Fort Smith Neuroscience Center

Figure 4:  Illustrates the healed incision that was utilized to perform this fusion procedure.


Figure 4: This x-ray demonstrates the removal of a cervical vertebral body (corpectomy) and subsequent reconstruction with a titanium cage


Ft. Smith Neuroscience Center offers comprehensive spine surgery options, including traditional open cervical and lumbar deompressions and fusions, minimally-invasive decompressions and fusions, cervical and lumbar arthroplasty, and complex techniques, such as corpectomies, occipital-cervical fusions, spinal tumor resections, and multilevel instrumentation and fusion procedures.

Cervical arthroplasty (or "artificial disk") is a modern technique that allows a standard anterior cervical decompression to be accomplished without a contomitant fusion.  Instead of replacing the disk with a fusion graft, a mobile implant is inserted (figure 1) that allows preservation of motion (figures 2 and 3).  This is an excellent option for patients who desire maximal preservation of spinal mobility after an anterior decompressive procedure.

Occasionally patients will develop stenosis adjacent to the vertebral body itself, as opposed to stenosis that typically occurs at the level of the disk space.  This can result from the formation of osteophytes, kyphotic deformity, or ossification of the posterior longitudinal ligament.  Treatment of stenosis adjacent to the vertebral body requires resection of this bone and the offending elements, which is referred to as a "corpectomy."  After the resection, the missing vertebral body or bodies are then reconstructed with titanium or other similar implants (figure 4).  These techniques are performed routinely at the Ft. Smith Neuroscience Center.
Figure 1: Drawing of Prestige(R) artificial cervical disk, courtesy of Medtronic

 

Figure 2


Figure 2: Illustrates spondylolisthesis (or "slippage") of the third lumbar vertebral body on the fourth lumbar vertebral body.
Figure 3:  Illustrates treatment of the spondylolisthesis with a minimally-invasive fusion procedure.


Complex Spinal Procedures


Fort Smith Neuroscience Center Spine Surgery

These lateral x-rays demonstrate the mobility of the cervical artificial disk with bending of the neck forward (flexion) and backward (extension)
Figure 3


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Figure 1: Diagram illustrating minimally-invasive port that is utilized to perform both decompression and fusion procedures on the lumbar spine.


Spine

Minimally-Invasive Spine Surgery

The development of the operative microscope, microinstruments, and improved access techniques have allowed traditional, open surgical spinal procedures to be performed in a less-invasive manner through smaller incisions.  This is traditionally called "Minimally-Invasive Spine Surgery" or MIS for short.  MIS procedures were originally simple procedures, encompassing basic decompressive procedures, such as lumbar microdiscectomies, foraminotomies, and hemi-laminectomies.  These procedures are now routinely performed through 16 to 18 mm incisions on an outpatient basis (see figure 1).  These procedures often result in less post-operative discomfort and earlier return to work compared to similar open surgical procedures.

When one considers MIS applications to more extensive spinal procedures, such as fusion and stabilization procedures,  the differences between open and MIS techniques can be dramatic.  A traditional open posterior lumbar fusion and instrumentation procedure requires a large incision (often 6 to 8 inches or more), along with aggressive, traumatic dissection of the paraspinous musculature, ligaments, and other tissues.  This procedure cannot be performed on an outpatient basis, and typically requires hospitalizations of 3-5 days.  MIS fusion procedures; however, can be performed through a 30 to 35 mm incision, which can result in a dramatic reduction in postoperative discomfort and hospital stays.  MIS fusions can be performed on an outpatient basis, with hospitalizations averaging less than 23 hours, and many patients are discharged the same day as the procedure.  The typical MIS fusion procedure requires approximately 60-90 minutes and is associated with minimal blood loss, which is a substantial improvement over traditional, open fusion procedures.  Even complex spinal problems, such as lumbar spondylolisthesis, can be treated with MIS fusion techniques (figures 2-4).

MIS technologies have resulted in less post-operative discomfort, shorter hospitalizations, and earlier return to work compared to traditional, open surgical spine procedures.  Ft. Smith Neuroscience Center routinely performs MIS decompressions and MIS fusions on an outpatient basis.