Step 3:Surgical instruments are used to remove the herniated disc. A bone graft is cut to the correct size and placed in between the vertebrae to add stability.

Step 4: A metal plate is placed over the bone graft. Two holes are drilled in each vertebra. Four screws are placed through the plate, to secure the plate to the vertebra adding additional support.

Summary Some patients require a cervical collar (brace) for a short period of time after surgery.

Introduction

A cervical laminectomy is performed to remove pressure on the spinal cord. Instrumentation can be added to provide stability to the spine.

Step 1: An incision is made in the back of the neck.

Step 2: Surgical instruments are used to remove the spinous process and lamina on the back of the spine.

Step 3: A motorized instrument (Bur) is used to remove the top layer of the remaining bone. This is the site where the fusion occurs.

Step 4: Hooks are placed on the back of the spine. The hooks are connected by metal rods and are added to provide stability.

Step 5: A second incision is made over the back of the pelvis. Bone is removed from this site and placed in the neck. This bone eventually ‘grows,’ fusing the spine and providing additional stability.

Summary: A cervical collar is often worn for 6 weeks following surgery. Patients should be careful to avoid heavy lifting and excessive neck motion for the first 6 weeks. Patients often have pain from the waist, where the bone graft was removed.

Introduction A cervical laminoplasty is performed to remove pressure on the spinal cord. Step 1: An incision is made in the back of the neck. Step 2: A motorized instrument (Bur) is used to cut 2 channels vertically on the back of the spine (lamina). Step 3: The lamina is then lifted and rotated. This increases the space for the spinal cord, relieving the compression that causes pain Step 4: Suture is placed around the spinous process. This is then tied to the back of the spine. This keeps the lamina in the elevated, rotated position. Summary: A cervical collar is often worn for 6 weeks following surgery. Patients should be careful to avoid heavy lifting and excessive neck motion for the first 6 weeks after surgery.

Introduction

Cervical laminotomies are performed to relieve the pressure on a nerve in the neck. Removal of bone spurs or disc herniations usually relieves arm pain.

Step 1: An incision is made on the back of the neck.

Step 2: Surgical instruments are used to remove a small portion of the back of the spine (lamina). Bone spurs are removed, to take the pressure off the painful nerves.

Summary: A cervical collar is usually worn for a short time after surgery. Many patients notice rapid relief of arm pain.

Introduction Correction of scoliosis usually involves the placement of multiple screws or hooks along the length of the curve. Step 1: A long incision is made in the middle of the back. Step 2: Metal screws are placed at multiple levels, on both sides of the spine. Step 3: Rods connect the screws. The rod is then rotated. This rotation straightens the spine. Step 4: A second incision is made over the back of the pelvis. Bone is removed from this site and placed in the back, next to the rods. This bone eventually grows, fusing the spine and providing additional stability. Summary: Surgical correction can achieve reduction of the curve by 50 percent. A brace is usually not necessary after surgery. Patients often have pain from the waist, where the bone graft was removed.

Introduction This procedure may be performed when a tumor has spread to the spine and is pushing on the spinal cord. Step 1: An incision is made in the middle of the back. Step 2: Surgical instruments are used to remove the spinous processes. Step 3: The lamina is removed to provide access to the tumor. Step 4: Surgical instruments are used to remove the tumor. This relieves the compression on the spinal cord Step 5: Screws are placed in the pedicles, above and below the tumor to provide support for the spine. The screws are connected with two rods. Summary: Radiation treatments are frequently used 2-4 weeks after surgery to treat any tumor remaining in the spine after surgery.

Introduction This procedure is used when a tumor has spread to the front of the spine, and the bone has fractured, sometimes pushing on the spinal cord. Step 1: An incision is made on the side of the chest. Step 2: Surgical instruments are used to remove the tumor. Step 3: The surrounding diseased bone is also removed. Step 4: A metal cage is placed between the remaining bones to act as primary support for the spine. Step 5: Screws are placed in the adjacent healthy vertebrae. The screws are connected together with metal rods to act as additional support. Summary: Radiation treatments are frequently used 2-4 weeks after surgery to treat any tumor remaining in the spine after surgery.

Introduction Anterior lumbar fusions are performed to remove a painful disc, and fuse the two vertebral bodies. Step 1: An incision is made on the lower abdomen, usually just left to the middle of the body. Step 2: Through this incision, exposure is provided to the front of the lumbar spine. Surgical instruments are used to remove the degenerated disc. Step 3: A drill is used to prepare the disc space for cage insertion. Step 4: Bone graft is placed in the cages to help new bone grow in and around the cage. The cages are then screwed into position between the vertebral bodies to provide stability. Summary: After a hospitalization of 2-4 days, patients should avoid strenuous activity for 6-12 weeks.

Introduction Artificial disc replacement involves the removal of the painful disc and replacement by a metal prosthesis. This new procedure is not yet widely available. Step 1: An incision is made on the lower abdomen, usually just left to the middle of the body. Step 2: Through this incision, exposure is provided to the front of the lumbar spine. Surgical instruments are used to remove the degenerated disc. The disc space is spread apart. Step 3: A metal disc replacement is placed between the vertebra. There is motion between the two halves of the disc replacement to mimic the original disc. This allows motion of the spine. Summary: Disc replacement is an exciting new technology that may give the patient an alternative to fusion for the treatment of a painful disc.

Introduction The addition of instrumentation known as pedicle screws to a lumbar fusion may improve the chance of a successful fusion. Step 1: An incision is made in the middle of the low back. Step 2: Surgical instruments are used to remove the spinous processes and lamina. This removes the pressure on the nerves. Step 3: A motorized instrument (Bur) is used to remove the top layer of the transverse processes. This is the site where the new fusion will occur. Step 4: A drill is used to make a hole in the pedicle area of the bone. Screws are placed in the drilled holes. Rods are placed to connect the screws. These rods and screws will provide stability to the spine. Step 5: A second incision is made over the back of the pelvis. Bone is removed from this site and placed on the transverse processes. This bone eventually grows, fusing the spine and providing additional stability. Summary: The addition of pedicle screws increases the strength of the spine after surgery and may decrease the need for a post-operative brace.

Introduction Posterior lumbar fusion is the common surgical method used to treat degenerative conditions of the low back. Step 1: An incision is made in the middle of the low back. Step 2: Surgical instruments are used to remove the spinous processes and lamina. This removes the pressure on the nerves. Step 3: A motorized instrument (Bur) is used to remove the top layer of the transverse processes. This is the site where the new fusion will occur. Step 4: A second incision is made over the back of the pelvis. Bone is removed from this site and placed on the transverse processes. This bone eventually grows, fusing the spine and providing stability. Summary: A brace may be required for up to 3 months after surgery. Patents often have pain from the waist, where the bone graft was removed.

Introduction Removal of the lumbar lamina is a common procedure performed to remove pressure on the spinal nerves. Step 1: An incision is made in the middle of the low back. Step 2: Surgical instruments are used to remove the spinous process. Step 3: The lamina and bone spurs are removed. The spinal nerves now have more space, with less pressure on the nerves. Summary: Patients are often discharged from the hospital after 1-2 days. Back pain from the incision usually subsides within 1-2 weeks.

Introduction This procedure involves removing the pressure on the nerves (laminectomy) and fusing the spine with bone grafts and screws. Step 1: An incision is made in the middle of the lower back. Step 2: Surgical instruments are used to remove the spinous process, the lamina and bone spurs. The spinal nerves now have more space, with less pressure on the nerves. Step 3: A motorized instrument (Bur) is used to remove the top layer of the transverse processes. This is the site where the fusion occurs. Step 4: A drill is used to make a hole in the pedicle. Screws are placed in the drilled holes. Rods are placed to connect the screws. This will provide stability for the spine. Step 5: A second incision is made over the back of the pelvis. Bone is removed from this site and placed in the back. This bone eventually ‘grows,’ fusing the spine. Summary: Patients often remain in the hospital for 2-4 days. Patients should avoid heavy lifting, bending, twisting and turning for 6-12 weeks.

Introduction

Surgery for removal of herniated discs is usually performed for patients with severe, shooting leg pains.

Step 1: An incision is made in the middle of the lower back.

Step 2: Surgical instruments are used to remove a portion of the lamina.

Step 3: The herniated portion of the disc is removed. This relieves the pressure on the painful nerve.

Summary: Patients usually notice rapid relief of leg pain. Occasionally, numbness persists for several weeks.

Introduction Fractures of the spine often involve the vertebral body. Severe fractures are unstable and often require surgery. Step 1: An incision is usually made on the left side of the upper abdomen. Step 2: Surgical instruments are used to remove the fractured bone, removing pressure off the nerves. Step 3: The vertebral body is replaced with a metal cage, filled with bone graft. Step 4: Screws are placed in the adjacent healthy vertebrae. The screws are connected together with metal rods. Summary: Replacement of the fractured bone with a metal cage restores stability of the spine. After 3-6 months the bone graft fuses between the vertebrae.

Introduction Surgery for removal of herniated discs is usually performed for patients with severe, shooting leg pains. Step 1: A short incision, approximately 3.5 cm. (1.5 inches), is made alongside the middle of the lower back. Step 2: Special dilators are used to go in between the muscles and sweep tissue (muscle) off the back of the spine bones (lamina). Step 3: After the initial dilator is “docked” on the back of the spine, larger dilators are placed to allow enough room for the surgical procedure. Step 4: The retractor is placed over the dilator and a lighting component is attached to provide illumination of the surgical field. After placement of the retractor, the dilators are removed. Step 5: A hex screwdriver is used on the retractor to open up the blades, holding the soft tissue out of the way. The surgical exposure is now complete. Step 6: Through the small opening in the retractor, the surgeon is now able to remove a portion of the lamina and facet to visualize the disc and nerves. Step 7: A grabbing instrument called a pituitary ronguer is used to remove a portion of the disc. By removing the herniated portion of the disc, the pressure on the nerve root is relieved. Summary: Patients usually notice rapid relief of leg pain. Occasionally, numbness persists for several weeks.

Introduction A posterior lumbar interbody fusion (PLIF) is a procedure that allows the surgeon to fuse the front and back of the spine through one incision on the back. This animation shows the PLIF procedure with a new surgical technique known as minimally invasive surgery. Step 1: A short incision (4.0 cm) is made in the middle of the low back. The muscles are moved aside and the back of the spine bone (lamina) is exposed. Cutting instruments are used to remove the back of the spine bone (laminectomy). A grabbing instrument (pituitary rongeur) is used to remove most of the intervertebral disc. Step 2: Decompression is performed by doing laminectomy, facectectomy, and disectomy. Step 3: A sharp awl is used to make a hole for insertion of the pedicle screw. Step 4: A screw is placed through the Techtonix Plate and then into the pedicle, ending in the middle of the vertebral body. Screws are placed on both sides of the spine. Step 5: Two more pedicle screws are then placed through the lower slot of the Techtonix Plate, into the pedicle and the vertebral body. Step 6: The disc space is then spread apart (distracted) and the screws are tightened to hold the disc space in this open position. Step 7: Two bone grafts are then placed in between the two vertebral bodies to allow for fusion of the vertebral bodies. Step 8: The inferior screws are loosened and the vertebral bodies are squeezed together (compressed). This allows for a tight fit of the grafts in between the vertebral bodies. Step 9: Small screws called blockers are placed on the pedicle screws to lock the screws to the Techtonix Plate. Summary: The Less Invasive Technologies (LITe) approach can be safely performed with less trauma to the surrounding muscles. This should lead to less postoperative pain, shorter hospitalizations and quicker patient recovery than traditional surgical methods.

Introduction A transforaminal lumbar interbody fusion (TLIF) is a procedure that allows the surgeon to fuse the front and back of the spine through one incision on the back. This animation shows the TLIF procedure with a new surgical technique known as Minimally Invasive Surgery (MIS). Step 1: A short incision, approximately 3.5 cm. (1.5 inches), is made alongside the middle of the lower back. Step 2: Special dilators are used to go in between the muscles and sweep tissue (muscle) off the back of the spine bones (lamina). Step 3: After the initial dilator is “docked” on the back of the spine, larger dilators are placed to allow enough room for the surgical procedure. Step 4: The retractor is placed over the dilator and a lighting component is attached to provide illumination of the surgical field. After placement of the retractor, the dilators are removed. Step 5: A hex screwdriver is used on the retractor to open up the blades, holding the soft tissue out of the way. The surgical exposure is now complete. Step 6: Through the small opening in the retractor, the surgeon is now able to remove a portion of the lamina and facet to visualize the disc and nerves. Step 7: A grabbing instrument called a pituitary rongeur is used to remove most of the intervertebral disc. The pressure on the nerve root is relieved by removing the herniated portion of the disc. Step 8: A bone graft is then placed in between the two vertebral bodies to allow for fusion of the vertebral bodies. Step 9: A sharp cutting needle is placed through the back of the spine, into the pedicle, to begin preparation for insertion of a titanium screw. Step 10: Pedicle screws are then placed over a guide wire and screwed through the pedicle, into the vertebral body. After the screws have been placed, the guide wire is removed. Step 11: A titanium rod is placed between the screw-heads. Step 12: Small screws called “blockers” are then placed over the rod and into the pedicle screw-heads for temporary fixation. Step 13: A torque wrench is then used for final tightening of the blockers to the screw-head. This allows for rigid fixation between the two vertebral bodies. Summary: The Less Invasive Technologies (LITe) approach can be safely performed with less trauma to the surrounding muscles. This should lead to less postoperative pain, shorter hospitalizations and quicker patient recovery than traditional surgical methods.

Introduction This procedure allows the surgeon to fuse the front and back of the spine, through one incision on the back. Step 1: An incision is made in the middle of the low back. Step 2: Surgical instruments are used to remove a portion of the lamina to allow access to the degenerated disc. Step 3: The degenerated disc is removed. A bone graft is placed in the disc space to provide stability. Step 4: A motorized instrument (Bur) is used to remove the top layer of the transverse processes. This is the site where the new fusion will occur. Step 5: A drill is used to make a hole in the pedicle. Screws are placed in the drilled holes. Rods are placed to connect the screws and add additional stability. Step 6: A second incision is made over the back of the pelvis. Bone is removed from this site and placed on the transverse processes. This bone eventually grows, fusing the spine. Summary: Patients often remain in the hospital for 2-4 days. Patients should avoid heavy lifting, bending, twisting and turning for 6-12 weeks. Patients often have pain from the waist, where the bone graft was removed.