Spine & Pain Medicine

Charles W. Graubert, M.D.

Non-Operative Orthopedic Medicine
Physical Medicine & Rehab, EMG/NCV, Acupuncture

Total Disc Replacement Surgery

Total Disc replacement is a surgical technique used to alleviate lower back pain for people who suffer from a degenerative disc disease. Also known as artificial disc replacement or artificial cervical disc replacement, this procedure is every bit as safe and effective as spinal fusion, while also allowing for a much shorter recovery and rehabilitation time-frame. In many cases, total disc replacement patients can begin the rehab process within a few days of the procedure, with a full recovery often within 2-3 months. A few other advantages of the total disc replacement surgery include:

• Protects and restores the segmental motion in the treated area of the spine
• Preserves the foraminal height and intervertebral architecture
• Protects the discs above and below the disc replacement against accelerated degeneration
• Restoration of normal biomechanical function across the lumbar region of the spine

Spinal Fusion

Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

Spine surgery is usually recommended only when your doctor can pinpoint the source of your pain. To do this, your doctor may use imaging tests, such as x-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans.

Spinal fusion may relieve symptoms of many back conditions, including:

• Degenerative disk disease
• Spondylolisthesis
• Spinal stenosis
• Scoliosis
• Fracture
• Infection
• Tumor
• Description

Spinal fusion eliminates motion between vertebrae. It also prevents the stretching of nerves and surrounding ligaments and muscles. It is an option when motion is the source of pain, such as movement that occurs in a part of the spine that is arthritic. The theory is if the painful vertebrae do not move, they should not hurt.

If you have leg pain in addition to back pain, your surgeon may also perform a decompression (laminectomy). This procedure involves removing bone and diseased tissues that can put pressure on spinal nerves.

Fusion will take away some spinal flexibility, but most spinal fusions involve only small segments of the spine and do not limit motion very much.

Understanding why spinal fusion is done can be difficult and confusing. Your surgeon will discuss your questions in detail. To help you better understand the different spinal fusion surgeries, this glossary of words and abbreviations has been developed.

Surgeons can reach the spine by making an incision (cut) in different places on your body. Incision sites are often described as:
Anterior. This term refers to the front of your body. In spinal fusion surgery, an anterior fusion is done by making an incision in the abdomen (belly).

Posterior. This refers to the back part of your body. If you are having a posterior fusion in your lower back, you will lie on your belly during the operation and your surgeon will make the incision in your lower back.

Lateral. This refers to the side part of your body. Surgeons can reach certain parts of the lumbar spine by making an incision in your side.

Surgeons will also perform the surgical procedure in specific parts of your spine, such as the vertebra or the intervertebral disk. In most cases, the part of your spine being operated on is the place where the problem is present.

Intertransverse or posterolateral. This is the part of the lumbar spine between the transverse processes of a vertebra.
Surgeons most often reach this area by making an incision on the back. This type of fusion is called:

• Posterior (from the back) posterolateral (specific spinal anatomy involved)
• Fusion. This procedure is often referred to as a PLF.

Interbody. This is the part of the spine where the disk is present, between the bones (vertebrae). An interbody fusion can be performed with different approaches:

• Anterior (from the belly) Lumbar (part of the spine being operated upon)
• Interbody (in the disk space) Fusion. You may see this written as an ALIF.
• Posterior (from the back) Lumbar (part of the spine being operated upon)
• Interbody (in the disk space) Fusion. or PLIF.
• A different type of PLIF is called transforaminal. Although the spine is still reached through an incision in the back, the disk space is approached from the side.
• Transforaminal (from the back) Lumbar (part of the spine being operated upon) Interbody (in the disk space) Fusion or TLIF.
• Lateral (from the side) Lumbar (part of the spine being operated upon) Interbody (in the disk space) Fusion (specific surgery being done). This type of surgery is often described as a Direct lateral or Extreme lateral approach (DLIF or XLIF).

Spine Procedure Education/Animations