How do I get an appointment with a neurosurgeon?
People seeing BayCare Clinic neurosurgeons for the first time must have a referral.
Your physician or medical provider will send that referral to our office. Our staff will contact you to schedule your first appointment.
What are the indications for cervical fusion?
This procedure is commonly done to treat a disc herniation or a bone spur that causes pressure on a spinal nerve which results in pain in the arm. The surgery is also done to relieve pressure on the spinal cord that can cause damage to the spinal cord, causing symptoms in the neck, arms and even legs. The surgery is done in some cases to stabilize the spine after trauma.
Why is the anterior cervical fusion surgery done from the front (anterior) of the neck versus the back (posterior) of the neck?
Generally, for patients that have purely a "soft" disc herniation, the pressure can sometimes be relieved by a posterior approach. For patients that have a combination of disc herniation and some bony spurs that crowd the hole through which the nerve leaves the spine, surgery is often performed from the anterior (front) approach because the spurs are easier to remove from the front and this can be done without retracting the delicate spinal cord when done from the front.
Why do you use cadaver bone during spinal fusion instead of your own bone from the patient’s hip?
Using a patient's own bone (taken from the patient's hip) causes much more discomfort for the patient. Patients that had their hip bone used often reported several weeks of pain near that incision and that's what increased the use of cadaver bone products. More recently, synthetic spacers have been developed also.
The decision as to which material to use is made between the surgeon and the patient based on the patient's condition (e.g. how many levels are to be treated) and other factors such as the patient's use of tobacco products. Smoking has been shown to have a slow bone healing and fusion and for that reason it is sometimes preferable to use a patient's own bone to encourage bony fusion for patients that smoke.
Does everyone going through cervial fusion have a stability plate as part of the surgery?
In our experience, most patients do choose to have a stabilizing plate applied as part of anterior cervical fusion surgery. While it is not required for non-trauma cases, (for many years the procedure was done without plates), using a plate does increase the success of the fusion and for patients that are not having multiple levels treated, using a plate can eliminate the need to wear a collar for a time after surgery.
Will the metal plate screws used during fusion surgery cause airport metal detectors to go off?
The metals currently used are not magnetic and will not cause alarms at airports.
Are braces or collars always needed after cervical fusion surgery?
Generally, for a single level fusion, a brace or collar is not necessary for most patients. The decision about use of neck brace depends on several factors including the strength of the patient's own bone (or if the patient has osteoporosis), use of tobacco products by the patient and how many levels of the spine are being treated. In cases for which a collar or brace is prescribed, the type of collar and how rigid it is along with the length of time that its use is recommended will also vary.
What are the risks to vertebrae & discs above & below the area of an anterior cervical fusion?
There is evidence to suggest that patients that have a fusion of the cervical spine may be more likely to develop problems at other levels of neck. The thought behind this is that as one level is "fused" and does not move any longer, that stresses and movements are then transmitted to other levels and this may increase the rate at which they develop what are called degenerative changes. Some patients do go on to need surgery at more than one level of the spine.
How long does it take to heal and be without pain after an anterior cervical fusion?
The recovery time after and anterior cervical fusion depends on the number of levels treated and what activities someone wants to do.
For an average 1 level fusion, most patients can go home the day of surgery. They are able to take care of themselves and to do light activities right away, even returning to work is OK if their job is a sedentary one. Patients that do heavy work are generally advised to wait longer, between 4-8 weeks before returning to their jobs.
It's important to remember that each patient's progress is unique to them and follow-up visits with the surgeon who performed the procedure are the key to monitoring progress and increasing activity in a manner that doesn't complicate the healing process.
What is the chance that the patient will have to have a repeat procedure; the chance that a patient will have to have the operation done over again?
In our experience, patients that develop recurrent symptoms after an anterior cervical fusion are more likely to do so at other levels of the cervical spine (as opposed to the level that was treated). It is unusual to need a "re-do" procedure at the spinal level treated by anterior cervical fusion because the entire disc is removed during the procedure. However, as the bones of the neck "fuse" and motion is restricted at that level, it is recognized that the stresses are then transmitted to other levels, which can predispose them to degenerative changes.
As for a percent of patients that have a "re-do" procedure at another level, different studies have been done. One study reported the incidence of developing new symptoms as just less than 3% per year in a cumulative manner up to approximately 25% likelihood in 10 years with about 2/3 of that group of patients needing additional cervical spine surgery.
What are the indications for lumbar laminectomy / discectomy?
This procedure is commonly done to treat sciatica (leg pain) that is caused by a disc herniation (also called ruptured or slipped disc) or an osteophyte (bone spur) putting pressure one of the nerves of low back.
Is the entire disc removed during a microdiscetotomy?
No. Only the ruptured part of the disc (and any other part that looks/feels abnormal to your surgeon) is removed during surgery. Usually this is less than 15% of the disc. The remaining disc continues to act as a shock absorber between the two spinal bones (vertebrae).
Is it OK to delay spine surgery until I can afford to be off of work? Will I do more damage if I delay surgery?
The nerves control pain, function and other symptoms such as sensation. Usually the decision to have surgery depends upon the degree of pain and how much the pain interferes with daily activities. However, if weakness is present the longer that the pressure on the nerve continues, the less predictable the response to surgery.
How successful is low back surgery?
Most patients notice significant relief of leg pain shortly after surgery. Some patients do experience continued back pain and may need other treatment for that.
When can I return to work and other activities after anterior cervical fusion or lumbar laminectomy/discetomy?
Most people go home the day of surgery. People with sedentary (desk) jobs can return to work as soon as they are comfortable enough to drive, usually within a week. Those returning to jobs that involve heavy lifting are likely to be off of work 4-8 weeks.
Will my back be “normal” after lumbar laminectomy/discectomy surgery?
Even with excellent pain relief the surgery involves making a small window in the bone over the nerves and removing part of the disc and therefore the disc will never be completely "normal" after surgery. (If it was a "normal" disc, it would not have ruptured in the first place).
Because the disc is abnormal, there is a risk of that same disc rupturing again.
What are the indications for lumbar fusion?
This procedure is most often done to treat low back pain (with or without leg pain) caused by an abnormal or degenerated disc between two spinal bones (vertebrae) or to correct a "slip" of one vertebrae over another called a spondylolisthesis. In other cases, it is done to stabilize the spine if it was injured in trauma.
What is involved in a lumbar fusion?
A fusion usually involves a laminectomy and discectomy (removal of the back of the spinal bone and of disc material) that causes pressure to the nerves. The disc may be replaced with a synthetic space and the patients own bone is used to "bridge" the space between spinal bones so that the body can heal or "fuse" that segment of spine which stops motion. Typically metal hardware is implanted to prevent motion while the bony fusion occurs.
How long is the hospital stay after lumbar fusion?
Most patients stay 1-3 days. After leaving the hospital patients can take care of themselves and do light things about the house.
Will I still be able to bend after a lumbar fusion?
Most of the motion to bend comes from the hips and the bending needed to daily activities is not impaired by most fusion procedures.
Will I need physical therapy after a lumbar fusion?
After surgery, the hospital nurses will help you out of bed to sit in the chair. This is really the start of your therapy. It is important to use your pain medication and to be up and lightly active soon after surgery. Physical therapists are available to help with instruction and specific exercises for you if needed.
What is disc replacement surgery?
Disc replacement surgery or Total Disc Arthroplasty (TDR) is an option for patients with pain caused by degenerative discs in the neck or low back that have not had adequate pain relief with non-surgical (conservative) treatments.
In TDR the patient's abnormal disc is removed just as it would be in a traditional fusion procedure. However, in a fusion, the disc space is packed with a graft material that the body will fuse and in TDR, a mechanical device is placed in the disc space that allows continued movement at the spinal level.
How long is the hospital stay for disc replacement surgery?
Patients undergoing TDR typically stay in the hospital about the same length of time as those undergoing a fusion.
Is disc replacement covered by insurance?
Because TDR is a fairly new treatment option, some insurances do cover the surgery. However, despite being an FDA approved procedure, other insurances do not. For this reason, it is important to contact your insurance company to find out if the procedure is covered, and if it is, to complete all preauthorization from the insurance company before surgery.