Pain Prevention

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Once you encounter back or neck pain, you are four times as likely to experience it again. This is why prevention is essential to your long-term recovery.

One of the best ways to avoid back pain is by exercising and stretching. Low-impact aerobics, such as walking or swimming, is an ideal way to prevent or treat back pain. Stop if the exercise becomes painful, and always remember to stretch. Stretching is easy to incorporate into your daily routine. You can even do it in front of the television.

Below are some more specific ways to prevent back or neck injuries:

Sitting for long periods

The spine likes movement. Anything that puts the spine in a static position creates stress, which can cause back and neck pain. Every hour, stand, walk around, bend, arch backward gently, and twist. Doing so at regular intervals will lengthen the amount of time you can sit comfortably. Also, get an ergonomically-designed chair or an orthopedic insert to support your spine, especially if your job involves long periods of sitting. Or roll up a towel, and place it behind your low back.

A comfortable way to stand

Prolonged standing can also strain the back. If you have to stand for long periods of time, prop one foot on a small stool or telephone book to reduce stress in the low back. Alternate with the other foot. Every half hour, bend over and touch your toes, with your knees slightly bent, or do some of the stretching exercises shown in the Seton Spine and Scoliosis website. They will help loosen your muscles, ligaments and joints.

Plane rides

While traveling on a plane, it helps to raise your feet on a briefcase or a bag underneath the seat in front of you. Ask for a pillow to place behind your low back to improve lumbar support. It is important to get up frequently and walk to the bathroom and back, whenever possible. Avoid hour-long periods in your seat.

The best sleeping position

Avoid sleeping on your stomach, which arches your back and puts pressure on your spine. Instead, lie on your back with a small pillow tucked under your knees. This position unloads the spine. An alternate position is to lie on your side with a pillow between your knees. If you like sleeping on your stomach, place a soft, flat pillow under your stomach to eliminate some of the arch that can stress your back.

Mattress considerations

It is important to sleep on a mattress with optimal back support, whether it is a conventional mattress or a waterbed. Older waterbeds were mushy and provided little support. However, now there are waterbeds that allow you to adjust their firmness. A good mattress should relate to your body shape. Generally, go with what feels comfortable to you.

Pain is a signal from the body to the brain that something is wrong. Either the back is too weak, too inflexible, or the wrong body mechanics were used to perform a task.

 

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BecomePainFree.com Treats

• https://www.becomepainfree.com/
  Herniated discs
• Pinched nerves
• Degenerative spine disease
• Spinal stenosis
• Spondylolisthesis (slipped spine)
• Scoliosis (deformity)
• Low back pain / neck pain
• Spine trauma
• Spine infection
• Osteoporotic fractures
• Spine and spinal cord tumors
• Peripheral nerve injury
• Chiari malformation
• Cavernous malformation
• Vascular malformation

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Minimally Invasive Spine Surgery

Minimally Invasive Surgery:

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Recent surgical advancements have focused on performing surgery through smaller incisions, with less disruption to surrounding soft-tissues. The idea behind minimally invasive surgery is to perform the same treatment without damage to normal surrounding tissues. The drawback of minimally invasive surgery is that sometimes the underlying problem may not be adequately addressed because of an inability to get to the problem. Whenever a new minimally invasive procedure is introduced, there is almost always controversy as to whether or not the procedure is as good as traditional surgery.

Endoscopic Spine Surgery:

Endoscopic spine surgery uses specialized video equipment inserted through small incisions to see the structures of the spine. Similar to arthroscopic surgery of a joint, endoscopic surgery has advanced over the past decade from merely being able to look to the area of interest, to the ability to repair and reconstruct a variety of complex problems.The benefit of endoscopic spine surgery is the potential to address problems through very small incisions. By not damaging the muscles around the spine, recovery can often be much faster than with a larger surgical exposure.

Microdiscectomy, Microlaminectomy and Microforamenotomy:

All of these micro-surgeries are variations of standard surgeries used to take pressure off of the nerves around the spinal cord. Traditionally done through larger incisions, the micro procedures use smaller incisions and specialized surgical instruments to accomplish the same goals of traditional surgery.There is no rule on where the line between traditional surgery and micro surgery is drawn. To some doctors this means a smaller incision, to others it means the use of special surgical instruments. Many variations of a procedure could be considered micro surgery.

Laser Spine Surgery:

Laser spine surgery is a technique that uses a laser to remove damaged tissues. Because a laser can be inserted through small incisions, it can be used to cut away damaged tissues (such as disc fragments) without having to make a large incision.There is significant controversy about laser spine surgery as this technique has not been shown to have significant benefits, despite advertising that may make you think otherwise. Often marketed in magazines and the Internet, laser spine surgery has become the focus of some lawsuits formisleading patients about expected results from surgery.

Is It Better?:

Is minimally invasive surgery better? There are many ways to answer this question. The bottom line is that we simply do not know. There are theoretic advantages, and there are possible downsides. But there are very few studies that compare the possible risks with the potential benefits of minimally invasive surgery.The bottom line I suggest is to find a surgeon who, above all, is interested in fixing your problem, not someone who is selling you on a smaller incision. If the same benefit can be achieved without damage to normal tissues, then minimally invasive surgery may be a good option.

_Sources:

_{Mathews HH and Long BH “Minimally Invasive Techniques for the Treatment of Intervertebral Disk Herniation” J. Am. Acad. Orthop. Surg., March/April 2002; 10: 80 – 85.}

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Adult Stem Cell Therapy to Treat Back Pain, Stem Cell, Spine Stem Cells, Stem Cell Treatment

Adult Stem Cell Therapy that doesn’t require FDA approval to treat lumbar and cervical spine conditions resulting from injury or aging, and is also involved with an FDA clinical trial investigating the use of Adult Stem Cells.

Stem Cell

These stem cells are autologous – they are taken from an adult patient and returned to that same patient in a concentrated form to the damaged area in a 30-minute procedure. This type of adult stem cell therapy does not require FDA approval to administer.

When it comes to stem cells, there is often a lot of mystique surrounding them.  We hear from the media that we can create a human being out of a bundle of cells, which is not necessarily true.  We also tend to look at embryonic stem cells as being the only type of stem cell.  With these types of embryonic stem cells, one idea is to be able to create a liver or kidney in a Petri dish, which is not controllable or feasible at this point, and the work being done by the BecomePainFree.com medical group.

When we look at stem cell types, we have embryonic stem cells on one hand and adult stem cells on the other.  The characteristics of each of these are not like other cells.  For instance, a liver cell can divide but it will only ever be a liver cell.  These stem cells, both embryonic and adult, can turn into different types of cells.  The embryonic stem cells can really turn into any cell type, but adult stem cells are limited as far as the cells they can turn into.  This depends upon environment or niche and what they are already programmed to become.  A lot of people think there is a lot of promise with embryonic stem cells and there is, although we are not quite there yet.

We are still at the forefront of stem cell technology and embryonic stem cells in particular. With those cells, we do not have the ability to control what types of tissue they turn into. For example, we could be trying to manipulate these cells to turn into kidneys, but they might start to develop as pancreatic cells, which is troublesome.  Another key with all stem cells is that they can proliferate quite a bit, usually at a higher rate than just a regular somatic cell.  Although this sounds good at first glance, the issue with this, particularly with embryonic stem cells, is we cannot control that division.  Hence, these cells can keep going and going without dying.  In the normal bodily process, cells are programmed to die after a certain time, but these embryonic stem cells can evade that action and continue dividing, which takes on the characteristic of cancer cells.  In some animal studies, an issue that keeps arising is development of tumors in some of these animals. It is difficult to predict if tumors are going to form when using some sort of embryonic stem cell treatment.  This is still a scary area through which we are still trying to navigate.

However, the focus of the BecomePainFree.com medical group is on adult mesenchymal stem cells. On the whole, the media does not give a lot of attention to these kinds of stem cells, as using them avoids any kind of ethical or controversial issues. There is a great amount of research being done on adult mesenchymal stem cells, however, because they are very powerful.

First off, we can control what cell type they turn into much more easily.  For example, the treatment used by the BecomePainFree.com medical group focuses on Mesenchymal precursor cells (MPC).  Mesenchymal means these cells are not going to turn into any kind of blood product such as a red blood cell or white blood cell, although they are derived from bone marrow.  The fact that they are precursor cells means these MPCs are only going to differentiate into one of a few cell types.  They are either going to become bone cells, i.e., osteoblasts, or chondrocytes, i.e., cartilaginous tissue such that we see in intervertebral discs and joints, etc.  All of that really depends on the environment in which we place these adult stem cells where it is well suited to do this.  For example, we can inject these MPCs into a bone fracture, and because the cells are surrounded by bone tissue, these cells will receive signals from the surrounding cells that tell them to turn into bone. However, the cells we use will be injected into a disc or joint, and the cells composing the disc and joint tissue will signal the stem cells to develop into similar tissue.  Again, there is no chance of any sort of pancreatic cell or nerve cell type spontaneously forming because we are using certain adult stem cell types, which are limited and cannot turn into anything like that.  In addition, as the tissue surrounding the disc and joint is relatively avascular, there is not really any worry of these cells migrating through the blood stream to somewhere else in the body and causing any sort of problem.  As far as the proliferation issue with embryonic stem cells, we have not seen this issue with adult stem cells in terms of dividing exponentially without ceasing.  There is almost a preset limit to how many times these adult stem cells will divide.

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About Minimally Invasive TLIF Transforaminal Lumbar Interbody Fusion

Overview  from https://www.becomepainfree.com/

A Transforaminal Lumbar Interbody Fusion (TLIF) is an operation often indicated for patients suffering from back and/or leg pain caused by the natural degeneration of the disc space or some type of traumatic event.

The Minimally Invasive TLIF technique is a less invasive option incorporating the use of specially designed instruments that allow surgeons to achieve the same clinical goals of traditional, “open” TLIF but with much smaller incisions, causing less damage to the surrounding soft tissue.

 

Procedure

The technique incorporates use of the II Tubular Retractor System and CD  II Spinal System. The METRx® II System provides minimally invasive access to the spine through tubular portals, while the CD  II Spinal System uses an innovative arc device to percutaneously (without a large skin incision) deliver screws and rods for spinal fusion.

* Through a minimal incision in the patient’s back, the surgeon uses specially designed dilators in the  II Tubular Retractor System to spread the muscle and tissues of the back. A tubular retractor, or “portal”, is then inserted over the dilators to maintain a clear pathway to the spine.

* Accessing the spine through the II Tubular Retractor, the surgeon removes a portion of the bone and the disc material, and places an implant in the disc space between the vertebral bodies. This spacer may serve to restore the natural height of the disc space, “unpinch” the nerves, and act as a scaffold for bone growth or “fusion” between the vertebral bodies.

* Finally, the surgeon may use the  Spinal System to place screws and rods in a minimally invasive fashion. These screws and rods are intended to stabilize the vertebral bodies while the bone fuses or heals.

Your browser may not support display of this image. Traditional, “open” TLIFs may often involve significant blood loss and a lengthy hospital stay. However, the Minimally Invasive TLIF technique may offer many patient benefits, including:

* Decreased intraoperative blood loss2
* Shorter hospital stays1
* Smaller incisions and scars
* Decreased post-operative medication needed while in the hospital1

1 Isaacs. Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion. J. Neurosurg: Spine. 3:98-105, 2005.

2 Park, Won Ha. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. SPINE 32(5):537-543, 2007.

 

Minimally Invasive Spine surgery These Dallas Doctors perform minimally invasive spine procedures: 

(These surgeons have extensive experience in both neurosurgery and orthopedics)  

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Adult Stem Cell Therapy, Stem Cell Spine Surgery, Stem Cell Injections, Stem Cell Injection

What are stem cells?

Contrary to what most people believe, there are two types of stem cells used in the advancement of modern medicine. At Minimally Invasive BecomePainFree.com, we are helping pave the way for the advancement of medicine using the most viable, and ethical method of stem cell healing called Adult Stem Cell Therapy. In living organisms, an adult stem cell is an undifferentiated cell that can produce other cells that eventually make up specialized tissues and organs that they inhabit. Adult stem cells are found in some tissues in the adult body, such as the epidermis of the skin, the lining of the small intestine, and the bone marrow, where they act as natural healers in the regeneration of old or worn tissue.

ADult Stem Cells

Adult Stem Cell Therapy

Adult stem cells move throughout our bodies and have vast potential and limitless capabilities. Although recent advancements in modern medicine have made adult stem cell therapy more widely known, it has been used to successfully treat cancer patients for over 40 years. At Minimally Invasive BecomePainFree.com, we strive to be on the forefront of the advancement of medicine for the sake of our patients. We fully understand the importance of the discovery, and practice, of unlocking the body’s secrets to heal itself, and using the adult stem cell treatment approach allows us to do so.

In this process, called adult (mesenchymal, multipotent) stem cell therapy, we use the patients’ own stem cells to allow for the healing and regenerating process for both minimally invasive surgical and non-invasive procedures for treating the injured, damaged, or painful areas due to aging or degeneration in the spine, knees, hips, shoulders, feet and ankles. Once injected, they function as the building blocks for tissue re-growth and increased blood flow to the ailing areas. The goal of the treatment is to replace damaged cells and to promote the growth of new blood vessels and tissues in order to help the target organ function at a largely improved capacity. The risk of rejection by the patient’s body is virtually non-existent, since the Adult Stem Cells received are directly from the patient. We use a highly advanced method of extracting the adult stem cells from the patient, and recycling them in their own bodies without manipulation during the procedure. This process makes our stem cell treatment safe, ethical, and effective in fulfilling positive medical outcomes. It is important to note that adult stem cell therapy is not controversial because it involves the use of a patient’s own blood and NOT derived from embryos.

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General Advantages of Adult Stem Cell Therapy:

• Natural and Ethical: Regenerative solutions replace damaged cells and tissue by making the most of the body’s natural regenerative potential, not just implant a temporary or artificial fix, and does so using the patient’s own stem cells, not taken from an embryo.
• Safe and Effective: Because the Adult Stem Cells are derived directly from the patient’s own blood, there is virtually no possibility for rejection, as compared to donor replacement organs and blood transfusions.
• Positive Side Effects: Stem cells also behave like beacons that alert the body to send its own regenerative resources to the site and reactivate the healing process in situations where the body would not have done so voluntarily.
• Proven Results: Clinical results thus far have proven positive. Remarkably, no patient has responded negatively to the cells and the small percentage of patients who did not respond to treatment showed no negative side effects.
• Another Chance at Life: With no side effects, when conventional methods fail, the risk is considered low, compared to possibilities.
• The Sooner, the Better: Treatment now, is better than treatment later. Just as with other medical treatments, time can make symptoms and complications more advanced and even harder to recover from.

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Pain Doctor, Pinnacle Pain, Chronic Pain, Pain Medication, Pain Meds, Dr. Jeffrey Wasserman

Dr. Jeffrey Wasserman received his B.S. from Lafayette University and his M.D. from Penn State. He completed his Anesthesiology residency at Harvard’s Massachusetts General Hospital where he did fellowships in pain management and cardiac anesthesia. He has been a pioneer, first to bring several advanced interventional therapies to Dallas, and specializes in minimally invasive disc healing therapies. He represents numerous state and national pain committees. Dr. Wasserman is board certified in anesthesiology and a Diplomate of the American Board of Pain Medicine. This Dallas Texas Pain Doctor who prescribes pain medications like hydrocodine and oxycontin etc offers the full services of pain medicine and pain disorders. Pain care and pain injections are part of the ways this doctor treats pain and injuries when you get hurt.

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Anesthesiology/Pain management

• Trigger Point Injections • Botulinum Toxin Type A • Cervical Epidural Injection • Thoracic Epidural Injection • Lumbar Epidural Injection  • Sacroiliac Joint Injection • Facet Block • Kyphoplasty

• Radiofrequency Lesioning (Rhizotomy) • Sympathetic Nerve Block • Cervical, Thoracic and Lumbar Discography • IDET (Intradiscal Electrothermal Therapy) • DISC Nucleoplasty • Intrathecal Pain (Pump) Therapy • Spinal Cord Stimulation • Epidural Lysis of Adhesions

Listing Details

Address

9301 N. Central Expressway,Dallas, Tx, USA, 75231

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What is Endoscopic Spine Surgery?, Binimally invasive procedure

Our Endoscopic Spine Surgery is a true minimally invasive procedure that has revolutionized the treatment of back and neck pain. If you’re searching for long lasting pain relief, we can help. Call Us: (214) 396-3647 | (888) 373-3720
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Learn more about this treatment.

• Mostly local anesthesia
• No removal of muscle or bone
• Immediate recovery
• High success rates
• Improved quality of life

• Microscopic incision
• Minimal or no blood loss
• Same day surgery
• Preservation of spinal mobility
• Reduced pain meds

Are you a candidate for Endoscopic Spine Surgery?

When you’re in pain, you don’t want to wait for help. Fill out this personalized pain assessment and our chief surgeon will review your answers and find you a diagnosis. www.becomepainfree.com

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Laser spine surgery is a minimally invasive surgery highly acclaimed by surgeons across the nation

Laser Spine Surgery/Endoscopic Spine Surgery

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Laser spine surgery is a minimally invasive surgery highly acclaimed by surgeons across the nation. It was introduced over 30 years ago, and has recently been excessively rising in popularity with evolved technology and knowledge. Laser spine surgery is typically a go-to procedure for patients with neck and back pain. Using lasers, doctors and neurosurgeons can more precisely target soft tissue to help relieve pain and ridding of excess dead tissue surrounding the spine. It is also a procedure used to trim any bulging or herniated discs to ease pressure on the spinal column and nerves.

Laser spine surgery has historically has been done by “going under the knife”, but with laser spine surgery, patients can rest assured that this minimally invasive procedure requires concentrated beams of light to relieve back pain. With laser spine surgery, the effects are safer and much more controlled. The result of the surgery is less blood loss, which results in a faster healing process, and minimal scarring due to it being less invasive. Also, using lasers can greatly decrease the amount of damage to any muscles or spine surrounding tissues because of the increased ability to control the concentrated beam of light, rather than “hand and knife.”

Although laser spine surgery is said to have unproven benefits by the National Institute of Health, doctors everywhere have relied on its usefulness to help relieve back and neck pain in countless patients. Laser spine surgery has become wildly popular in the medical field, and it is continuously and rapidly growing into an effective, helpful, and patient-convenient procedure that will undoubtedly continue to climb the charts.

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Anterior cervical discectomy & fusion (ACDF), ACDF, ACDF Spine Surgery

ACDF Spine/Back Surgery Overview

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Anterior cervical discectomy and fusion (ACDF) is a surgical procedure performed to remove a herniated or degenerative disc (Fig. 1) in the cervical (neck) spine. The surgeon approaches the spine from the front, through the throat area. After the disc is removed, the vertebrae above and below the disc space are fused together. Your doctor may recommend a discectomy if physical therapy or medication fail to relieve your neck or arm pain caused by inflamed and compressed spinal nerves. Patients typically go home the same day; recovery time takes 4 to 6 weeks.

Spine Surgery

Figure 1, top. (top view of vertebra) Degenerative disc disease causes the discs (purple) to dry out. Tears in the disc annulus can allow the gel-filled nucleus material to escape and compress the spinal cord causing numbness and weakness. Bone spurs may develop which can lead to a narrowing of the nerve root canal (foraminal stenosis). The pinched spinal nerve becomes swollen and painful.

What is an anterior cervical discectomy & fusion (ACDF)?

Discectomy literally means “cutting out the disc.” A discectomy can be performed anywhere along the spine from the neck (cervical) to the low back (lumbar). The surgeon reaches the damaged disc from the front (anterior) of the spine — through the throat area. By moving aside the neck muscles, trachea, and esophagus, the disc and bony vertebrae are accessed. In the neck area of the spine, an anterior approach is more convenient than a posterior (back) because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles of the back. Depending on your particular case, one disc (single-level) or more (multi-level) may be removed.

After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, the surgeon fills the open disc space with a bone graft. The graft serves as a bridge between the two vertebrae to create a spinal fusion. The bone graft and vertebrae are often immobilized and held together with metal plates and screws. Following surgery the body begins its natural healing process and new bone cells are formed around the graft. After 3 to 6 months, the bone graft should join the vertebrae above and below to form one solid piece of bone. With instrumentation and fusion working together, the bone may actually grow around the plates and screws – similar to reinforced concrete.

Bone grafts come from many sources. Each type has advantages and disadvantages.

• Autograft bone comes from you. The surgeon takes your own bone cells from the hip (iliac crest). This graft has a higher rate of fusion because it has bone-growing cells and proteins. The disadvantage is the pain in your hipbone after surgery. Harvesting a bone graft from your hip is done at the same time as the spine surgery. The harvested bone is about a half inch thick – the entire thickness of bone is not removed, just the top half layer.
• Allograft bone comes from a donor (cadaver). Bone-bank bone is collected from people who have agreed to donate their organs after they die. This graft does not have bone-growing cells or proteins, yet it is readily available and eliminates the need to harvest bone from your hip. Allograft is shaped like a doughnut and the center is packed with shavings of living bone tissue taken from your spine during surgery.
• Bone graft substitute comes from man-made plastic, ceramic, or bioresorbable compounds. Often called cages, this graft material is packed with shavings of living bone tissue taken from your spine during surgery.

After fusion you may notice some range of motion loss, but this varies according to neck mobility before surgery and the number of levels fused. If only one level is fused, you may have similar or even better range of motion than before surgery. If more than two levels are fused, you may notice limits in turning your head and looking up and down. New motion-preserving artificial disc replacements have emerged as an alternative to fusion. Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion. Outcomes for artificial disc compared to ACDF (the gold standard) are similar, but long-term results of motion preservation and adjacent level disease are not yet proven. Talk with your surgeon about whether ACDF or artificial disc replacement is most appropriate for your specific case.

Who is a candidate?

You may be a candidate for discectomy if you have:

• diagnostic tests (MRI, CT, myelogram) show that you have a herniated or degenerative disc
• significant weakness in your hand or arm
• arm pain worse than neck pain
• symptoms that have not improved with physical therapy or medication

ACDF may be helpful in treating the following conditions:

• Bulging and herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve.

• Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to foraminal or central stenosis or disc herniation (Fig. 1).

The surgical decision

Most herniated discs heal after a few months of nonsurgical treatment. Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to consider all the risks and benefits before making your decision. Only 10% of people with herniated disc problems have enough pain after 6 weeks of nonsurgical treatment to consider surgery.

Your surgeon will also discuss the risks and benefits of different types of bone graft material. Autograft is the gold standard for rapid healing and fusion, but the graft harvest can be painful and at times lead to complications. Autograft is more commonly used these days as it has proven to be as effective for routine 1 and 2 level fusions in non-smokers.

Who performs the procedure?

A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.

What happens before surgery?

You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctor’s office, you will sign consent and other forms so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). Discuss all medications (prescription, over-the-counter, and herbal supplements) you are taking with your health care provider. Some medications need to be continued or stopped the day of surgery.

Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (Coumadin, Plavix, etc.) 1 to 2 weeks before surgery as directed by the doctor. Additionally, stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. No food or drink is permitted past midnight the night before surgery.

Smoking
The most important thing you can do to ensure the success of your spinal surgery is quit smoking. This includes cigarettes, cigars, pipes, chewing tobacco, and smokeless tobacco (snuff, dip). Nicotine prevents bone growth and puts you at higher risk for a failed fusion. Patients who smoked had failed fusions in up to 40% of cases, compared to only 8% among non-smokers [1]. Smoking also decreases your blood circulation, resulting in slower wound healing and an increased risk of infection. Talk with your doctor about ways to help you quit smoking: nicotine replacements, pills without nicotine (Wellbutrin, Chantix), and tobacco counseling programs.

Morning of surgery

• Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home (including wedding bands).
• Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
• Bring a list of allergies to medication or foods.

Arrive at the hospital 2 hours before (surgery center 1 hour before) your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks. An intravenous (IV) line will be placed in your arm.

What happens during surgery?

There are seven steps to the procedure. The operation generally takes 1 to 3 hours.

Step 1: prepare the patient 
You will lie on your back on the operative table and be given anesthesia. Once asleep, your neck area is cleansed and prepped. If a fusion is planned and your own bone will be used, the hip area is also prepped to obtain a bone graft. If a donor bone will be used, the hip incision is unnecessary.

Step 2: make an incision 
A 2-inch skin incision is made on the right or left side of your neck (Fig. 2). The surgeon makes a tunnel to the spine by moving aside muscles in your neck and retracting the trachea, esophagus, and arteries. Finally, the muscles that support the front of the spine are lifted and held aside so the surgeon can clearly see the bony vertebrae and discs.

Figure 2. A 2-inch skin incision is made on the side of your neck.

Step 3: prepare to remove disc
With the aid of a fluoroscope (a special X-ray), the surgeon passes a thin needle into the disc to locate the affected vertebra and disc.

To remove the damaged disc, the vertebrae above and below the disc must be held apart. Your surgeon first inserts a spreader into the body of each vertebra above and below the disc to be removed. Gentle tension is placed on the spreader to separate the two vertebrae.

Step 4: remove the disc fragments
The outer wall of the disc (annulus) is cut (Fig. 3). The surgeon removes about 2/3 of your disc using small grasping tools, and then looks through a surgical microscope to remove the rest of the disc. The posterior longitudinal ligament, which runs behind the vertebrae, is removed to reach the spinal canal. Any disc material pressing on the spinal nerves is removed.

Figure 3. The muscles are retracted to expose the vertebra. The disc annulus is cut open and the disc material is removed with grasping tools.

Step 5: decompress the nerve
Bone spurs (osteophytes) that press on your nerve root are removed. The foramen, through which the spinal nerve exits, is enlarged with a drill (Fig. 4). This procedure, called a foraminotomy, gives your nerves more room to exit the spinal canal.

Figure 4. (top view) The disc annulus and nucleus are removed to decompress the spinal cord and nerve root. Bone spurs are removed and the spinal foramen is enlarged to free the nerve.

Step 6. prepare a bone graft fusion
Using a drill, the open disc space is prepared on the top and bottom by removing the outer cortical layer of bone to expose the blood-rich cancellous bone inside. This “bed” will hold the bone graft material that you and your surgeon selected:

• Bone graft from your hip. A skin and muscle incision is made over the crest of your hipbone. Next, a chisel is used to cut through the hard outer layer (cortical bone) to the inner layer (cancellous bone). The inner layer contains the bone-growing cells and proteins. The bone graft is then shaped and placed into the “bed” between the vertebrae (Fig. 5).

• Bone bank or fusion cage. A cadaver bone graft or bioplastic cage is filled with the leftover bone shavings containing bone-growing cells and proteins. The graft is then tapped into the shelf space.

Figure 5. (side view) A bone graft (blue) is shaped and inserted into the shelf space between the vertebrae.

The surgeon may reinforce the bone graft with a metal plate screwed into the vertebrae to provide stability during fusion – and possibly a better fusion rate. An x-ray is taken to verify the position of the bone graft and the metal plate and screws (Fig. 6).

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New option: artificial disc replacement. Instead of a bone graft or fusion cage, an artificial disc device is inserted into the empty disc space. In select patients, it may be beneficial to preserve motion. Talk to your doctor – not all insurance companies will pay for this new technology and out-of-pocket expenses may be incurred.

Step 7. close the incision
The spreader and retractors are removed. The muscle and skin incisions are sewn together with sutures. Steri-Strips or biologic glue is placed across the incision.

What happens after surgery?

You will awaken in the postoperative recovery area, called the PACU. Blood pressure, heart rate, and respiration will be monitored. Any pain will be addressed. Once awake, you will be moved to a regular room where you’ll increase your activity level (sitting in a chair, walking). Patients who have had bone graft taken from their hip may feel more discomfort in their hip than neck incision. Most patients having a 1 or 2 level ACDF are sent home the same day. However, if medical complications such as difficulty breathing or unstable blood pressure develop, you may need to stay overnight. You will be given written instructions to follow when you go home.

Discharge instructions

Discomfort

• After surgery, pain is managed with narcotic medication. Because narcotic pain pills are addictive, they are used for a limited period (2 to 4 weeks). As their regular use can cause constipation, drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) can be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g., Tylenol).
• Hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. These symptoms usually resolve in 1 to 4 weeks.

Restrictions

• If you had a fusion, do not use non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve) for 6 months after surgery. NSAIDs may cause bleeding and interfere with bone healing.
• Do not smoke. Smoking delays healing by increasing the risk of complications (e.g., infection) and inhibits the bones’ ability to fuse.
• Do not drive for 2 to 4 weeks after surgery or until discussed with your surgeon.
• Avoid sitting for long periods of time.
• Avoid bending your head forward or backward.
• Do not lift anything heavier than 5 pounds (e.g., gallon of milk).
• Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
• Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.

Activity

• You may need help with daily activities (e.g., dressing, bathing), but most patients are able to care for themselves right away.
• Gradually return to your normal activities. Walking is encouraged; start with a short distance and gradually increase to 1 to 2 miles daily. A physical therapy program may be recommended.
• If applicable, know how to wear a cervical collar before leaving the hospital. Wear it when walking or riding in a car.

Bathing/Incision Care

• You may shower 1 to 4 days after surgery. Follow your surgeon’s specific instructions. No tub baths, hot tubs, or swimming pools until your health care provider says it’s safe to do so.
• If you have staples or stitches when you go home, they will need to be removed. Ask your surgeon or call the office to find out when.

When to Call Your Doctor

• If your temperature exceeds 101° F, or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.
• If your swallowing problems interfere with your ability to breathe or drink water.

Recovery and prevention

Schedule a follow-up appointment with your surgeon for 2 weeks after surgery. Recovery time generally lasts 4 to 6 weeks. X-rays may be taken after several weeks to verify that fusion is occurring. The surgeon will decide when to release you back to work at your follow-up visit.

A cervical collar or brace is sometimes worn during recovery to provide support and limit motion while your neck heals or fuses (see Braces & Orthotics). Your doctor may prescribe neck stretches and exercises or physical therapy once your neck has healed.

If you had a bone graft taken from your hip, you may experience pain, soreness, and stiffness at the incision. Get up frequently (every 20 minutes) and move around or walk. Don’t sit or lie down for long periods of time.

Recurrences of neck pain are common. The key to avoiding recurrence is prevention:

• Proper lifting techniques
• Good posture during sitting, standing, moving, and sleeping
• Appropriate exercise program
• An ergonomic work area
• Healthy weight and lean body mass
• A positive attitude and relaxation techniques (e.g., stress management)
• No smoking

What are the results?

Anterior cervical discectomy is successful in relieving arm pain in 92 to 100% of patients [3]. However, arm weakness and numbness may persist for weeks to months. Neck pain is relieved in 73 to 83% of patients [3]. In general, people with arm pain benefit more from ACDF than those with neck pain. Aim to keep a positive attitude and diligently perform your physical therapy exercises.

Achieving a spinal fusion varies depending on the technique used and your general health (smoker). In a study that compared three techniques: ACD, ACDF, and ACDF with plates and screws, the outcomes were [3]:

• 67% of people who underwent ACD (no bone graft) achieved fusion naturally. However, ACD alone results in an abnormal forward curving of the spine (kyphosis) compared with the other techniques.
• 93% of people who underwent ACDF with bone graft placement achieved fusion.
• 100% of people who underwent ACDF with bone graft placement and plates and screws achieved fusion.

What are the risks?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots (deep vein thrombosis), and reactions to anesthesia. If spinal fusion is done at the same time as a discectomy, there is a greater risk of complications. Specific complications related to ACDF may include:

Hoarseness and swallowing difficulties. In some cases, temporary hoarseness can occur. The recurrent laryngeal nerve, which innervates the vocal cords, is affected during surgery. It may take several months for this nerve to recover. In rare cases (less than 1/250) hoarseness and swallowing problems may persist and need further treatment with an ear, nose and throat specialist.

Vertebrae failing to fuse. Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.

Hardware fracture. Metal screws, rods, and plates used to stabilize the spine are called “hardware.” The hardware may move or break before your vertebrae are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.

Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) are not used to secure the bone graft. It’s also more likely to occur if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.

Transitional syndrome (adjacent-segment disease). This syndrome occurs when the vertebrae above or below a fusion take on extra stress. The added stress can eventually degenerate the adjacent vertebrae and cause pain.

Nerve damage or persistent pain. Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the disc herniation itself. Some disc herniations may permanently damage a nerve making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor.

Sources & links

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Sources

1. Bose B: Anterior cervical instrumentation enhances fusion rates in multilevel reconstruction in smokers. J Spinal Disord 14:3-9, 2001.
2. Hilibrand AS, et al.: Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 83-A:668-73, 2001.
3. Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery 61:107-16, 2007.

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www.spine-health.com
www.spineuniverse.com
www.knowyourback.org

Glossary

allograft: a portion of living tissue taken from one person (the donor) and implanted in another (the recipient) for the purpose of fusing two tissues together. 

annulus (annulus fibrosis): tough fibrous outer wall of an intervertebral disc.

autograft (autologous): a portion of living tissue taken from a part of ones own body and transferred to another for the purpose of fusing two tissues together.

bone graft: bone harvested from ones self (autograft) or from another (allograft) for the purpose of fusing or repairing a defect.

discectomy: a type of surgery in which herniated disc material is removed so that it no longer irritates and compresses the nerve root.

foraminotomy: surgical enlargement of the intervertebral foramen through which the spinal nerves pass from the spinal cord to the body.

fusion: to join together two separate bones into one to provide stability.

herniated disc: a condition in which disc material protrudes through the disc wall and irritates surrounding nerves causing pain.

interbody cage: a device made of titanium, carbon-fiber, or polyetheretherketone (PEEK) that is placed in the disc space between two vertebrae. It has a hollow core packed with bone morsels to create a bone fusion.

osteophytes: bony overgrowths that occur from stresses on bone, also called bone spurs.

posterior longitudinal ligament (PLL): a strong fibrous ligament that courses along the posterior surface of the vertebral bodies within the spinal canal from the base of the skull to the sacrum.

vertebra (plural vertebrae): one of 33 bones that form the spinal column, they are divided into 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal. Only the top 24 bones are moveable.

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