Lumbar Microdiscectomy for herniated lumbar disc
Performed through minimally invasive (MIS) approaches, usually through progressive dilatation of tissues and working channels. Less pain and a faster recovery. May be performed under epidural anesthesia.
Patients are discharged on day 1 after the surgery (Figure 1).
Lumbar Endoscopy for herniated lumbar disc
Performed through a minimally invasive approach using progressive dilatation of the tissues. Approach is obtained postero-lateral to the spine through the transforaminal entry zone. Disc extrusions are resected this way.
Under sedation and local anesthesia. Patients are discharged on the same day.
Oxygen-ozone therapy and transforaminal injection for herniated lumbar disc
Performed under local anesthesia and short sedation. Access is postero-lateral to the spine. Oxygen-ozone is a mixture of an anti-inflammatory gas injected directly to the herniated disc. It also works dehydrating the herniated nucleus of the disc. The transforaminal injection targets the compressed and inflamed nerve root. A mixture of anti-inflammatory steroids plus an anesthesic drug is placed.
Patients are discharged on the same day.
Facet injections and radiofrecuency
Back pain may be caused by facet degeneration. In those cases patients may benefit from facet injections or even facet radiofrecuency. Performed under local anesthesia.
Patients discharged on the same day.
Microsurgical nerve decompression
Nerve roots may be compressed by facet arthrosis at the lateral recess or at the foramen. High-speed drilling is performed targeting the compressed area. Always through MIS approaches.
Patients are discharged the following day.
Minimally invasive decompression for lumbar canal stenoses
Nerve roots may be globally compressed by stenosis of the lumbar canal which they travel through before exiting the spine. Patients refer inability to walk and need to stop often. High-speed drilling is performed targeting the compressing laminae. Performed through MIS approaches. May be supplemented by screws or a motion sparing device (see “dynamic stabilization of the spine”)
Under general anesthesia. Patients are discharged the following day or day 2.
Minimally invasive lumbar fusion
Back pain from a degenerative disc disease (DDD) may be treated with a fusion. This is performed through MIS approaches placing intervertebral cages filled with bone graft supplemented by percutaneous screws and rods.
Performed under general anesthesia.and discharged on day 2 or 3 after the surgery.
Minimally invasive lumbar fusion with the Trans1-AxiaLIF® rod
Back pain from DDD of the L5-S1 disc space is best treated with the Trans1 rod. Discectomy and fusion is performed through the S1 vertebral body which is approached through an incision 2 cm long close to the coxis (tail-bone).
Under general anesthesia. Patients are discharged on the same day or day 1 after the surgery.
Dynamic stabilization of the lumbar spine:
Placement of different devices for unloading of the DDD causing back pain.
These are placed percutaneously. Motion is spared but limited. They may be combined with fusion systems in the same surgery.
Under local or general anesthesia. Patients are discharged on the same day.
Sagital and coronal imbalance
Flat back and other saggital and coronal misalignments may lead to intense back pain. Open procedures with bone resections may be needed for correction. Screws and rods leave the spine aligned after the correction.
Under general anesthesia. Patients are discharged on day 4 after the surgery.
Kyphoplasty
Indicated for patients that have suffered a vertebral body compression fracture. Occasionally it may be performed for biopsy and stabilization if a vertebral body tumor is causing pain.
The vertebral body (lumbar, dorsal or cervical) is approached percutaneously and special cement is placed to increase stiffness of the collapsed vertebra.
Under general anesthesia. Patients discharged on the same day.
Epiduroscopy
A catheter is advanced from the sacrum in to the lower lumbar epidural space and enzymes are placed to release nerve roots trapped by epidural scarring.
Performed under local anesthesia. Patients are discharged on the same day.
Anterior approaches to the lumbar spine
Together with our vascular surgeon, the lumbar spine is approached through the abdomen behind the peritoneum. Discectomy is performed. Cages for a fusion or a lumbar artificial disc are placed after the discectomy. Indicated in some cases of DDD.
Under general anesthesia. Patients discharged on day 2.