Alabama Neurosurgeons, P.C.

Spine - Surgery

Cervical:
Anterior Cervical Discectomy with Fusion
Foraminotomy
Corpectomy
Laminoplasty
Recovery

Low Back:
Lumbar Laminectomy
Decompressive Lumbar Laminectomy
Lumbar Microdiscectomy
Microscopic Discectomy
Spinal Fusion
Interbody Fusion
Interbody Fusion with Cages
Osteoporosis, Fractures and Treatment
Artificial Disc
Recovery

 

Cervical

Anterior Cervical Discectomy with Fusion

Anterior cervical fusion is an operation performed on the upper spine to relieve pressure on one or more nerve roots, or on the spinal cord. The term is derived from the words anterior (front), cervical (neck), and fusion (joining the vertebrae with a bone graft).

Why Is It Done?
When an intervertebral disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (often called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck, arms, and even legs. In this operation, the surgeon reaches the cervical spine through a small incision in the front of the neck. After the muscles of the spine are spread, the intervertebral disc is removed and a bone graft is placed between the two vertebral bodies. Over time, this bone graft will create a fusion between the vertebrae it lies between.

In more than ninety percent of cervical spine fusion surgeries done in the United States today a small cervical plate is used to stabilize the spine immediately after surgery. This hardware is used to improve the stability of the spine immediately after surgery and to also decrease the chance that the bone graft might be dislodged or moved slightly from the position that it was placed in by the surgeon. The use of hardware for stabilizing the cervical spine has changed the way in which cervical collars are used after surgery. Today, collars are typically worn for a shorter period of time after surgery than in the past.

What Happens Afterwards?
Successful recovery from anterior cervical fusion requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he or she and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on you having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.

The Operation

Incision Spine Surgery Illustration
Surgery for anterior cervical fusion is performed with the patient lying on his or her back. A smallincision is made in the front of the neck, to one side.


Exposure and Removal of the Cervical Disc

After a retractor is used to pull aside fat and muscle, the disc is exposed between the vertebrae. Part of it is removed with a forceps.

Spine Surgery Illustration

Then a surgical drill is used to enlarge the disc space, making it easier for the surgeon to empty the intervertebral space fully and remove any bone spurs. Afterwards, only a single ligament separates the surgical instruments from the spinal cord and nerve roots.

Spine Surgery Illustration


Placement of the Bone Graft
Spine Surgery IllustrationA small section of bone is obtained from the patient's iliac crest (i.e. hip), through a separate incision and used as a bone graft. The bone graft is placed in the disc space, where it will begin to fuse the vertebrae it lies between.


Adding Stability: Fusion Spine Surgery Illustration
Placing a bone graft between the two vertebral bodies is done in order to create a fusion between these bones. The fusion is a direct result of the bone graft, but small, specialized metal plates are also placed on the front of the cervical spine in order to increase the stability of the spine immediately after the operation. Surgeons use cervical hardware to decrease the amount of time that you will have to wear a collar after surgery, and also to increase your chances of getting a solid fusion between the two vertebral bodies.


Incision Closure Spine Surgery Illustration
The operation is completed when the neck incision is closed in several layers. Unless dissolving suture material is used, the skin sutures (stitches) or staples will have to be removed after the incision has healed.

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Foraminotomy

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."

Indications for Operation:
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 cause the above symptoms. Patients who do not improve with conservative treatment may be candidates for the operation.

What happens afterward?
Some pain at the operative site is expected, but generally resolves over time and can be controlled with oral pain medicines. Most patients can be discharged the same day. However this incision is more uncomfortable than most, and frequent rotation and movement of the neck is "encouraged" to minimize spasm of the muscles following the procedure. Most patients will notice immediate improvement in some or all of 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.

The Operation

Incision
A small incision is made in the middle of the neck after localizing the area of interest with an x-ray.

Decompression
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.

Closure
The muscles and tissues are closed in layers

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Corpectomy

Cervical corpectomy is an operation to remove a portion of the vertebra and adjacent intervertebral discs for decompression of the cervical spinal cord and spinal nerves. A bone graft with or without a metal plate and screws is used to reconstruct the spine and provide stability.

Indication for operation
In some patients, the cervical spinal canal can be narrowed by bone spurs arising from the back of the vertebral body or the ligament behind the vertebral bodies. In this situation it may be necessary to remove one or more vertebral body and the discs above and below to adequately decompress the spinal cord and/or nerve roots because the area of compression cannot be addressed by an anterior cervical discectomy alone.

What happens afterward?
Most patients experience only mild discomfort at the operative site, which is generally well controlled with oral pain medicines. A mild sore throat is not uncommon and is usually short lived. Most patients are discharged from the hospital in 24-48 hours. Patients may notice immediate improvement in some or all of their symptoms, however, some symptoms may improve only gradually. A successful outcome will depend on your compliance with the health care provider's recommendations, and a realistic expectation for meeting the goals of surgery (which depend on one's condition preoperatively).

Since cigarette smoking dramatically impairs bone healing, smoking cessation will significantly improve the likelihood for a successful fusion.

The Operation

Incision Spine Surgery Illustration
The patient is positioned on their back. If using the patient's own bone, an incision is made over the hip to harvest bone from the iliac crest. For the corpectomy, a small incision is made on either side of the neck. (A longer "up and down" incision may be required for multiple corpectomies).

Decompression
Spine Surgery IllustrationThe cervical spine is widely exposed by separating the spaces between the normal tissues. The discs above and below the vertebrae involved are removed. The middle portion of the vertebrae is removed (some of which is saved for use in the fusion) using special cutting instruments and drills to decompress the underlying spinal cord and nerve roots.


Reconstruction Spine Surgery Illustration
A strut of bone is placed to span the bony defect and provide support to the front of the spine. The bone is incorporated (fused) into the remaining vertebrae over time. Bone from the bone bank (allograft) may be substituted for the patient's own bone. A metal plate and screws are often used to provide extra support and facilitate the fusion process.

Spine Surgery Illustration

Closure
Spine Surgery IllustrationAbsorbable sutures and sometimes skin staples are used to close the incisions. A cervical collar may or may not be required for use after surgery. The doctor will follow the fusion with periodic x-ray exams after the operation.

Licensed under one or more of G. Karlin Michelson, M.D., Patent Nos.: 6,193,721; 6,398,783; 6,454,771.

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Laminoplasty

What is it?
For patients with painfully restricted spinal canals in their necks, this procedure immediately relieves pressure by creating more space for the spinal cord and roots. The technique is often referred to as an "open door laminoplasty," because the back of the vertebrae is made to swing open like a door.

The Operation

Incision
An incision is made on the back of the neck.

A groove is cut down one side of the cervical vertebrae creating a hinge.

The other side of the vertebrae is cut all the way through.

The tips of the spinous processes are removed to create room for the bones to pull open like a door.

The back of each vertebrae is bent open like a door on its hinge, taking pressure off the spinal cord and nerve roots.

Small wedges made of bone are placed in the opened space of the door.

End of Operation
The door of the vertebrae swings shut, and the wedges stop it from closing all the way. The spinal cord and the nerve roots rest comfortably behind the door.

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Recovery

Healing and Recovery

Healing is the body's natural process of restoring its damaged tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it.

Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths and minimize weaknesses. You must concentrate on what is improving, rather than on what symptoms remain. This focus on progress that has been made, combined with the constant effort to improve, make up the positive attitude that will speed your return to normal daily activity.

Hospital Recovery

Pain
It is normal to have pain after the operation, especially in the incision area. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Pain in the neck or arms is also not unusual, caused by inflammation of the previously compressed nerve. It will slowly lessen as the nerve heals. Medication will be given to control pain. Moist heat and frequent repositioning may also help.

Numbness
Numbness or tingling sensations are often the last symptoms to leave. Numbness, which lingers in parts of the arm or fingers usually is no cause for worry and should gradually go away.

Physical Activity
You may move about in bed and rest in any comfortable position when you have recovered from anesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. Avoid pulling up from a flat position.

Gradually increase the amount of walking you do each day. Since it may at first be painful, try making short trips. Begin with a trip to the bathroom, then to the door, and later out into the corridor. Sitting and standing also require a gradual pace. If discomfort occurs, change positions frequently.

Nutrition
Intravenous (I.V.) fluids will be ordered during the early recovery period and continued until you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices.

Emotional Changes
It is normal to feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity.

Discharge from the Hospital
The hospital stay for anterior cervical fusion patients usually lasts 1 or 2 days. This will be determined by your progress and by the amount of comfort and help available to you at home.

Home Recovery

Physical Activity
Daily walking is the best exercise. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs when you feel able.

Sexual relations may be resumed during the recovery period, but positions that cause pain should be avoided.

"Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly.

Working
Your doctor will help determine when you can return to work and with what limitations. If a work release is required, it will be given to you during the first post-operative visit.

Driving
Drive a car only when you have recovered full coordination and are experiencing minimal pain. Do not drive after taking pain medication.

Medication
You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. A certain amount of discomfort and pain can be expected until the inflammation and nerve sensitivity have subsided. Heat, exercise, massage, and short rest periods will also help relieve pain.

Inflammation
If you notice increased redness, swelling, or any drainage around the incision after leaving the hospital, notify your doctor.

Nutrition
A well balanced diet is necessary for proper healing. Include foods from each basic food group: dairy products, meats, vegetables, and fruits. Since you will be less active during recuperation, avoid rich, heavy foods and those high in calories but low in nutrients.

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Low Back

Lumbar Laminectomy for stenosis and other conditions

What is It?

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View the Back Lumbar Laminectomy Animation

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Lumbar laminectomy for stenosis and other conditionsis an operation performed on the lower spine to relieve pressure on one ormore nerve roots. The term is derived from lumbar (lower spine), lamina (part of the spinal canal's bony roof), and -ectomy (removal).

Why is it Done?
Pressure on a nerve root in the lower spine, often called nerve root compression, causes back and leg pain. In this operation the surgeon reaches the lumbar spine through a small incision in the lower back. After the muscles of the spine are spread, a portion of the lamina is removed to expose the compressed nerve root(s).

Pressure is relieved by removal of the source of compression part of the herniated disc, a disc fragment, a tumor, or a rough protrusion of bone, called a bone spur.

What Happens Afterwards?
Successful recovery from lumbar laminectomy requires that you approach the operation and recovery period with confidence based on a thorough understanding of the process. Your surgeon has the training and expertise to correct physical defects by performing the operation; he and the rest of the health care team will support your recovery. Your body is able to heal the involved muscle, nerve, and bone tissues. Full recovery, however, will also depend on your having a strong, positive attitude, setting small goals for improvement, and working steadily to accomplish each goal.

The Operation

Incision

Spine Surgery IllustrationSurgery for lumbar laminectomy is performed with the patient lying on his abdomen or side. A small incision is made in the lower back.

Spine Surgery IllustrationLaminectomy

After a retractor is used to pull aside fat and muscle, the lamina is exposed. Part of it is cut away to uncover the ligamentum flavum - a ligament that supports the spinal column.


Entering the Spinal Canal Spine Surgery Illustration

Next an opening is cut in the ligamentum flavum through which the spinal canal is reached. The compressed nerve is now seen, as is the cauda equina (bundle of nerve fibers) to which it is attached. The cause of compression may now also be identified - a bulging, ruptured or herniated disc, or perhaps a bone spur.

Spine Surgery IllustrationSometimes a fragment of disc has moved away from the disc space to press on the nerve root as it leaves the spinal canal. This will often cause more severe symptoms. Because of its distance from the disc space, the fragment may not be seen on a myelogram, and a CT scan (computerized x-ray) may be required to locate it.


Removal of the Herniated disc Spine Surgery Illustration

The compressed nerve is gently retracted to one side, and the herniated disc is removed. As much of the disc is taken out as is necessary to take pressure off the nerve. Some surgeons will remove all "safely available" disc material. After the cause of compression is removed, the nerve can begin to heal. The space left after removal of the disc should gradually fill with connective tissue.


Fusion and Instrumentation

Spine Surgery Illustration


Spine Surgery IllustrationIncision Closure

The operation is completed when the incision is closed in several layers. Unless absorbable suture material is used, the skin sutures (stitches) will have to be removed after the incision has healed.

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Decompressive Lumbar Laminectomy

What is it?

A Decompressive Lumbar Laminectomy is a decompression performed by removing the lamina and the spinous process.

Why is it done?

A decompressive lumbar laminectomy is usually recommended only when specific conditions are met. In general, surgery is recommended when a spinal nerve root(s) is pinched and you have:

  1. Leg pain which limits your normal daily activities
  2. Weakness in your leg(s) or feet
  3. Numbness in your l egs
  4. Difficulty in walking or standing

The Operation

Incision

In the operating room, a decompressive lumbar laminectomy begins with an incision in your lower back . Through this opening, your surgeon will reach the area where your cauda equina and/or spinal nerve(s) are being pinched.

Spine Surgery Illustration


Reaching the Pinched Nerve

After the incision is made, the surgeon will use a retractor to pull aside fat and muscle until the vertebra is exposed. A fine drill is then used to remove a section of the vertebra. Next, an opening is cut in the ligamentum flavum through which the spinal canal can be reached.

Spine Surgery Illustration


Removing the Cause of Pressure

Once the spinal nerve root(s) and cauda equina have been exposed, the surgeon will use a fine drill to remove bone spurs or rough edges of the intervertebral disc . This will make the openings of the foramen and the spinal canal larger and help to relieve pressure on your spinal nerves.

Spine Surgery Illustration


Spine Surgery IllustrationFusion And Instrumentation

On some occasions it may be necessary to stop the movement between two adjacent vertebr ae. This is called a fusion. Your surgeon will place bone graft chips between the vertebrae to create a solid section of bone which prevents the motion. The surgeon may also elect to use metal impl ants to prevent any motion while the bone graft heals.


Closing the Incision

The operation is completed when each layer of the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed.

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Lumbar Microdiscectomy

What is it?

Projector
View the Lumbar Microdiscectomy
Animation

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Lumbar microdiscectomy is an operation on the lumbar spine performed using a surgical microscope and microsurgical techniques. A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc which is "pinching" one or more spinal nerve roots. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery.

Why is it done?
Lumbar microdiscectomy is usually recommended only when specific conditions are met. In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:

  1. Leg pain which limits your normal daily activities
  2. Weakness in your leg(s) or feet
  3. Numbness in your extremities
  4. Impaired bowel and/or bladder function

The Operation

Incision

In the operating room, a lumbar microdiscectomy begins with a small incision in your lower back. Through this opening, your surgeon will insert microsurgical instruments. Because the work is viewed through a microscope, this approach requires a relatively small incision.

Reaching The "Pinched" Nerve

Guided by diagnostic studies, your surgeon will remove a small portion of bony material from the back of your vertebra . Once this material is removed, the surgeon can locate the exact area where the nerve root is being pinched.

Spine Surgery Illustration

Identifying the Cause of the Pressure

Once the "pinched" nerve is located, the extent of the pressure on the nerve can be determined. Using microsurgical procedures, your surgeon will remove the ruptured portion of the disc and any disc fragments which have broken off from the main disc. The amount of work required to complete your microdiscectomy will depend in part on the number of disc fragments present and the difficulty presented in finding and removing them.

Spine Surgery Illustration

Closing the Incision

The operation is completed when each layer of the incision is closed with suture material (stitches) or surgical staples. If the outer incision is closed with staples or non-absorbable sutures, they will have to be removed after the incision has healed.

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Microscopic Discectomy

What is it?

The procedure using the METRx™ System is an operation on the lumbar spine performed using microscope and microsurgical techniques.

The METRx ™ System procedure requires only a very small incision and will remove only the portion of the ruptured disc, which is "pinching" one or more spinal nerve roots. The recovery time for this particular surgery is usually much less than is required for traditional lumbar surgery.

Why is it done?
Lumbar microdiscectomy using the METRx™ System is usually recommended only when specific conditions are met. In general, surgery is recommended when a ruptured disc is pinching a spinal nerve root(s) and you have:

  1. Leg pain which limits your normal daily activities
  2. Weakness in your leg(s) or feet
  3. Numbness in your extremities
  4. Impaired bowel and/or bladder function

The Operation

Incision
In the operating room, the METRx ™ System begins with a small incision in your lower back. Through this opening, your surgeon will insert the endoscope and surgical instruments. Because the work is viewed through an endoscope, this approach requires a relatively small incision.

Spine Surgery Illustration

Reaching the "Pinched" Nerve
Guided by diagnostic studies, your surgeon may remove a small portion of bony material from the back of your vertebra. Once this material is removed, the surgeon can locate the exact area where the nerve root is being pinched.



Spine Surgery Illustration

Identifying the Cause of the Pressure
Once the "pinched" nerve is located, the extent of the pressure on the nerve can be determined. Using endoscopic microsurgical procedures, your surgeon will remove the ruptured portion of the disc and any disc fragments which have broken off from the main disc. The amount of work required to complete your METRx ™ System will depend in part on the number of disc fragments present and the difficulty presented in finding and removing them.

Closing the Incision

The operation is completed when the endoscope is removed and the incision is closed with suture materials and a bandage.

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Spinal Fusion

What is it?

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View the Spinal Fusion Animation

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A spinal fusion is simply the uniting of two bony segments, whether a fracture or a vertebral joint. The reason for instrumentation with rods and screws is to act as and 'internal cast' to stabilize the vertebra until the fusion, or bony re-growth, can occur.

Why is it done?
Historically spinal fusions have been used to correct degenerative spondylolisthesis. However, there are many indications for a spinal fusion and it is not the only procedure preformed to treat those various conditions. You should talk to your doctor about what procedure is best for you.

The Operation

The Incision Spine Surgery Illustration
The patient is positioned on the operating table in a prone position. The incision is made over the anatomic position of the spinous process.

Bone is Removed
When indicated, soft tissue and bony decompression are performed to relieve neurological compression.

Screw Placement
For a degenerative spondylolisthesis case, a blunt probe is inserted through the pedicle and into the vertebral body.

Spine Surgery Illustration

Once the pedicle canals are prepared and the screw length determined, the TSRH-3D® screws are sequentially inserted.

Spine Surgery Illustration


Bone Graft Spine Surgery Illustration
The facet joint capsules are removed and cancellous bone graft is placed into each facet joint. The transverse processes, sacral alae, and the lateral walls of the facet joints are decorticated with high-speed burs and curettes.

Corticocancellous bone graft taken from the iliac crest, along with any fragments of bone taken during decompression are firmly pressed into the bone fusion bed.

Compression
Once the construct has been assembled, segmental distraction and compression may be carved out.

Spine Surgery Illustration

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Interbody Fusion

What is it?
An Interbody Fusion is the uniting of two bony segments, whether a fracture or a vertebral joint. In time, normally within 4 months, the bone grafts will unite with the vertebrae above and below to form one piece of bone.

Why is it done?
The reasons for the operation are to:
· Remove the degenerative disc
· Separate the two vertebral bodies, as they were before the disc degenerated
· Keep them in that position by interposing several pegs of bone (bone graft)

The Operation

Incision
There are a number of techniques for an interbody fusion of the lumbar spine.

Lamina are Removed
First the surgeon removes the lamina or the portion of the vertebra that covers the spinal cord. Removing the lamina relives some of the pressure on the spine.

Bone is Removed
Then any bone that may be pinching the nerve roots is removed.

Bone Grafts
Bone grafts are added.

Rods and Screws
Rods are secured to the spine with screws in order to hold the discs in place while the bone graft fuses.

Closing the Incision
The incision is closed. The bone graft will fuse over time.

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Interbody Fusion with Cages

What is it?
An Interbody Fusion using cages is designed to be a less invasive method to obtain spinal fusion. The procedure can be performed through an anterior or posterior approach.

Why is it done?
The reasons for the operation are to:
· Remove the degenerative disc
· Separate the two vertebral bodies, as they were before the disc degenerated
· Keep them in that position

The Operation

Incision
The disc space is approached through an incision. The muscles are not cut because they run vertically and can be moved to the side. The disc is removed by excising the front portion and removing the disc material back to the spinal canal. This removes the inflammatory proteins within the disc.

Spacers
Temporary spacers are impacted into the empty disc space disctracting and realigning the vertebral bodies into the proper position. This maneuver opens the collapsed foramen (nerve canal) and lifts pressure from the pinched nerve roots.

Spine Surgery IllustrationReamer and Thread Tap
A hole in the vertebral body is created using a reamer and a thread tap. A threaded titanium cage is packed with bone graft and then screwed tightly into the hole. The threaded cage replaces the distraction plug and maintains the proper position of the vertebral bodies. Spine Surgery Illustration

Temporary Plug Removed
The other temporary plug is removed and the hole is made ready for the second implant. The other implant packed with bone is inserted.

Incision Closure
The incision is closed and the bone graft will grow through and around the implants, forming a bone bridge that connects the vertebral bodies above and below.

Incorporates technology developed by Gary K. Michelson, M.D.

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Artificial Disc

Projector
Charite' Artificial Disk In Patients

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Projector
Charite' Artificial Disk

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Recovery

Healing and Recovery

Healing is the body's natural process of restoring its damaged tissues to a normal or nearly normal state. Although healing may be improved by general good health, proper nutrition, rest, and physical fitness, it will occur without your having to work at it.

Recovery is the process during which you work to become well. It requires a gradual but persistent effort to increase physical strengths and minimize weaknesses. You must concentrate on what is improving, rather than on what symptoms remain. This focus on progress that has been made, combined with the constant effort to improve, make up the positive attitude that will speed your return to normal daily activity.

Hospital Recovery

Pain
It is normal to have pain after the operation, especially in the incision area. This does not mean that the procedure was unsuccessful or that your recovery will be slow. Pain in the back or legs is also not unusual, caused by inflammation of the previously compressed nerve. It will slowly lessen as the nerve heals. Medication will be given to control pain. Moist heat and frequent repositioning may also help.

Numbness
Numbness or tingling sensations are often the last symptoms to leave. Numbness, which lingers in parts of the arm or fingers usually is no cause for worry and should gradually go away.

Physical Activity
You may move about in bed and rest in any comfortable position when you have recovered from anesthesia. Walking may begin within several hours. The easiest way for you to get out of bed is to raise the head of the bed as far as it will go, and then swing your legs to the floor. Avoid pulling up from a flat position.

Gradually increase the amount of walking you do each day. Since it may at first be painful, try making short trips. Begin with a trip to the bathroom, then to the door, and later out into the corridor. Sitting and standing also require a gradual pace. If discomfort occurs, change positions frequently.

Nutrition
Intravenous (I.V.) fluids will be ordered during the early recovery period and continued until you can tolerate regular liquids without nausea or vomiting. Your diet will then be adjusted back to normal as your appetite returns. Constipation will be treated with laxatives and a diet of whole grain cereals, fruits, and fruit juices.

Emotional Changes
It is normal to feel discouraged and tired for several days after surgery. These feelings may be your body's natural reaction to the cutback of extra hormones it put out to handle the stress of surgery. Although emotional let-down is not uncommon, it must not be allowed to get in the way of the positive attitude essential to your recovery and return to normal activity.

Discharge from the Hospital
The hospital stay for anterior cervical fusion patients usually lasts 1 or 2 days. This will be determined by your progress and by the amount of comfort and help available to you at home.

Home Recovery

Physical Activity
Daily walking is the best exercise. Try to increase your distance a little each day, setting a pace that avoids fatigue or severe pain. You may climb stairs when you feel able.

Sexual relations may be resumed during the recovery period, but positions that cause pain should be avoided.

"Listen" to your body. Discomfort is normal while you gradually return to normal activity, but pain is a signal to stop what you are doing and proceed more slowly.

Working
Your doctor will help determine when you can return to work and with what limitations. If a work release is required, it will be given to you during the first post-operative visit.

Driving
Drive a car only when you have recovered full coordination and are experiencing minimal pain. Do not drive after taking pain medication.

Medication
You should gradually use less pain medication while recovering at home. This can be accomplished by increasing the amount of time between taking pills, then by reducing the number taken each time. A certain amount of discomfort and pain can be expected until the inflammation and nerve sensitivity have subsided. Heat, exercise, massage, and short rest periods will also help relieve pain.

Inflammation
If you notice increased redness, swelling, or any drainage around the incision after leaving the hospital, notify your doctor.

Nutrition
A well balanced diet is necessary for proper healing. Include foods from each basic food group: dairy products, meats, vegetables, and fruits. Since you will be less active during recuperation, avoid rich, heavy foods and those high in calories but low in nutrients.

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