Treatments & Procedures

Physical therapy is commonly used to improve strength, flexibility, mobility, and posture. Treatment may focus on strengthening the core muscles and improving the muscular and ligamentous support of the cervical or lumbar spine, depending on the condition being treated.

A structured therapy program may reduce strain on painful joints and discs, improve spinal stability, and help patients return to normal activities. The specific exercises and treatment plan are tailored to the patient's symptoms, physical examination, and underlying spinal condition.

An epidural steroid injection places anti-inflammatory medication into the space surrounding the spinal nerves. It may be recommended when an irritated or compressed nerve is causing pain, numbness, tingling, or other symptoms in an arm or leg.

The goal is to reduce inflammation around the affected nerves and provide relief while the underlying condition improves or while the patient participates in physical therapy. The duration and degree of relief vary between patients.

A targeted nerve root injection delivers medication around a specific spinal nerve believed to be causing symptoms. These injections may be performed in either the cervical or lumbar spine.

They can serve both therapeutic and diagnostic purposes. The medication may reduce inflammation and relieve pain, while the patient's response can also help determine whether that particular nerve is the source of the symptoms. This information may be helpful when planning additional treatment or deciding whether surgery is appropriate.

Facet joints are the small joints located along the back of the spine. Arthritis, inflammation, or abnormal movement within these joints may cause mechanical or axial neck or back pain.

A facet joint injection places local anesthetic, often with anti-inflammatory medication, into or around the suspected painful joint. Like nerve root injections, facet injections may be used for both diagnosis and treatment. Meaningful temporary relief can help confirm that the joint is contributing to the patient's pain.

Radiofrequency ablation may be considered when diagnostic injections confirm that one or more facet joints are the likely source of a patient's pain. During the procedure, controlled radiofrequency energy is used to interrupt the small sensory nerves that carry pain signals from the affected joints.

The goal is to provide relief that lasts longer than an injection alone. Radiofrequency ablation does not correct the underlying arthritis or degeneration, and the treated nerves may gradually recover over time. However, in appropriately selected patients, it may reduce pain, improve function, and help delay or avoid more invasive treatment.

A craniotomy is a procedure in which a temporary opening is made in the skull to provide access to a brain tumor. The goal is usually to remove as much of the tumor as can be safely achieved, relieve pressure on the brain, and obtain tissue to establish or confirm the diagnosis.

The procedure begins with an incision in the scalp. The tissue beneath the skin is carefully separated to expose the skull. One or more small openings are made in the skull, and a section of bone, called a bone flap, is temporarily removed. This exposes the dura, which is the protective covering over the brain.

The dura is then opened to provide access to the tumor. The tumor is carefully separated from the surrounding brain and removed to the greatest extent safely possible. The amount that can be removed depends on the tumor's location and its relationship to areas responsible for speech, movement, sensation, vision, memory, and other important functions.

Tumor tissue is typically sent to a pathologist for examination. This analysis helps determine the exact diagnosis and guides decisions regarding any additional treatment.

Craniotomy for tumor is frequently performed with neuronavigation. This technology uses the patient's preoperative MRI and CT scans to create a three-dimensional map of the head and brain. It helps the surgeon plan a precise incision and bone opening and identify the safest route to the tumor.

Once the tumor resection is complete, bleeding is controlled and the dura is closed with sutures. The bone flap is returned to its original position and secured with small titanium plates and screws. The deeper tissues and skin of the scalp are then closed in layers.

An epidural hematoma is a collection of blood between the skull and the dura. It often develops after a head injury and is commonly caused by arterial bleeding. Because the blood collection can enlarge rapidly and place life-threatening pressure on the brain, emergency surgery may be necessary.

The procedure begins with an incision in the scalp over the area of the hematoma. The scalp and underlying tissues are carefully separated to expose the skull. Openings are made in the skull, and a temporary bone flap is removed to reach the blood collection.

The epidural blood clot is then removed from the space between the skull and the dura. The surgeon carefully inspects the area to locate the source of bleeding. An injured artery or other bleeding vessel is controlled using cautery, clips, surgical material, or other methods.

Once the clot has been evacuated and the bleeding has been stopped, the surgical area is irrigated and inspected. The bone flap is usually returned to its original position and secured with small titanium plates and screws. The scalp and skin are then closed in layers.

Prompt evacuation can relieve pressure on the brain and may be lifesaving.

A subdural hematoma is a collection of blood between the dura and the surface of the brain. Acute subdural hematomas often contain a thick blood clot and may require urgent craniotomy when they are large, cause neurological symptoms, or produce significant pressure on the brain.

The procedure begins with an incision in the scalp. The tissue beneath the skin is separated to expose the skull, and a section of bone is temporarily removed. The dura is then carefully opened to reach the blood clot beneath it.

The clot is gently removed from the surface of the brain. The area is irrigated, and the surgeon looks for any active bleeding from injured veins or other blood vessels. Bleeding is controlled while minimizing disturbance to the brain tissue.

Once the clot has been removed and bleeding is controlled, the dura is closed. The bone flap is usually returned to its original position and secured with titanium plates and screws. The scalp and skin are then closed in layers.

If there is severe brain swelling, the bone flap may occasionally need to be left off temporarily to give the brain additional room. The skull opening can then be repaired later with a separate procedure called a cranioplasty.

Burr-hole drainage is a less invasive procedure most commonly used for subacute or chronic subdural hematomas. In these cases, the blood has often partially or completely liquefied, allowing it to be drained through one or more small openings rather than through a larger craniotomy.

The procedure begins with one or two small scalp incisions over the location of the hematoma. The tissue is separated to expose the skull, and a small circular opening, called a burr hole, is made through the skull.

The dura and the membrane surrounding the hematoma are carefully opened. The liquefied blood is allowed to drain, and the space may be gently irrigated with sterile fluid until the returning fluid becomes clearer.

A small temporary drainage tube is often placed through one of the burr holes. This allows additional blood and fluid to drain after surgery and helps the brain gradually return toward its normal position. The drain is typically removed after a short period of monitoring.

The scalp incisions are then closed. Because only small openings are made in the skull, burr-hole drainage generally requires less exposure than a full craniotomy. However, chronic subdural hematomas can occasionally return and may require further drainage, craniotomy, or middle meningeal artery embolization.

A stereotactic brain biopsy is a minimally invasive procedure used to obtain a small sample of abnormal brain tissue. It may be recommended when the diagnosis is uncertain or when a lesion is located in an area where removing it would carry an unacceptable risk.

Before surgery, the patient's MRI and CT scans are used to identify the exact location of the abnormality and plan the safest path to it. This may be performed with a stereotactic frame or with frameless neuronavigation.

A small incision is made in the scalp, followed by a small opening in the skull. A narrow biopsy needle is then carefully guided through the brain to the targeted area using the planned coordinates and navigation system.

Several small samples are typically collected from different portions of the lesion. The tissue is sent to a pathologist for examination and may also undergo molecular or genetic testing. The biopsy may identify a tumor, infection, inflammatory condition, or another disease process.

Once adequate tissue has been obtained, the needle is removed. The small skull opening may be covered, and the incision is closed. Because only a tissue sample is taken, the purpose of stereotactic biopsy is to establish a diagnosis rather than remove the entire lesion.

Cranioplasty is a procedure used to repair an opening or defect in the skull. A skull defect may remain after trauma, infection, tumor surgery, or a decompressive craniectomy performed to allow the brain room to swell.

The procedure begins by reopening or incorporating the previous scalp incision. The scalp and underlying tissues are carefully separated from the edges of the skull defect and from the protective covering over the brain.

Once the entire defect has been exposed, the surgeon prepares the surrounding bone edges. The opening is then repaired using the patient's preserved bone flap or a specially designed implant. Custom implants may be created from the patient's CT scan so that they closely match the natural shape of the skull. Common materials include titanium and medical-grade synthetic implants.

The bone flap or implant is placed into the skull defect and secured with titanium plates, screws, or other fixation devices. The area is carefully inspected to ensure that the implant is stable and that there is no active bleeding.

The deeper scalp tissues and skin are then closed in layers. A temporary drain may occasionally be placed beneath the scalp to prevent fluid from collecting.

Cranioplasty restores the shape and strength of the skull and helps protect the underlying brain. In some patients, repairing a large skull defect may also improve headaches, balance, concentration, or other neurological symptoms.

Anterior cervical discectomy and fusion, commonly called ACDF, is performed through an incision in the front of the neck. This approach allows the surgeon to reach the cervical spine without cutting through the muscles along the back of the neck.

After the incision is made, the tissues of the neck are carefully separated using a natural corridor between the trachea and esophagus on one side and the carotid artery and jugular vein on the other. This provides access to the front of the cervical spine.

Once the spine is exposed, imaging is used to confirm the correct level. The damaged disc is then removed, along with bone spurs, thickened ligaments, or other arthritic tissue that may be compressing the spinal cord or nerve roots. This creates additional space for the nerves and spinal cord.

The empty disc space is then filled with an implant designed to restore and maintain the normal disc height. This is typically a titanium implant containing material intended to promote bone growth and fusion. The implant also helps restore or maintain the normal forward curvature, or lordosis, of the cervical spine.

Depending on the number of levels being treated and the underlying condition, a plate may be placed along the front of the spine. Screws are inserted into the vertebrae above and below the removed discs to provide additional stability while the fusion heals.

Once the implants are confirmed to be in the appropriate position, the tissues are returned to their normal locations and the incision is closed in layers. Over time, the vertebrae are expected to grow together across the treated disc space, creating a stable fusion.

Cervical disc arthroplasty, also called cervical disc replacement, uses the same general approach through the front of the neck as an anterior cervical discectomy and fusion.

The incision is made in the front of the neck, and the spine is reached through the natural corridor between the trachea and esophagus and the major blood vessels of the neck. Imaging is used to confirm the correct level before the damaged disc is removed.

The disc, bone spurs, and other tissue compressing the spinal cord or nerve roots are carefully removed. The disc space is then prepared to receive an artificial disc.

Unlike ACDF, cervical disc arthroplasty does not attempt to fuse the two vertebrae together. Instead, an artificial disc is placed into the space with the goal of preserving motion at the treated level while maintaining disc height and spinal alignment.

Maintaining motion may reduce stress on the discs immediately above and below the treated level. Studies have shown that properly selected patients undergoing disc replacement may have a lower risk of developing symptomatic deterioration at nearby levels when compared with fusion.

Once the artificial disc is confirmed to be in the proper position, the tissues are returned to their normal locations and the incision is closed. Cervical disc replacement is not appropriate for every patient. The decision depends on factors such as the number of involved levels, the amount of arthritis, spinal alignment, instability, bone quality, and the location of the compression.

Posterior cervical decompression and fusion is performed through an incision along the back of the neck. It may be recommended when compression involves multiple levels, when the spine is unstable or deformed, or when the spinal cord and nerves are best reached from behind.

The muscles along the back of the neck are carefully separated from the laminae, which form the back portion of the cervical vertebrae, and from the lateral portions of the spine where the stabilization implants will be placed.

Using a combination of standard anatomical techniques, imaging, and neuronavigation, screws are placed into the lateral masses or pedicles of the cervical vertebrae. The type and location of the screws depend on the spinal levels being treated and the patient's anatomy. The screws are connected with rods to provide structural support and stabilize the spine.

After the stabilization implants are placed, the laminae and any thickened ligaments, bone spurs, or arthritic tissue causing compression are removed. This creates additional room for the spinal cord and nerve roots.

Bone graft material is then placed along the exposed surfaces of the cervical spine to encourage the treated vertebrae to fuse together over time. Once the decompression and instrumentation are complete, the muscles and deeper tissues are returned to their normal positions and the incision is closed in layers.

The goals of posterior cervical decompression and fusion are to relieve pressure on the spinal cord and nerves, prevent further neurological decline, and stabilize the spine.

A lumbar discectomy is performed to remove a portion of a herniated disc that is compressing a nerve in the lower back. The goal is to relieve pain, numbness, tingling, or weakness traveling into the buttock, leg, or foot.

The procedure may be performed through a traditional open approach or through a minimally invasive tubular approach. A tubular minimally invasive technique is typically favored when it can provide adequate and safe access to the affected nerve.

With either approach, an incision is made over the appropriate level of the lumbar spine. Imaging and, in selected cases, neuronavigation may be used to confirm the correct location and guide the surgical approach.

In an open discectomy, the muscles are separated from the back of the spine to provide a wider view of the affected area. A small portion of bone and ligament may be removed to expose the compressed nerve. The nerve is gently protected while the herniated portion of the disc is removed.

In a minimally invasive tubular discectomy, progressively larger dilators are passed between the muscle fibers, creating a narrow working corridor. A tubular retractor is then placed over the affected level. The procedure is performed through this tube using magnification, specialized instruments, and image guidance when appropriate.

The tubular approach generally requires a smaller incision and causes less disruption to the surrounding muscles. This may reduce postoperative pain and allow a faster recovery. The tradeoff is that the surgeon works through a smaller field with more limited exposure.

An open approach provides broader visualization and may be preferable when the anatomy is complex, when a more extensive decompression is required, or when the nerve compression cannot be safely addressed through a narrow corridor. However, open surgery generally requires a larger incision, greater muscle exposure, and a longer recovery.

Once the nerve has been fully decompressed, the surgical area is inspected and the incision is closed in layers.

A lumbar laminectomy is performed to relieve pressure on the nerves caused by spinal stenosis. The procedure removes some or all of the lamina, which forms the back portion of the vertebra, along with thickened ligaments, bone spurs, or enlarged arthritic joints that are narrowing the spinal canal.

Lumbar laminectomy may be performed using an open approach or a minimally invasive tubular approach. Imaging and neuronavigation may be used to identify the correct levels and guide the decompression.

During an open laminectomy, an incision is made over the affected portion of the lower back. The muscles are separated from the spine to expose the laminae and joints. The necessary portions of bone, ligament, and arthritic tissue are then removed to create more room for the nerves.

The open approach provides a wide field of view and allows the surgeon to directly inspect and decompress multiple levels or both sides of the spinal canal. This can be particularly helpful when stenosis is severe or widespread. The disadvantage is that it usually involves a larger incision, more muscle exposure, increased postoperative discomfort, and a longer recovery.

During a minimally invasive tubular laminectomy, a small incision is made and muscle fibers are gradually separated using dilators. A tubular retractor is placed over the spine, and the decompression is performed through this narrow corridor. In many cases, the surgeon can reach both sides of the spinal canal from a single-sided approach.

The minimally invasive technique generally results in less disruption to the muscles, less postoperative pain, and a shorter recovery. However, the smaller working corridor provides less direct exposure and may not be appropriate for every pattern of stenosis.

Once adequate space has been created around the nerves, the surgical area is inspected and the incision is closed. A fusion is not always required with a laminectomy but may be recommended when instability, deformity, or significant slippage is also present.

A transforaminal lumbar interbody fusion, commonly called a TLIF, is performed to decompress the nerves and stabilize one or more levels of the lumbar spine. It may be recommended for conditions such as spondylolisthesis, spinal instability, recurrent disc herniation, severe foraminal stenosis, or painful degenerative disc disease.

The procedure is performed from the back of the spine and may be completed through an open exposure or using a minimally invasive tubular technique. Imaging and neuronavigation may be used to confirm the operative level and guide placement of the implants.

During the procedure, a portion of the lamina and facet joint is removed to reach the affected nerve and disc space. This allows the compressed nerve to be fully decompressed. The damaged disc is then removed, and the surfaces of the neighboring vertebrae are prepared for fusion.

An interbody implant, or cage, is filled with bone graft material and placed into the disc space. The cage helps restore disc height, maintain alignment, support the front portion of the spine, and provide an area for bone to grow between the vertebrae.

Pedicle screws are then placed into the vertebrae above and below the treated level and connected with rods. These implants stabilize the spine while the fusion heals.

With an open TLIF, the muscles are separated more broadly from the spine, providing greater exposure and allowing direct visualization of the nerves, joints, and implant placement. This may be advantageous when a wide decompression is needed, multiple levels are being treated, or the anatomy is complex. The disadvantages generally include a larger incision, greater muscle disruption, more postoperative pain, and a longer recovery.

With a minimally invasive TLIF, the decompression and cage placement are performed through a tubular retractor. Pedicle screws are commonly placed through separate small incisions using fluoroscopy, image guidance, or neuronavigation. This approach generally reduces muscle injury, blood loss, postoperative discomfort, and recovery time. The limitation is a smaller working corridor and less direct exposure.

The choice between open and minimally invasive TLIF depends on the patient's anatomy, the severity and location of the compression, the number of levels involved, prior surgery, and the degree of instability or deformity.

An anterior lumbar interbody fusion, commonly called an ALIF, reaches the lumbar spine through the abdomen rather than through the muscles and nerves of the back.

A general surgeon or vascular surgeon typically performs the initial exposure. An incision is made in the abdomen, and the abdominal contents and major blood vessels are carefully moved to the side to create a pathway to the front of the spine.

Once the correct level is confirmed, the damaged disc is removed. The disc space is prepared, and a large interbody cage containing bone graft material is placed between the vertebrae.

Although the pathway to the front of the spine is longer, the anterior approach often causes less direct injury to the muscles of the lower back. Many patients therefore experience less postoperative back pain than might be expected from the size of the procedure.

The large cage used in an ALIF provides strong biomechanical support. It can help restore lost disc height, improve the normal curvature or lordosis of the lumbar spine, and enlarge the openings through which the nerves exit. This indirect decompression may relieve pressure on the nerves without requiring them to be directly exposed or moved.

The anterior approach can also use positioning and gravity to help reduce spondylolisthesis, or slippage between the vertebrae. Because the implant spans a large portion of the disc space, it provides a broad surface for fusion and may allow more complete restoration of spinal alignment than a smaller posterior implant.

Another advantage is that the spinal canal and nerve roots are generally not directly entered during the interbody portion of the operation. This minimizes manipulation of the neural structures and can provide an additional margin of safety in appropriately selected patients.

Depending on the level treated, the amount of instability, and the patient's anatomy, the anterior cage may include integrated screws or may be reinforced with posterior pedicle screw fixation.

Percutaneous pedicle screw fixation is a minimally invasive technique used to stabilize the thoracic or lumbar spine through several small incisions rather than one larger open exposure.

This technique may be used to reinforce an anterior lumbar fusion, support a minimally invasive interbody fusion, or stabilize an unstable thoracic or lumbar spinal fracture.

The procedure is performed using fluoroscopy, image guidance, neuronavigation, or a combination of these technologies. The imaging system creates a detailed map of the spine and helps guide each screw through the pedicle and into the vertebral body.

Small puncture or stab incisions are made over the planned screw locations. Guidewires or navigated instruments are advanced into the pedicles, and screws are placed through the small incisions. Rods are then passed beneath the skin and connected to the screws to stabilize the involved levels.

Because the muscles do not need to be widely separated from the spine, percutaneous fixation generally causes less muscle injury, blood loss, and postoperative pain than traditional open instrumentation. Patients may require less pain medication, begin mobilizing sooner, and have a shorter hospital stay.

In fracture treatment, the screws and rods create an internal support system that maintains spinal alignment while the fracture heals. When used with an anterior lumbar fusion, the posterior screws provide additional stability while bone grows through and around the interbody cage.

Percutaneous fixation is not suitable for every condition. A traditional open approach may still be needed when extensive nerve decompression, correction of a major deformity, direct fracture reduction, or broad fusion exposure is required.