Spine Surgery
Surgical Treatments for Conditions of the Neck, Back and Spine
At our leading back and spine centers across New Jersey, RWJBarnabas Health offers the latest in surgical back pain treatment through disc replacement surgery, spinal fusion and other advanced spine surgery options to aid in healing your neck or chronic back pain. Our board-certified spine surgeons are leaders in the fields of orthopedics and neuroscience, with advanced experience in minimally invasive techniques using robotic tools and other groundbreaking methods.
If you have explored nonsurgical therapies such as massage, physical therapy, spinal traction, medications, spinal injections, or activity modification for pain management but have not found relief, spine surgery may be the next logical step. Some of our procedures include disc replacement surgery, foraminotomy, laminectomy, kyphoplasty, spinal fusion, traditional open surgery and spinal fusion using both traditional and newer, minimally invasive surgical techniques.
Spine Surgery Is Safe and Often Minimally Invasive
Advancements in technology have made many spinal procedures simpler and less invasive. With minimally invasive spine surgery, many procedures can be done with only a few small incisions in the back, making the post-surgical recovery period easier.
Disc Replacement Surgery
The bones that make up your spine are known as vertebrae. In between each vertebra is a round, rubbery piece of cartilage called a disc. The job of each disc is to absorb shock and keep the vertebrae in place. Although they can withstand a lot of pressure, certain situations such as trauma, a disorder or even general wear and tear can cause damage.
When a disc gets compressed (herniated disc) or slips out of place, added pressure is put on the surrounding spinal nerves. When this condition leads to chronic back pain or shooting nerve pain, a spine surgeon can treat the condition by performing disc replacement surgery when necessary.
Disc replacement surgery is performed by a highly skilled spine specialist and involves removing the damaged disc and replacing it with an artificial disc implant. The artificial implant may be made of medical-grade plastic, metal-grade alloys or a combination of the two.
This spine surgery is sometimes preferred over spinal fusion surgery as it still allows the patient to have movement throughout the entire spine.
Foraminotomy
A foraminotomy is a type of spine surgery that is performed to relieve pressure on the nerves.
The spinal cord is responsible for sending commands and sensory information to and from the brain, and the spine helps protect it from injury. Spreading from the spinal cord are nerves that help deliver these messages to the rest of the body. The nerves exit the spinal column through holes called foramen.
Some conditions may cause these holes to become too small, leading to pressure and chronic back pain that may also include pain or numbness in the arms and legs. Some of these conditions include spinal stenosis, degenerative arthritis, cysts or tumors. Some people may be born with narrow foramen.
During a foraminotomy, your spinal surgeon makes an incision or cut to expose the vertebrae and widen the foramen to relieve pressure on the nerves. Your spine surgeon may also remove any blockages that may be contributing to your chronic back pain, providing relief. A spinal fusion may also be required as part of this spine surgery to strengthen the back.
Laminectomy
A spine surgery known as a laminectomy or decompression surgery is performed to address nerve compression from a narrowed spinal canal. A portion of the lamina — a piece of bone that surrounds the spinal canal — may be removed to help provide more space.
During this procedure, the lamina is removed by a spine surgeon who then widens the spinal canal to relieve pressure on the spinal cord and nerves. This is a common treatment for spinal arthritis, which can cause the lamina to develop painful spurs.
As a more advanced surgical back pain treatment, this procedure is also performed to treat herniated discs or remove spinal tumors. This form of spine surgery may be helpful when more conservative treatments, such as medication, physical therapy or injections have failed to relieve symptoms of chronic back pain.
Kyphoplasty
This spine surgery is an advanced procedure that expands and stabilizes compression fractures in the spine.
Seldom a first option for spine surgery, kyphoplasty is most commonly performed on patients who have osteoporosis, an arthritic condition involving the weakening of the bones or on certain types of spine or vertebra fractures caused by cancer. It may also be performed on people who have had an injury to the spine.
During a kyphoplasty, a spine surgeon introduces a balloon device into the spine which is inflated so it can expand the bone. The cavity created by the balloon is then filled with a bone cement mixture to provide stability where the patient’s bone has been weakened. Once this spine surgery has been completed, an internal cast is formed inside this space in the vertebra. The cast stabilizes the damaged area and restores the lost height within the vertebral column. Most importantly, patients often have immediate improvement of their pain and can safely increase activity.
Spinal Fusion
When a patient is dealing with a herniated disc, weakness of the spine caused by arthritis or a spinal deformity such as scoliosis, spinal fusion may provide relief.
This spine surgery is performed while the patient is under sedation. Your surgeon may choose to use your bone, cadaver bone and/or bone substitutes as materials to achieve a spinal fusion. The spine surgeon places this bone between the two vertebrae that will be fused together. Metal plates, screws and rods may be used to hold the vertebrae together.
Endoscopic Spine Surgery
Endoscopic spine surgery is a procedure in which a small, high-definition scope is inserted into a patient’s back via a small incision to give surgeons a clear, magnified view of the spine. It helps enhance accuracy and precision as the surgeon conducts spine surgery. It results in reduced blood loss, a lower risk of infection, less pain and faster recoveries for patients than traditional open spine surgery.
RWJBarnabas Health pioneered the use of unilateral biportal endoscopy (UBE) for lumbar spine, which is a kind of endoscopic spine surgery, in New Jersey. UBE offers new possibilities to help relieve degenerative conditions such as spinal stenosis, herniated discs and spondylolisthesis, a condition in which a vertebra moves out of place.
Traditional Open Spine Surgery
Time-tested traditional open surgical techniques are often performed by spinal surgeons to treat a variety of chronic back pain causes. A spine surgeon can remove diseased bone and damaged discs and correct or replace them as needed, as well as insert screws, cages and other materials to stabilize the area. Advances in modern medicine have given rise to less-invasive spine surgery options for back pain treatment, but there are times when open spine surgery is still necessary.
Preparing for Spine Surgery
Deciding to have spine surgery is a big step. Once you have opted for surgical back pain treatment, it is important to discuss all of your concerns with your spine specialist prior to your procedure. Depending on your age, health condition and the type of surgery you are receiving, your spine surgeon may request a checkup from your primary care doctor or another doctor who oversees your care on a regular basis. This medical clearance test is performed to ensure that you are healthy enough for disc replacement surgery, spinal fusion surgery or other spine surgery, and the instructions from your doctor should always be followed.
Pre-Surgery Consultation
A presurgery consultation may include the following topics:
- Medication. Before your spine surgery, tell your doctor about any medications you are taking. Certain drugs can interfere with or create problems with anesthesia or the procedure itself. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen and some supplements act as blood thinners and will need to be stopped at least a few days before your procedure. In addition, many of the dietary supplements and neutroceuticals may need to be stopped prior to your procedure.
- Smoking. Nicotine users risk greater complications from surgery like slower healing and higher risks for infection. If you smoke, make sure you quit several months before your spine surgery. If necessary, enroll in a with a smoking cessation program so that you may proceed with your surgical back pain treatment. Learn about the Nicotine and Tobacco Recovery Program at RWJBarnabas Health.
- Donating blood. You generally aren’t required to donate blood before having spine surgery, however, some blood loss may occur during your procedure. For this reason, you may want to talk to your doctor about donating blood in advance.
- Advance planning. Designate a responsible adult to help you in your spine surgery recovery. You will need an initial period of rest after your procedure and some help with daily activities such as walking, getting dressed, bathing and doing chores. You may also need someone to drive you to and from appointments or shopping trips.
Your Health Team Will Make Sure You Understand What to Expect
Before surgery, we will provide you with patient education materials to prepare you for what to expect before, during and after surgery. Your health team will ensure that you have reviewed and understood the materials, and will make sure that any outstanding questions you may have are answered before your surgery.
Recovering from Spine Surgery
Be sure to ask your spine surgeon how long your scheduled surgery is expected to take and how long it may take to return to your usual activities. Remember that your spine surgery is just one part of your back pain treatment; the other portion may involve exercises and new lifestyle habits.
You may need the help of a responsible adult such as a friend, family member or home health aide to drive you home from the procedure and to help with your daily tasks.
Following your spine surgery, you can expect the following:
- Pain management. Your spine specialist may prescribe over-the-counter medications, local anesthetics or opioids for pain if needed. As part of the Opioid Use Reduction Initiative, we take opioid use seriously. If you are prescribed opioids as part of your back pain treatment, it is important to use them only as prescribed. Heavier or longer-term use of opioids to manage your chronic back pain can lead to addiction or cause other health issues.
- Posture. Proper spinal alignment is important following your surgery. Your spine surgeon will show you techniques on how to sit, stand, walk and move in a way that best encourages healing from your spine surgery. You may also be fitted with a brace or cast for additional support.
- Movement. Although your movement will be impacted following your spine surgery, it is important to do regular stretches, movements and walking, as advised by your doctor. This helps benefit your back pain treatment by encouraging healthy circulation and reducing your chances of developing a blood clot.
- Wound care. If your spine surgery involves minimal incisions, your wounds may be closed with absorbable sutures which dissolve on their own as the wound heals. Larger wounds may be closed with traditional stitches or staples, which will need to be removed by your spine specialist approximately two weeks after your surgery. Make sure to keep the wound site clean and covered, following the instructions provided by your spine surgeon.
- Diet and nutrition. Although a minor loss of appetite is to be expected after spine surgery, maintaining your strength and health in recovery is important. Eat well-balanced, nutritious meals and drink plenty of fluids throughout your recovery.
Risks Associated with Spine Surgery
With any surgery comes certain risks. Although complications from back surgery are relatively low, side effects and complications can occur and will depend on your health, condition and the type of spine surgery.
It is important to use your pre-surgery consultation to discuss any questions or concerns with your spine surgeon. If you encounter any of the following symptoms following your surgery, contact your doctor or dial 911.
- Blood clots. Often associated with long periods of inactivity such as bed rest, blood clots can sometimes result from a lack of circulation in the blood. Warning signs to be aware of after your spine surgery include pain in the calf, tenderness or redness above or below the knee and swelling in the lower leg, ankle or foot.
- Difficulty urinating or producing a bowel movement. Short-term bladder problems including dribbling, urinating only a small amount or feeling like your bladder does not empty completely are fairly common after surgery. Postoperative urinary retention (POUR), is a more serious condition that can occur when surgery interferes with your bladder function and requires monitoring.
- Heart attack. Undergoing surgery is a traumatic event for the body. Although rare, spine surgery can occasionally lead to a heart attack or myocardial infarction (MI). This is more likely to occur among patients who are at increased risk for a heart attack or have had previous cardiac issues.
- Infection. Post-spine surgery infections are unusual, but do sometimes occur. Redness, tenderness and swelling, liquid or drainage coming out of the wound, shaking, chills or a fever reaching or exceeding 100 degrees Fahrenheit are all signs of a potential infection.
- Nerve damage. Due to the complexity of spine surgery, temporary or long-lasting nerve damage can sometimes occur, resulting in pain, numbness or tingling.
- Problems with implants, rods or screws. Occasionally, problems occur when a piece of hardware or implant breaks or migrates after surgery. If this occurs, it can result in discomfort, pain or tissue damage which may need to be corrected in a later surgery.
- Stroke. Experiencing a stroke or transient ischemic attack (TIA) following spine surgery is very rare but possible. Patients with prior vascular issues have a slightly increased likelihood of this occurring.
Comprehensive Approach to Spine Surgery
At RWJBarnabas Health, our team of board-certified spine surgeons will administer your spine treatment with compassion and expertise. Our goal is to get you back to enjoying life as quickly and seamlessly as possible. Whether your condition requires nonsurgical therapies or spine surgery, we will work with you to tailor a back pain treatment plan that will help you heal and recover.
What Does It Mean to Be Board Certified?
When your physician is board certified, it means that they are dedicated to providing exceptional patient care through a rigorous, voluntary commitment to lifelong learning. Orthopedic surgeons are certified by the American Board of Orthopaedic Surgery and neurosurgeons are certified by the American Board of Neurological Surgery. In addition to completing education, residency and state licensure, your surgeon is committed to participating in continuing education programs to stay current with the latest advances and techniques in medical science and technology. In addition to Board Certification many RWJBarnabas Health spinal surgeons have also completed additional years of spine training by completing rigorous spine surgery fellowships.
To connect with an RWJBarnabas Health spine surgeon, request an appointment today.