Spinal surgeries

Question 1

what is the difference between a discectomy and a microdiscectomy?

Answer 1

the former removes a large piece of the vertebral disc while the latter describes part of the bulging disc being shaved off (along with maybe some bone and ligament)

Question 2

what is a laminoforaminotomy?

Answer 2

lamina+ potentially part of the facet processes/post disc/part of ossified PLL using fluoroscopy
-addresses facet pain

Question 3

describe a laminoplasty

Answer 3

this “open door” surgery basically laterally shifts the spinous process and opens the space up by adding a bridge to the lamina

Question 4

describe the approach, process and indication for a laminectomy

Answer 4

posterior approach to remove the spinous processes and both laminae to open up central canal–but it has to be less than 25% of the zpop articulation (otherwise a fusion is indicated)

Question 5

Describe the procedure for an anterior cervical discectomy and fusion (ACDF aka anterior arthrodesis)

Answer 5

1. remove cause of compression
2. immobilize @ disc level
3. distract vertebral segments
4. internal fixation + graft
5. Halo stabilization

Question 6

where does the graft typically come from for an ACDF (anterior cervical discectomy and fusion) procedure?

Answer 6

6-7 mm from illiac crest or cadaver

Question 7

describe the process of a cervical disc arthroplasty

Answer 7

disc space is distracted to “typical” height and a prosthetic is implanted.

typically allows for d/c in 24-48 hrs w/ min restriction+ 1-3 month x ray f/up

Question 8

Describe the process and indication for a medial branch neurotomy

Answer 8

radiofrequency ablation of medial branch dorsal rami in order to relieve pain in z-joint.

Question 9

Describe the process and indication for a percutaneous discectomy.

Answer 9

partial or full suction of nucleus via a probe to address HNP/disc pathology

Question 10

why and how would someone undergo an interbody fusion.

Answer 10

To eliminate segmental motion and stress secondary to stenosis via TLIF or ALIF

Question 11

Transforaminal lumbar interbody fusion (TLIF) and Anterior Lumbar Interbody Fusion (ALIF) involve 2 different approaches. describe each. Which is more common now?

Answer 11

TLIF- fixation via bone graft+ titanium mesh> distracted IV space.

ALIF- fixation w/ bone graft, cages, dowels

TLIF more commonly used

Question 12

arthroplasty is more common in the____ (cervical/lumbar) spine than in the (cervical/lumbar). Because it enables motion there is a decreased risk of adjacent joint degeneration.

Answer 12

lumbar, cervical