Spine Care

Cartilage Repair and Restoration

Cartilage does not heal well once it is damaged. If your joint is able to grow new cartilage, it will have a tendency to be rough and bumpy, therefore less able to provide you with smooth joint movement.

Our surgeons will work to repair or encourage the development of healthy cartilage through the following options:

• Bone marrow stimulation, which stimulates cartilage growth by making precise micro fractures in the surrounding bone
• Osteochondral transplantation techniques (OATS), also referred to as “mosaicplasty,” which involves transplanting cartilage from one site to another
• Autologous chondrocyte implantation (ACI), which requires two surgeries. In the first, cartilage cells are harvested and then grown in a laboratory for several weeks. During the second surgery the cartilage cells are re-implanted.

At VHC Health, the purpose of back surgery or neck surgery is to correct your anatomical lesions that fail to show improvement with conservative (nonsurgical) treatment. Surgery is only useful to change your anatomy (e.g. remove a disc herniation).

Reasons for Spine Surgery

Our spine surgeons will work to accomplish three tasks:

• Decompress a nerve root or the spinal cord
• Stabilize an unstable or painful segment with spinal fusion surgery
• Reduce a deformity (e.g. scoliosis surgery in the thoracic spine).

What causes the pain?

Degenerative back conditions erode your disk’s ability to handle mechanical stress, leading to your back pain. If you experience persistent pain you may suffer from symptomatic disk degeneration, a condition in which your disk loses its normal water content and the ability to absorb weight and shock during any motion.

Surgical Treatments

If your pain persists despite medical treatment, our spine surgeons may recommend surgery. Listed below are our surgical treatment options for degenerative back conditions:

• Laminectomies are recommended when you have spinal stenosis. In a laminectomy, the lamina, or back portion of the spine, is removed to give the nerves more room and reduce inflammation. Although the lamina will not grow back, scar tissue will develop and will protect the spinal nerves.
• Spinal fusion is recommended in the most severe degenerative back conditions and involves joining the bones together with screws or bone grafts to provide stability. It may be combined with laminectomy surgery. The surgery lasts several hours and can be done using one of two methods:
  • Bone is removed from elsewhere in the body or obtained from a bone bank. This bone is used to create a bridge between vertebrae and stimulate the growth of new bone.
  • Metal implants, such as rods, hooks, wires, or screws, are secured to the vertebrae to hold them together until new bone grows between them.

Surgical removal of an inferior disk may involve the removal of disk fragments and compression of the nerve. Micro-discectomy is often a preferred procedure requiring smaller incisions resulting in reduced scarring and a more rapid recovery.

The term ‘disc’ is short for ‘intervertebral disc’. These are the spongy cushions that separate your spinal bones (vertebrae). Discs provide you with shock absorption, keep your spine stable and give your vertebrae ‘pivot points’ to allow movement. 

Symptoms of disc problems

• back pain
• increased back pain when repetitively bending or with prolonged sitting
• increased back pain with coughing, sneezing, laughing or straining
• pain, numbness or pins-and-needles radiating into an arm or leg if a disc has caused irritation of a nearby nerve.

Types of disc problems

• disc strains and sprains
• degenerative disc disease (which can also be found in people who do not have any symptoms) 
• protruded discs (also called ‘herniated’, ‘prolapsed’, ‘extruded’ or ‘slipped’ discs). For some people, protruded discs can cause nearby nerve irritation and result in sciatica (nerve pain spreading into the lower limbs).

Treatment for disc problems

If you experience sciatica pain, your pain may be treated with an injection of anti-inflammatory steroids into the area of the affected spinal nerve. In severe cases of sciatica caused by a large disc protrusion, pain may be relieved by surgery to trim your protruding disc.

In severe cases of degenerative disc disease, surgery may be considered to remove your disc and fuse together the two vertebrae on either side. 

Fractures caused by osteoporosis most often occur in the spine. These spinal fractures — called vertebral compression fractures — occur in nearly 700,000 patients each year.

Cause

Your weakened vertebrae are at a high risk for fracture. A vertebral compression fracture occurs when too much pressure is placed on the weakened vertebra and the front of it cracks and loses height. Vertebral compression fractures are often the result of a fall, but people with osteoporosis can suffer a fracture even when doing everyday things, such as reaching, twisting, coughing, and sneezing.

Symptoms

If you have a vertebral compression fracture, it can cause back pain. The pain will typically occur near the break itself. Vertebral compression fractures most commonly occur near the waistline, as well as slightly above it (mid-chest) or below it (lower back).

Your pain will often get worse with motion, particularly when you are changing positions. It is often relieved if you rest or lay down. Coughing and sneezing can also make your pain increase. Although the pain may move to other areas of your body (for example, into the abdomen or down the legs), this is uncommon.

Surgical Treatment

Two types of vertebral augmentation methods available are:

• Kyphoplasty- a needle is inserted into the fractured vertebra using an x-ray for guidance. A small device called a balloon tamp is then inserted through the needle and into the fractured vertebra. The balloon tamp is inflated from within the vertebra, which restores the height and shape of the vertebral body. When the balloon tamp is removed, it leaves a cavity that is filled with a special bone cement that strengthens the vertebra.
• Vertebroplasty- a technique similar to kyphoplasty, but a balloon tamp is not used to create a space for the cement. Instead, the cement is injected directly into the narrowed vertebra. Like kyphoplasty, this procedure is performed while the patient is lying face down so that the surgeon can access the fractured vertebra from the back.

Decompressive laminectomy is the most common type of surgery that our surgeons at VHC Health will perform to treat lumbar (low back) spinal stenosis. This surgery is done to relieve pressure on your spinal nerve and treat other conditions, such as injuries to your spine, herniated discs, or tumors.

Our surgeons will perform a laminectomy to remove bone (parts of the vertebrae) and/or thickened tissue that is narrowing your spinal canal and squeezing your spinal nerve roots.

Spinal fusion

There are different methods of spinal fusion that our surgeons can perform:

• In the most common method, bone is taken from elsewhere in your body or obtained from a bone bank. This bone is used to make a "bridge" between adjacent spinal bones (vertebrae). This "living" bone graft stimulates the growth of new bone.
• In some cases an additional fusion method (called instrumented fusion) is done in which metal implants (such as rods, hooks, wires, plates, or screws) are secured to the vertebrae to hold them together until new bone grows between them.

Surgery for spinal stenosis is considered when:

• Severe symptoms restrict normal daily activities and become more severe than you can manage.
• Nonsurgical treatment does not relieve pain, and severe nerve compression symptoms of spinal stenosis (such as numbness or weakness) are getting worse.
• You are less able to control your bladder or bowels than usual.
• You notice sudden changes in your ability to walk in a steady way, or your movement becomes clumsy.