Nedal Hejazi, MD
 

 

  
 

 

MRI of lumbar disc herniation. 

 

 

Figures demonstrate the situation after artificial disc surgery of the cervical spine.

 

 

MRI of cervical Myelopathy preoperatively.

 

 

This  figure demonstrates the situation after the cervical decompression with open-door-laminoplasty (3D-reconstructed cervical CT postoperatively)

 

 

MRI

 

 

 

 

 

 

 

 

                     

 

Lumbar and cervical disc disease

Artificial Disc Replacement is a recent development in cervical spine surgery, and may become an alternative to anterior discectomy and fusion. The advantages lie in the ability to replicate the mechanics of the normal disc at the treated level. This may reduce stresses that would otherwise be transmitted to adjacent spinal levels, as in cervical discectomy and fusion. We perform this modern methode now routinely, and the results have been encouraging so far.
 


Cervical Corpectomy

This operation is an extension of the discectomy procedure. Also using an anterior approach, the surgeon removes a part of the vertebral body to relieve pressure on the spinal cord. One or more vertebral bodies may be removed including the adjoining discs. The incision is generally longer. The space between the vertebrae is filled using a piece of bone (fusion) and maybe a metal plate. Because more bone is removed, the recovery process for the fusion to heal and the neck to become stable again is usually longer than with anterior cervical discectomy.

Cervical Laminectomy and Discectomy

This operation is performed through a vertical incision in the back of the neck, generally in the middle. Through this opening the surgeon will use an instrument (a retractor) to pull aside the strong muscles of the neck and expose the arch of bone (lamina) that forms the spinal canal. A drill and bone cutting instruments are used to remove the bone around the spinal cord (laminotomy) or the bone around the nerve opening (foraminotomy).

Once the nerve is located, it is moved gently aside and an incision is made on the outside covering of the disc through which the disc material is then removed.

See also:

Hejazi N, et al: Intraoperative cervical epidurography: a simple modality for assessing the adequacy of decompression during anterior cervical procedures. Technical Note. J Neurosurg (Spine 1) 98:96–99, 2003

Witzmann A, Hejazi N. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy. Neurosurg Rev 2000;23(4):213-217.

Glossary

Anesthesiologist: Physician who administers pain-killing medications during surgery.
Anterior (Front): Refers to the direction from which the surgeon removes the cervical disc.
Cervical Spine:
The seven vertebrae in the upper part of the neck.
CT Scan (computed tomography scan): A diagnostic imaging technique in which a computer reads x-rays to create a three-dimensional map of soft tissue or bone.
Degeneration:
Deterioration or worsening of a structure or condition.
Disc: A small mass of elastic, gristle-like tissue located between each vertebra in the spinal column which acts as a "shock absorber" for the spinal bones. The disc is composed of an outer, tough covering and a softer, gelatinous material within.
Fusion: The surgical joining of vertebrae.
Herniated Disc: Condition in which gelatinous disc material slips or bulges out of position and puts painful pressure on surrounding nerves.
Laminectomy: Surgical removal of the rear part of a vertebra in order to gain access to the spinal cord or nerve roots, to remove tumors, to treat injuries to the spine, or to relieve pressure on a nerve.
Ligament: Fibrous connective tissue linking bones at a joint.
MRI (magnetic resonance imaging): Diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology rather than x-rays.
Myelogram: An x-ray examination in which injected dye outlines the spinal cord and associated nerve roots to illustrate spinal tumors and other conditions affecting the nerves and spinal cord.
Nerves: Fibers that conduct impulses (messages) from the brain and spinal cord to the muscles and glands, or from sensory organs to the brain and spinal cord.
Spinal Cord: Bundle of nerve fibers enclosed in the vertebral column.
Spinal Stenosis: Narrowing of the vertebral column, resulting in pressure on the vertebral column or pressure on the spinal cord or nerve roots arising from the spinal cord.
Vertebrae: The 33 individual bones composing the backbone or spine.
X-ray: Application of electromagnetic radiation to produce a film or picture of a bone or soft tissue area of the body

 

REFERENCES


Hejazi N. Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations. Technical note. J Neurosurg Spine. 2005 Jan;2(1):88-91.

Hejazi N, et al: Intraoperative cervical epidurography: a simple modality for assessing the adequacy of decompression during anterior cervical procedures. Technical Note. J Neurosurg (Spine 1) 98:96–99, 2003

Hejazi N, et al. Combined transarticular lateral and medial approach with partial facetectomy for lumbar foraminal stenosis: Technical note. Journal of Neurosurgery (free article) 96:118-121, 2002

Hejazi N, et al. Spinal intramedullary teratoma with exophytic components. Neurosurg Rev (May 2003) 26: 113-116

Witzmann A, Hejazi N. Special neurosurgical paintherapy of the chronic back pain. (German) J. Neurol. Neurochir. Psychiatr. 2001(4):23-32

Hejazi N, et al. Spinal intramedullary teratoma with exophytic components. Neurosurg Rev (May 2003) 26: 113-116

Witzmann A, Hejazi N. Special neurosurgical paintherapy of the chronic back pain. (German) J. Neurol. Neurochir. Psychiatr. 2001(4):23-32

Witzmann A, Hejazi N. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy. Neurosurg Rev 2000;23(4):213-217.

Hejazi N; Hassler W. Microsurgical treatment of intramedullary spinal cord tumors. Neurol Med Chir (Tokyo) 1998;38(5):266-273.

Hejazi N; Hassler W. Microsurgical treatment of intrameduallry spinal cord tumors. Results of 80 patients and review of the relevant literature. Neurosurgery 1998;43(3):675.

Hejazi N; Hassler W. Nine cases of nontraumatic spinal epidural hematoma. Neurol Med Chir (Tokyo) 1998;38(11):718-724.