TYPES OF NEUROLOGICAL SURGERY
This information is intended to give a broad overview of these tests and is not intended to be a comprehensive list of the benefits and risks associated with these tests. Should you have questions about any of the information presented here, please consult your physician during your next office visit.
Today, there are many forms of treatment for various conditions of the spine, brain, and peripheral nerves. Your physician will usually try to get you well by prescribing such things as physical therapy, nerve blocks, and sometimes medications. When these types of conservative treatment are not effective, or if your physician feels that they would not help your individual condition, surgery may be an option. If this is the case, he will discuss the type of surgery recommended with you, as well as the benefits and associated risks.
Preparing for Surgery
There are several things you can do to prepare for any type of neurological surgery. Your physician will give you exact instructions on how to prepare for your surgery based on your diagnosis, what type of procedure you are having, and any other health factors. Some of these things often includediscontinuing aspirin or other blood thinners several days before your surgery. It is best if you quit smoking, as smoking can lengthen the amount of time it takes to heal from surgery, especially spinal fusions. Be sure to arrange to have someone to take you home from the hospital and to be with you for the first few days after your surgery. You may want to have some meals already prepared so that you will not have to exert yourself cooking. One of our Patient Care Coordinators will also give you instructions such as to not eat or drink anything after midnight, where to go and what other medications to take the morning of your surgery.
Cervical Spine Surgery
Surgery for the Cervical Spine can be done through a small incision on the side of your neck (called an Anterior Cervical Discectomy and Fusion) or an incision down the back of your neck, called a Posterior Cervical Laminectomy. Your physician will determine which approach is best for you, based on your diagnosis and other factors.
During an Anterior Approach, you physician will make a small horizontal incision on the side of your neck somewhere above your collarbone. Special surgical instruments are used to reach the herniated disc and remove it, unpinching the nerve. Then a bone graft is inserted between the vertebrae, where the disc used to be. This is called a fusion. The fusion is to stabilize the vertebrae and try to prevent further problems in the cervical spine. Sutures are placed under the skin and steri-strips outside the skin to hold the incision closed as it heals. The sutures will not need to be removed, and the steri-strips will peel away from the skin in a few days under warm water.
In a Posterior Approach, a vertical incision is made down the back of the neck. Special surgical instruments are then used to remove the bone behind the disc, while other instruments are used to remove the herniated part of the disc and unpinch the nerve. Staples are placed on the outside of the incision to hold it closed as it heals. Your physician will inform you when you need to return to the office to have the staples removed.
Following either approach, you will spend a short time in the recovery room and then go to a regular hospital room. Many patients can go home the same day as their surgery. Your physician will determine if it is better for you to go home or spend the night and go home the next day. Before you leave the hospital, you will be given post-operative instructions on caring for your wound, restrictions on your activities, and when to return to the office for a post-operative visit.
PRESTIGE® Cervical Disc.(external link) Our surgeons are now utilizing the PRESTIGE® Cervical Disc as an alternative to the customary surgical treatment for patients suffering from degenerative disc disease or disc herniation in their necks.
Traditionally, a procedure called an anterior cervical discectomy with fusion (ACDF) has been the “gold standard” for surgical treatment. Using bone grafts and instrumentation such as metal pla tes and screws, this procedure fuses, or creates a bond between, two or more adjacent vertebrae, ideally stabilizing the segment and providing relief. Many patients achieve excellent results with ACDF.
The PRESTIGE® Cervical Disc replaces a diseased or damaged disc and is made of stainless steel with two articulating components (a ball on top and a trough on the bottom) that are inserted into the disc space and attached to the vertebral bodies on either side. This unique structure helps patients recover and maintain a natural range of motion in their necks.
Lumbar Spine Surgery
There are a variety of types of surgery for the low back, or Lumbar Spine. Your physician will decide what is the best type for you based on your diagnosis and other factors.
Two of the most common types of Lumbar surgery are a Lumbar Micro-Discectomy and a MetRX. Both are usually done under general anesthesia. In the Micro-Discectomy, your physician will make a small, vertical incision near your spine. Special surgical instruments and a microscope are used to locate the herniated part of the disc and unpinch the nerve. Staples are placed on the outside of the incision to hold it closed as it heals. The MetRx is a minimally invasive procedure(external link) and requires a smaller incision. The ruptured disc is removed through a small tube and the incision is usually closed using steri-stips instead of sutures or staples. Many patients can go home the same day as their surgery after a Lumbar Microdiscectomy and a MetRx. Your physician will inform you when you need to return to the office to have the staples removed.
Another common type of Lumbar surgery is a Lumbar Laminectomy. During this procedure, your physician will make a small, vertical incision near your spine. Special surgical instruments are used to locate and remove the Lamina, a certain section of the vertebrae. Once the lamina is removed, any bone spurs or disc material that is still pressing on the nerve can also removed, unpinching the nerve. Staples are placed on the outside of the incision to hold it closed as it heals. Most patients will spend a couple of days in the hospital before going home. Your physician will inform you when you need to return to the office to have the staples removed.
Sometimes, removing the bone spurs or herniated part of the disc is not enough. In this case, a Lumbar Fusion may be necessary to stabilize the spine and relieve pressure on the nerves. There are several types of Lumbar Fusions. Your physician will determine which is best for you based on your diagnosis and other factors. Lumbar Fusions require you to stay in the hospital several days following surgery.
In cases of a compression fracture of the lumbar vertebrae, a procedure known as Kyphoplasty may be recommended. Under general anesthesia, your physician will use a type of balloon to elevate the collapsed vertebral body to its correct position. The balloon is removed and the resulting cavity is filled with a special cement that holds the vertebral body in place. It’s like placing an internal cast to help a broken bone heal. Most patients go home the day after the procedure.
Your physician will determine what is best for you. Before you leave the hospital, you will be given post-operative instructions on caring for your wound, restrictions on your activities, and when to return to the office for a post-operative visit.
Carpal Tunnel Release
A Carpal Tunnel Release is an outpatient surgery, performed under local anesthetic and sedation. You physician will make a small incision at the base of your palm and release the carpal ligament, which covers the carpal tunnel. This frees the median nerve which runs through the carpal tunnel into the hand and fingers and relieves the symptoms of pain, tingling, and numbness you may have been experiencing prior to surgery. (Your hand and fingers may feel numb for several hours after surgery, due to the anesthetic administered in the operating room.) Once the surgery is over, your physician will give you instructions on how to take care of your incision at home, and tell you when to come back to the office to have your bandage changed or sutures removed.
Ulnar Nerve Decompression
An Ulnar Nerve Decompression is an outpatient surgery performed under general anesthetic. Your physician will make a small incision near the elbow and free the ulnar nerve which runs down the forearm and into the hand. An Ulnar Nerve Decompression should relieve the symptoms of pain, tingling, and numbness you may have been experiencing prior to surgery. (Your hand and fingers may feel numb for several hours after surgery, due to the anesthetic administered in the operating room.) Once the surgery is over, your physician will give you instructions on how to take care of your incision at home, and tell you when to come back to the office to have your bandage changed or staples removed.
Craniotomy
A Craniotomy may be necessary for many different reasons. Some of the most common reasons are bleeding and/or swelling of the brain, a brain tumor, or an aneurysm. Craniotomies are usually performed under general anesthesia. In the operating room, your physician will remove a piece of the skull, which is the bony covering around the brain. The size of the incision varies according to the reason for it Once a window is made into the skull, your physician will open the dura, or covering around the brain. The next step depends on your diagnosis. In the case of bleeding, the source of the bleeding is controlled and the excess blood and any damaged tissue are removed. For brain tumors, your physician may take a biopsy or try to remove as much of the tumor as possible. Sometimes, special chemotherapy wafers are placed in the brain where the tumor was to give further treatment to the tumor site. For aneurysms, the artery is clipped at the weakened spot to prevent normal blood flow from rupturing the area.
After the goal of the surgery is met, the dura is closed and the skull bone is usually replaced, held in place by small plates. Sometimes, a drain may be placed in the brain through a small burr hole in the skull to allow blood or fluid to continue to exit the brain for a few days following surgery. The skin is closed with staples and covered with a bandage.
Once the incision is closed, you will go to ICU, the Intensive Care Unit, to be closely monitored for a day or two. In most cases, steroids will be prescribed for a short time to reduce or prevent any brain swelling. Anticonvulsants may also be prescribed for a short time to prevent seizures. Your physician will prescribe the medications that are appropriate for you and your condition.
