FREQUENTLY ASKED QUESTIONS

A majority of back and neck problems can be treated effectively without spinal surgery. Non-surgical treatment can include physical therapy, pain management, massage and alternative medicine techniques. The new standard of care today is to combine these therapies to maximize patient outcomes.

Massage is a popular therapy that helps millions of people with a wide variety of spinal conditions. Massage improves blood circulation, relaxes muscles for improved range of motion, and leads to increased endorphin levels, which is very effective in managing pain.

For many patients, managing the pain of their condition is the most important aspect of their treatment. A pain management specialist develops a treatment plan to relieve, reduce, or manage pain and help patients return to everyday activities quickly without surgery or heavy reliance on medication.

After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.

Members of your surgical team may ask you to respond to some simple commands, such as “Wiggle your fingers and toes” and “Take deep breaths.” When you awaken, you will be lying on your back, which may seem surprising, if you have had surgery through an incision in the back; however, lying on your back is not harmful to the surgical area.

Prior to the surgery, an intravenous (IV) tube will be inserted into your arm to provide your body with fluids during your hospital stay. The administration of these fluids will make you feel swollen for the first few days after the operation.

When you awake from the anesthesia, you may feel the urge to urinate. So, in addition to the IV, a catheter tube (also commonly called a Foley Catheter) may be placed into your bladder to drain urine from your system. The catheter serves two purposes: (1) it permits the doctors and nurses to monitor how much urine your body is producing, and (2) it eliminates the need for you to get up and go to the bathroom. Once you are able to get up and move around, the catheter will be removed, and you can then use the bathroom normally.

During your hospital stay, you will get additional instructions from your nurses and other members of your surgical teams regarding your diet and activity.

Proper nutrition is an important factor in your recovery. Your surgeon may restrict what you drink and eat, or place you on a special diet, depending on the surgical approach that was used during the operation.

Through a small incision made near the front of your neck (a surgical approach called the anterior approach) your surgeon will:

Gently pull aside the soft tissues – skin, fat and muscle – as well as the trachea, or windpipe, to access the cervical spine. Expose the area where disc fragments and/or bone spurs are pressing against the neural structures.  Remove the disc and bone material from around the neural structures to give them more space.  Insert and secure the artificial disc into the intervertebral space, using specialized instruments. 

Ease the soft tissues of the neck and other structures back into place; and close the incision. Knowing what to expect during your procedure can help you face your surgery with confidence. Your doctor can give you additional details about the procedure specific to your condition.

Recovery:

We will have a specific post-operative recovery plan to help you return to your normal activity level as soon as possible. Your length of stay in the hospital will depend on your treatment and physical condition. You typically will be up and walking by the end of the first day after the surgery. Your return to work will depend on how well your body is healing and the type of work/activity level you plan to return to.

Posterior lumbar interbody fusion (PLIF) is a type of spine surgery that involves approaching the spine from the back (posterior) of the body to place bone graft material between two adjacent vertebrae (interbody) to promote bone growth that joins together, or “fuses,” the two structures (fusion). The goal of the procedure is to restore spinal stability.         

Today, a PLIF may be performed using minimally invasive spine surgery, which allows the surgeon to use small incisions and gently separate the muscles surrounding the spine rather than cutting them. A minimally invasive approach preserves the surrounding muscular and vascular function and minimizes scarring.

A PLIF may be recommended as a surgical treatment option for patients with a condition causing spinal instability in their lower back, such as degenerative disc disease, spondylolisthesis or spinal stenosis, that has not responded to conservative treatment measures. The symptoms of lumbar spinal instability may include pain, numbness and/or muscle weakness in the low back, hips and legs.

We will take several factors into consideration before recommending a PLIF, including the condition to be treated, your age, health and lifestyle and your anticipated level of activity following surgery. 

We will make a small incision in the skin of your back over the vertebra(e) to be treated.  The muscles surrounding the spine will then be dilated to allow access to the section of spine to be stabilized. After the spine is accessed, the lamina (the “roof” of the vertebra) is removed to allow visualization of the nerve roots. The facet joints, which are directly over the nerve roots, may be trimmed to give the nerve roots more room.

The nerve roots are then moved to one side and disc material is removed from the front (anterior) of the spine. Bone graft is then inserted into the disc space. Screws and rods are inserted to stabilize the spine while the treated area heals and fusion occurs.

We will then close the incision, which typically leaves behind a small scar. This minimally invasive procedure typically allows many patients to be discharged the day after surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all their symptoms; other symptoms may improve more gradually.

Cervical foraminotomy is an operation to enlarge the space where a spinal nerve root exits the cervical spinal canal to relieve the symptoms of a “pinched nerve.”

Compression of the cervical nerve roots can cause neck pain, stiffness, and pain radiating into the shoulder, arm, and hand, as well as numbness, tingling and/or weakness in the arm and hand. Protruding or ruptured discs, bone spurs, and thickened ligaments or joints can all cause narrowing of the space where the nerve exits the spinal canal and causes the above symptoms. Patients who do not improve with conservative treatment may be candidates for the operation.

Some pain at the operative site is expected but generally resolves over time and can be controlled with oral pain medicines. Some patients can be discharged the same day of surgery, but most patients will require 24-48 hours in the hospital. Most patients will notice immediate improvement in some or all their symptoms, however some symptoms may improve only gradually. A positive attitude, reasonable expectations, and compliance with the doctor’s recommendations all contribute to a satisfactory outcome. A cervical collar (brace) is rarely necessary. Most patients can return to their regular activities within several weeks.

A small incision is made in the middle of the neck after localizing the area of interest with an x-ray. The muscles on the side of the spine involved are dissected and a retractor is placed. (Sometimes an endoscope and tubular retractor or microscope are used). Bone from the posterior arch of the spine and joint over the nerve are removed using special cutting instruments and/or a drill. Thickened ligament, bone spurs and/or bulging discs are removed to decompress the exiting nerve, which is checked with a probe to insure adequate space around the nerve root. The muscles and tissues are closed in layers with absorbable sutures. The skin may be closed with absorbable sutures and steri-strips, or surgical staples, which are removed when the wound is well healed.

Ultra–Minimally Invasive Spine Surgery (Ultra-MIS)—also known as Endoscopic Spine Surgery (ESS)—utilizes a pencil-thin incision (approximately ¼ inch or smaller) and high-definition endoscopic visualization to perform precise spinal procedures with minimal disruption to surrounding muscles and tissues. This advanced approach provides superior visualization of spinal anatomy and is associated with faster recovery, markedly reduced postoperative pain, minimal blood loss, and, in some cases, elimination of opioid requirements.

Key features of this approach include:

• Targeted Access: Rather than cutting through muscle, surgeons gently dilate soft tissue to reach the spine, preserving muscle integrity and significantly reducing surgical trauma.

• Advanced Technique: A specialized endoscope equipped with a high-resolution camera allows surgeons to accurately navigate the spinal canal, remove damaged tissue, treat herniated discs, and decompress affected nerves.

• Accelerated Recovery: Most procedures are performed on an outpatient basis, enabling patients to resume normal activities within days instead of weeks.

• Broad Clinical Applications: Effective in treating conditions such as spinal stenosis, herniated discs, and degenerative disc disease.

Compared with traditional open spine surgery, Ultra-MIS represents a significant advancement, offering less tissue damage, improved patient outcomes, and a more rapid return to function.

Physical Therapy (PT) is often prescribed for patients with back pain and other spinal problems. It can help to reduce pain, increase flexibility, build strength, and even improve your posture. A well-designed PT treatment plan can help speed a spine patient’s recovery. Water therapy (also called aquatic therapy), is an element of PT treatment plans that consists of a variety of aquatic-based treatments and exercises designed for back pain relief and to condition and strengthen muscles. Water therapy exercise offers many of the same benefits associated with a land-based exercise program with the added benefits of water.

The term alternative medicine encompasses a wide array of treatments, which may include acupuncture, yoga, Pilates and Tai Chi. Although supporting research is limited, many patients experience positive progression and relief from pain as a result of alternative treatments.

Acupuncture – Acupuncturists insert very fine needles (sterilized and disposable) into precise points on the body called Meridians. The purpose of acupuncture is to restore a healthy flow of energy throughout the body.

Yoga – Yoga works to integrate the mind, body and spirit, incorporating ethical disciplines, physical postures, gestures, breathing exercises and meditation.

Pilates – Pilates is a unique system of stretching and strengthening exercises that involves exercises performed using specialized equipment that both supports and challenges functional movements.

Tai Chi – Tai Chi has demonstrated usefulness in the prevention and treatment of certain problems such as back pain. Tai Chi is non-invasive, relatively inexpensive and gentle on the spine. Many people with back pain use it as an adjunct to traditional medical approaches

After the operation, you will be brought to the recovery room or intensive care unit (ICU) for observation. When you wake up from the anesthesia, you may be slightly disoriented, and not know where you are. The nurses and doctors around you will tell you where you are, and remind you that you have undergone surgery. As the effects of the anesthesia wear off, you will feel very tired, and, at this point, will be encouraged to rest.

This minimally-invasive procedure is performed through a tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. This surgery is usually performed on an outpatient basis, which allows the patient to leave the hospital the same day.

Guide Wire Inserted: A guide wire is inserted through a small incision to locate the correct disc level. The surgeon uses a special type of x-ray machine called a fluoroscope to ensure that the route to the herniated disc is made in the correct location.

Dilating Tubes Inserted: A series of dilating tubes are passed over the guide wire to push apart the tissue down to the vertebrae. The guide wire is then removed.

Retractor Inserted: The tubular retractor, through which the surgery will be performed, slides over the dilating tubes. It is positioned on the bone surface. All the dilating tubes are then removed.

Instruments Inserted: A surgical light and small camera or microscope are used to see through the tube. Surgical instruments are used to clear away bone and soft tissue in order to access the spinal canal.

Spinal Cord Moved: A nerve retractor is used to gently move the spinal cord away from the herniated disc. Herniated Portion Cleared: The herniated portion of the disc is removed and the area is cleared, which allows room for the nerve to move back to its normal position.

End of Procedure: The tubular retractor is removed, allowing the body tissue to close around the surgery area. A small bandage is used to close the surface wound.

Cervical artificial disc surgery is a type of joint replacement procedure, or arthroplasty, which involves inserting a cervical artificial disc into the intervertebral space after a natural cervical disc has been removed.

A cervical artificial disc is a prosthetic device designed to maintain motion in the treated vertebral segment. A cervical artificial disc essentially functions like a joint, allowing for flexion, extension, side bending and rotation. 

Cervical artificial disc replacement surgery may be an appropriate treatment option for you if:

- You have been diagnosed with cervical radiculopathy, myelopathy or both with the presence of disc herniation and/or bone spurs.

- Your symptoms did not improve after conservative treatment measures, such as exercise, pain relievers, physical therapy and/or chiropractic care.

- You require treatment at only one cervical level.

- You are at least 18 years of age with skeletal maturity.

- Are not pregnant or nursing at the time of surgery.

To determine whether cervical artificial disc replacement surgery is the right treatment for you, your physician will perform a physical exam and other diagnostic testing, such as a spinal X-ray; magnetic resonance imaging (MRI), computed tomography (CT) scan, myelogram and/or a bone scan.

Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home – a list of “dos and don’ts,” which you will be asked to follow for the first 6 to 8 weeks of your home recovery. So, if you are unsure of any of these instructions, ask for clarification. Following these instructions is crucial to your recovery.

Nowadays, surgery involves one or more incisions depending on the surgical approach used to perform the operation. Therefore, when you are discharged home you may still have a surgical dressing on your incision(s). Either a nurse will visit your home to change the dressing or a caregiver, such as one of your family members, will be taught to do it for you. It is important that the dressing be changed daily and kept dry.

If any signs of infection are observed while changing the dressing, call your doctor. These signs include:

- Fever – a body temperature greater than 101°F (38°C)

- Drainage from the incision(s)

- Opening of the incision(s), and

- Redness or warmth around the incision(s).

In addition, call your doctor if you experience chills, nausea/vomiting, or suffer any type of trauma (e.g., a fall, automobile accident).

During this recovery period, you will also be instructed to keep your incision(s) clean, making sure only to use soap and water to cleanse the area. In general, you should not shower until your doctor has permitted you to do so.

In addition to caring for your incision(s), you will also be encouraged to:

- Drink plenty of fluids

- Maintain a healthy diet (high in protein)

- Walk or do deep-breathing exercises, and

- Gradually increase your physical activity.

Activities to avoid include any heavy lifting, climbing (including stairs), bending, or twisting. You should also avoid the use of skin lotion around the incision(s); you need to keep this area dry until it has had the opportunity to heal well.

Cervical myelopathy is a serious condition caused by compression of the spinal cord within the neck (cervical spine). This compression most commonly results from age-related degenerative changes such as cervical spondylosis, herniated discs, or spinal canal narrowing (stenosis). The condition is typically progressive and can lead to worsening neurological function if left untreated. Common symptoms include hand numbness or clumsiness, impaired balance, difficulty walking, and muscle weakness. Surgical decompression is often necessary to halt progression and relieve pressure on the spinal cord.

Key Aspects of Cervical Myelopathy

• Definition: A potentially progressive neurological disorder involving direct compression of the spinal cord—not just the spinal nerves.

• Symptoms:

  • Hands and Arms: Loss of fine motor control (such as difficulty buttoning clothing or changes in handwriting), weakness, numbness, and tingling.

  • Gait and Legs: Unsteady walking, balance difficulties, and coordination problems.

  • Additional Symptoms: Neck stiffness or pain, and in advanced cases, changes in bowel or bladder control.

• Causes: The most common cause is cervical spondylotic myelopathy, related to degenerative “wear-and-tear” changes of the spine with aging. Less common causes include tumors, infections, or traumatic injury.

• Diagnosis: Confirmed through magnetic resonance imaging (MRI) to visualize spinal cord compression, combined with a detailed neurological examination.

• Treatment Options:

  • Surgical Management: The standard treatment for moderate to severe symptoms or documented progression, with the goal of decompressing the spinal cord and preventing further neurological decline.

  • Conservative Management: May be appropriate in select mild cases and can include physical therapy, bracing, and medication.

Without appropriate treatment, cervical myelopathy can result in permanent spinal cord injury and significant, irreversible loss of function.