusion). After the decompression and fusion are completed, a titanium plate and screws are inserted under fluoroscopy to obtain stabilization. The tube is removed allowing the separated muscle fibers to close together undamaged. The fascia and skin are closed using dissolvable sutures. The result is a marked reduction in blood loss, decreased hospital stay, speedy recovery time and decreased risk of chronic low back pain after surgery. The fusion process can take approximately 3 to 6 months depending on a patient's medical problems, tobacco history and age.
. Bone densitometry is used to determine bone mineral content and density to diagnosis osteoporosis as early as possible. Osteoporosis & osteopenia (low bone mass) are terms used for bone that becomes weakened which can lead to fractures easily. Testing is painless and takes approximately 10 minutes. Several groups of bones are routinely evaluated because they accurately represent the entire skeleton. The lumbar spine is the best representative of cancellous bone (sponge-like inner structure). The radius is the most easily studied cortical bone (compact outer layer). The hip (neck of the femur) is the best representative of mixed (cancellous and cortical) bone. How it works: A DEXA machine directs photons through a bone into a gamma detector. If a bone is dense, it will absorb more photons then a bone that has osteoporosis (less dense). This is measured by the gamma detector. The measurement is charted and compared to the sex, height, weight and race of a patient the same age to determine if he or she has osteoporosis or osteopenia. A diagnosis of osteoporosis can be made when vertebral done density is more the 10% below that expected according to the chart. The measurement is then translated into a T-score. The World Health Organization has established diagnostic guidelines as T-score -1.0 or greater is "normal." A T-score between -1.0 and -2.5 is osteopenia and -2.5 or below as osteoporosis.
Osteoporosis Risk Factors Non-Modifiable:
Female Age Family History of Osteoporosis Family History of Fractures European or Asian Ancestry Dementia Modifiable:
Low Calcium and Vitamin D intake Inadequate Physical Activity (i.e. too little or if done in excess) Estrogen Deficiency Early Menopause (<45 years) or bilateral oophorectomy Premature ovarian failure Alcoholism Recurrent falls Prolonged use of prescription steroids (i.e. prednisone) Low body weight <127lb Poor Health Intake of soft drinks (containing phosphoric acid) Various Metabolic & Endocrine Disorders You should see your doctor or if you are concerned about osteoporosis or have multiple risk factors for osteoporosis. |
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