v2 Underlying Work 2010, Marshall Steele & Associates, LLC. All rights Reserved. Modifications 2010, Yampa Valley Medical Center.

Size: px
Start display at page:

Download "2 2010-03v2 Underlying Work 2010, Marshall Steele & Associates, LLC. All rights Reserved. Modifications 2010, Yampa Valley Medical Center."

Transcription

1

2 2

3 Table of Contents Section One: General Information Welcome Using the Guidebook Your Spine Surgery Team Anatomy and Physiology of the Spine Common Spinal Problems Common Spinal Operations FAQs about Lumbar Laminectomy FAQs about Lumbar Fusion FAQs about Cervical Laminectomy FAQs about Cervical Fusion Risk Factors Possible Complications Section Two: Pre-operative Checklist Pre-Hospital Assessment Pre-operative Exercises - Lumbar Pre-operative Exercises - Cervical Four to Six Weeks before Surgery One Week before Surgery The Day before Surgery The Night before Surgery Section Three: Hospital Care Day of Surgery - Arrival - What to Expect - Post-op Routine through PCU Discharge - Understanding Pain Management - Discharge Plans and Expectations - Physical Therapy Centers - Home Health and Short Term Rehabilitation Center 3

4 Table of Contents Section Four: Post-operative Care Control Your Discomfort Body Changes Caring for Your Incision Dressing Change Procedure Stockings Blood Clots in Legs Pulmonary Embolus Section Five: Post-operative Activity Guidelines Cervical - Spinal Precautions - Bed Positioning - Bed Mobility: Getting In/Out of Bed - Transfers: In/Out of Chair, Bed, Car, Commode, etc. - Using a Walker - Using Stairs - Brace Lumbar - Spinal Precautions - Bed Positioning - Bed Mobility: Getting In/Out of Bed - Transfers: In/Out of Chair, Bed, Car, Commode - Using a Walker - Using Stairs - Brace - Activities of Daily Living, Cervical and Lumbar 4

5 Table of Contents Section Six: Body Mechanics - Cervical & Lumbar General Rules Standing Sitting Bending Lifting Turning Reaching Push/Pulling Sleeping Household Chores Do s and Don ts for the Rest of Your Life Section Seven: Discharge Instructions Cervical Laminectomy Cervical Fusion Lumbar Laminectomy Lumbar Fusion Post-Op Care Instruction Ice/Cold Therapy Reasons to Call Your Doctor Home Set Up Nutrition Section Eight - Appendix Anesthesia for Spine Surgery Glossary of Terms 5

6 6

7 Section One: General Information Welcome Thank you for choosing the Spine Center of Steamboat Springs, part of the New Mobility Joint and Spine Center at Yampa Valley Medical Center. The Spine Center was founded in August 2004 with Henry F. Fabian Jr., M.D., a fellowship trained orthopaedic spine surgeon, as Director. Since its inception, the Spine Center has been a leader in delivering the highest quality of spine surgery services to its patients. Dr. Fabian is an internationally recognized spine specialist, with an extensive background in developing new surgical techniques and technologies, including advances in minimally invasive spine surgery. He has lectured throughout the world and assisted in the training of spine surgeons from North America, Latin and South America, Asia and Europe. In 2010 Dr. Fabian was honored with a Patient s Choice Award as well as being named one of America s Top Orthopedists. Along with his colleagues at Orthopaedics of Steamboat Springs, Dr. Fabian serves as a team physician for the United States Ski Team. At the New Mobility Joint and Spine Center, Dr. Fabian is supported and assisted by a comprehensive team of fellow physicians, physical and occupational therapists, nurses and other professionals trained in the care of patients undergoing spine surgery. A 96.19% patient satisfaction score and an overall complication rate of less than 1%, as well as benchmark leading reduced hospital length of stay and infection rates, are testimony to the diligent and comprehensive care offered at the New Mobility Joint and Spine Center at Yampa Valley Medical Center. Back pain, including neck and low back pain, is the second most common reason for seeing a doctor, besides the common cold. Over 90 million people will see a doctor in the U.S. in any given year with complaints of back pain. In addition, more than 200,000 people undergo spine surgery in the U.S. each year. Many suffer from debilitating arm, leg, neck and back pain that they can no longer tolerate. Fortunately, there have been significant advances in surgical technique, implants and rehabilitation that have allowed surgical spine patients to return to fully active and productive lives. These days most patients undergoing spinal surgery recover quickly. 7

8 A significant number are able to undergo outpatient/ambulatory surgery, with even multilevel cervical and lumbar fusion patients discharged in 2-3 days! At the New Mobility Joint and Spine Center, some patients have returned to sedentary and light duty work after lumbar discectomy, lumbar laminectomy, cervical fusion, and even lumbar fusion in a week! Heavy laborers with cervical fusions return to work in 4-6 weeks and in weeks after lumbar fusions. The Spine Center of Steamboat Springs recently partnered with the New Mobility Joint and Spine Center at Yampa Valley Medical Center to develop a comprehensive program and team approach to assure the best outcomes for our patients. We believe that patients play a key, truly essential, role in ensuring a successful surgical outcome. Our goal is to involve patients in their treatment along the entire continuum of care, with the patient an active team member in each step of the program. This guidebook provides the information needed to maximize your surgical results, ensuring a safe and successful surgical experience. Features of the New Mobility Joint and Spine Center s Program Include: A dedicated and experienced surgical team Nursing and therapists specialized in the postoperative care of spine surgery patients Emphasis on individual and patient-specific care Family and friends participating as coaches in the recovery process A spine care coordinator to facilitate discharge planning A multi-disciplinary medical physician team to assist in postoperative care Comprehensive case management care Attention to consistent and high standards of surgical and postoperative care 8

9 Using the Guidebook Preparation, education, continuity of care, and a pre-planned discharge are essential for optimum results in joint surgery. Communication is essential to this process. The Guidebook is a communication tool for patients, physicians, physical and occupational therapists, and nurses. It is designed to educate you so that you know: What to expect every step of the way What you need to do How to care for your spine Remember, this is just a guide. Your physician, physicians assistant, nurses, or therapist may add to or change any of the recommendations. Always use their recommendations first and ask questions if you are unsure of any information. Keep your Guidebook as a handy reference for as long as you need it after your surgery, then please return it so it can be recycled. The information in the Guidebook covers a lot of details, so it may look overwhelming. As it will assist you with your surgery, we recommend reading the entire guide, at a pace that suits you. 9

10 Your Spine Surgery Team The undertaking and completion of a successful spine surgery and postoperative rehabilitative course is a multi-faceted and complex process requiring the hard work and diligence of many highly skilled health care providers. That having been said, the most important person in the equation and in obtaining the optimal result is You, the patient! It has often been said by people from little league baseball coaches to CEOs of Fortune 500 Companies that there is no I in TEAM, but you, the patient, are the I in this Spine Surgery Team, and you are the most important person. A patient who is actively engaged in the process, and works alongside all of the various healthcare providers, stands the best chance of assuring a predictably successful outcome. Listed below are the members of Yampa Valley Medical Center s Spine Surgery Team and the New Mobility Joint and Spine Center. With your help, they will work together to return you to an active, independent and rewarding lifestyle: Spine Surgeon: Dr. Fabian and his staff are extremely well trained in the surgical techniques involved in your specific procedure. They will see you in the pre-operative period, in the surgical suite, post-operatively in the hospital and after discharge. Dr. Fabian monitors his cervical and lumbar fusion patients for a minimum of 2 years, with followup evaluations at 1 and 6-8 weeks postoperatively and then at 3,6,12 and 24 months. Outpatient laminectomy/discectomy patients are typically followed for 3-4 months. Patient satisfaction and outcomes are tracked through the continuum of care by Marshall Steele and Associates, a nationally recognized organization dedicated to developing destination centers of excellence for spine surgery. Anesthesiologist: The board certified physicians of Elk River Anesthesiology Associates, P.C. will provide anesthesia for your spine surgery. They have worked exclusively with Dr. Fabian and his surgical team since program inception, to develop specific intraoperative and postoperative protocols for your anesthesia care. Internists and Local Primary Care Physicians: Every spine surgery patient is required to have a pre-operative evaluation/history and physical examination by either an internist/primary care physician or Dr. Fabian and members of his team. Patients undergoing lumbar fusion, select cervical fusion patients, patients with medical issues and elderly patients frequently require a more comprehensive preoperative evaluation. Internists and primary care physicians are specifically trained to complete the general medical pre- 10

11 operative assessment to make sure the patient is medically fit for the specific surgery. For in-patient spine surgery, they will follow your medical progress and assist in the daily postoperative care. If your primary care physician is not on the YVMC staff, a YVMC staff physician will work with you and closely communicate with your doctor so that your care can be effectively and efficiently managed while you are an in-patient. Your Spine Care Coordinator The Spine Care Coordinator will be responsible for your care needs from the surgeons office, to the hospital, and home. The Spine Care Coordinator will: Obtain health database. Review what you ll need at home after your surgery, including support if required. Assess and plan for your specific care needs such as anesthesia and medical clearance for surgery. Coordinate your discharge plan to home or a facility with additional support. Act as your advocate throughout the course of treatment from surgery to discharge and home. Answer questions and coordinate your hospital care with New Mobility team members. You may call the Spine Care Coordinator at any time to ask questions or discuss concerns about your surgery. The coordinator will assist you in completing your pre-op patient outcomes survey. Preoperative Care Nurse : These individuals serve as liaisons among the various Departments, Surgery and You, the patient. The POC nurse will obtain your health history, communicate with the primary care physician, schedule pre-admission diagnostic testing, and physical therapy pre-surgical evaluations. 11

12 Case Management and Discharge Planning Please call with any questions or concerns you may have prior to surgery. Case Manager: This person will provide patient education, is available to answer questions, and assists in coordinating your care. We will assist in discharge planning, insurance questions and, along with your health care team, help determine if you can safely manage at home. You can anticipate to be discharged 1-3days after your surgery. Your case manager and physician will keep you informed of your discharge status. A case manager will visit you while you are in the hospital to discuss your plans for managing at home after surgery. The case manager is there to help you arrange for assistive devices such as a walker or crutches, arrange home health, or to assist in the transfer to a transitional care unit. A case manager can also provide emotional support during your stay. We work as the patient advocate and will try to address any question or concern that comes up during your hospital stay. Nursing Department: This includes Peri-operative and Departmental Floor Nursing. The Peri-operative nursing staff includes the surgical team nurses and the post anesthesia care nurses. These nurses prepare you for surgery and then care for you in the acute phase after surgery in the PACU. They are responsible for starting intravenous fluids and I.V. lines, initial patient intake questionnaires and then for managing your acute needs, including pain management, after surgery. For spine surgery in-patients, the departmental floor nurses assist you in meeting your goals. They are specifically trained to care for patients who have undergone spine surgery. Physical Therapy: This individual is critical to your progress in mobility and strength. Ultimately, you and the effort you put forth, as well as the relationship you develop with your therapist is responsible for the long-term success of your care. You will meet with a physical therapist pre-operatively to assess any deficiencies that might hinder your postop rehab and to begin the education process in postural alignment, core stabilization and strengthening 12

13 exercises you will need to be successful for short and long-term. The therapist will work with you while you are an in-patient and assist you in accomplishing the standardized goals of the New Mobility Program, as well as those additional goals that are specific to your problem. Occupational Therapist: This therapist will assist you with self-care needs and adaptive equipment as needed during your hospital stay. Somatosensory Evoked Potentials (SSEP)/EMG (Electromyogram) Recording/Monitoring Technician: Select cases involving cervical and lumbar fusion are done at the Center using SSEP/EMG monitoring. This technique allows for continuous monitoring of the function of the spinal cord and nerve roots and offers an additional level of safety in cases where there is risk of neurologic injury secondary to placement of rods and screws as well as when spinal curvature correction is undertaken. The technician is certified and services are contracted on an independent contractor/consultant basis. Dietician: A YVMC dietician will review your dietary requirements and restrictions or special diets your condition may warrant. You, the Patient: Your input and full participation along every step of the process is vital to the team s success. By preparing yourself prior to surgery and understanding the course of events before, during and after your hospitalization, you will be contributing to your own care and to achieving a successful outcome. Please read this entire book in advance of surgery and seek additional information from Dr. Fabian, his staff and the hospital program personnel when and where necessary. It cannot be emphasized enough that the success of your surgery depends significantly on your preparation and hard work! The team members will help you achieve your goal of a successful surgical outcome and a complete and fulfilling postoperative rehab. THE REST OF THIS RESOURCE BOOK WILL GO OVER THE PROCESS DETAILS. 13

14 Durable Medical Equipment Suppliers of oxygen, walkers, toilet riser and other equipment Willow Creek Oxygen and Medical Supply 2570 S. Copper Frontage # 6 Steamboat Springs, CO PS Homecare 2851 Riverside Plaza #12 Steamboat Springs, CO G & G Medical Supply 581 Tucker Craig, CO Sullivan Respiratory Care 246 Market Street Meeker, CO

15 Anatomy and Pathology of Spine Surgery By Henry F. Fabian Jr., M.D. The human spine is an incredibly complex piece of machinery with a remarkable range of function and motion. If you have ever witnessed the movements of a gymnast or a Cirque de Soleil performer you have seen the capabilities of the spine at its best. Unfortunately, as with most things with a lot of moving parts, things can go awry. The aging process, poor nutrition, poor posture, bad ergonomics and inadequate exercise can lead to debilitating injuries and complaints of pain, extremity weakness and numbness, and all the loss of independence and function that go with these problems. You, as a patient who is undergoing surgery, are at a crucial point where conservative care has failed or been insufficient in dealing with your problem. A fundamental understanding of the anatomy of the spine and the pathology and problems that can develop is very important. Educating yourself about this subject is the most important step in being fully engaged as a team player in your care. Learning about spine anatomy and pathology will help you to understand the entire process that follows once you have made the decision to seek surgical care. Before you cringe at how complex the spine may seem, thinking back (maybe not so fondly) on high school biology class, remember that all systems and problems can be broken down into less complex, smaller parts. Understanding these smaller pieces of the spine puzzle will help you to understand and see the big picture. The entire spinal column is comprised of 22 vertebrae in total. There are 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae. In between the bony vertebrae (referred to as vertebral bodies) are intervertebral discs. These discs are made of cartilage and serve as the shock absorbers of the entire column. Discs are labeled based on which vertebral bodies they lie between. For example, the disc between the fourth and fifth lumbar vertebrae would be labeled L4-5 and the disc between the second and third lumbar vertebrae would be labeled L2-3. The fifth lumbar vertebra, L5, sits on the sacrum, a part of the spinal column that links the spine to the pelvis. 15

16 This disc level is uniquely labeled L5-S1. The sacrum below S1 is no longer really mobile or segmented, and attaches to the coccyx. The four sections of the spine are highlighted and reviewed in the drawing below: The spine is divided into four main sections: 1. The cervical spine is composed of seven vertebrae and generally control the arms and hands. 2. The thoracic spine is composed of twelve vertebrae and control the region of the chest and abdomen. 3. The lumbar spine is composed of five vertebrae and controls the region of the legs and feet. Running up and down the left a Running up and down the left a 4. The sacrum is the lowest part of the spine and serves as the junction between the spine and pelvis. These nerves control the bowel and bladder. Running up and down the left and right sides of the back of the spine are the paired facet joints, labeled just like the disc levels. As an example, the left sided facet joint between the fourth and fifth lumbar vertebral bodies is called the left L4-5 facet joint. The facet joints are real functioning joints, just like our knee or hip joints. With two opposing surfaces covered in hyaline cartilage, the type of smooth, glistening white cartilage found in your Thanksgiving turkey legs, these joints allow a variety of movements. Our ability to flex, 16

17 extend, twist and bend is because of the function of these joints. There are 44 (yes, 44!) facet joints along the entire spinal column. The intervertebral cartilage discs are also considered a type of joint and as a result, we have a total of 66 functioning joints in our spines! Total joint replacement surgeons are challenged by a single hip, shoulder or knee joint. Imagine facing the task of addressing 66 joints and you begin to realize the scope of complexity and the difficulty in isolating a single source of pain! With all these pieces and parts it is best to focus on the basic building block of the spinal column, the Functional Spinal Unit or FSU. Whether we are talking about the cervical, thoracic or lumbar spine, this Functional Spinal Unit, or FSU remains the same. A functional spinal unit is composed of two adjacent vertebral bodies with a cartilage intervertebral disc between them, paired left and right facet joints, and the corresponding ligaments between the vertebrae and attaching muscles. The drawing below shows an FSU, or functional spinal unit, and its relationship to the spinal cord and branching nerve root. The spinal column is composed of these building blocks stacked one on top of the other, from the base of the skull to the sacrum and pelvis. Each individual functional spinal unit allows for flexion, extension, rotation and bending from side to side. The intervertebral disc, 17

18 positioned between the vertebral bodies, serves as the fulcrum, or pivot point for motion. The disc is made of visco-elastic cartilage and can be compressed, stretched, rotated, and flexed and extended, defined by certain mechanical limits and based on location in the cervical, thoracic or lumbar spine. The corresponding facet joints, paired left and right move up and down to allow flexion and extension. Surrounding the facet joints, just like in the hip socket or knee, are joint capsule fibers and ligaments that serve to control and restrain the limits of motion. If you look back to our first drawing, showing the entire spinal column, you see that it is S- shaped. The cervical and lumbar curves match to some extent and the thoracic curve is directed in the opposite direction. Spine surgeons talk about the cervical and lumbar curves being lordotic and the thoracic curve being kyphotic. These curves actually serve several, very functional purposes. Muscles attaching to the spine and the effect of gravity generate tremendous forces in, and around the spinal column. The curvature of the spinal column allows those forces to be dissipated in a very efficient manner. If our spines were perfectly straight, we would either fall on our faces or every vertebra in the column would be crushed because of the compressive forces placed on the spine merely from standing and resisting gravity! Think of the Golden Gate Bridge in San Francisco as you ponder that last sentence. If the Golden Gate Bridge, or the arches in the Cathedral Notre Dame were not curved, or cantilevered, they would collapse under the forces placed on them! The combination of curvatures also places a plumb line dropped from under your chin exactly one centimeter in front of your sacrum, allowing for a perfectly balanced spine. If we didn t have this, the effort in walking and daily living activities like lifting or carrying objects would be almost impossible! 18

19 The figure to the left shows a functional spinal unit and then the entire column of FSUs. The spinal column is usually described as having three columns, an anterior (front), middle and posterior (back) column. The anterior column is defined as the front half of the vertebral body and disc, along with a thick ligament that runs along the front from one level to the next called the anterior longitudinal ligament (ALL). The middle column is the back half of the vertebral body and disc, along with a posterior longitudinal ligament (PLL). The posterior, or back column, is described as the pedicle, lamina, facet joint and spinous process. The facet joints have ligament capsules and running over the tips of the spinous processes and in between them are the supraspinous and interspinous ligaments. These posterior ligaments serve as major restraints to hyperflexion and protect the discs from rotational forces they can t resist. When you think about the apparently complex interaction of these columns, think about that toy wooden snake with the interlocking wooden parts. No matter where you jiggle that toy snake, the individual wooden segments stay aligned to each other. The middle and posterior (back) columns are attached to each other via the bony structures called the pedicles, shown in the drawing. The back of the vertebral body, the pedicle and then the arch of bone spanning from left to right define the spinal canal. The spinal canal is the protective chamber for the spinal cord and nerve roots. Many patients have the mistaken impression that the spinal cord and nerve roots run through the middle of the bony vertebral bodies and through the cartilage discs. The truth of the matter is that they run behind these structures. When we talk about pinched nerves or spinal cord, there are several structures that can cause this problem. The nerves pass behind the disc, around the pedicle and then underneath the facet joint to exit and then travel down an arm or leg. Compromise at any of these locations can cause nerve irritation. 19

20

21 Common Spinal Problems Degenerative Disc Disease and Facet Arthritis: is a gradual process that eventually compromises the spine. It is a result of the normal wear and tear of the aging process. The intervertebral disc loses its elasticity and shock absorbing capabilities and the facet joints start to lose the smoothness of their cartilage surfaces and begin to form bone spurs, as we have already talked about in the previous pages. As this process evolves and matures, the disc and facet joints become stiff and limit movement. Pain usually occurs in the area where the degeneration occurs but can also be referred up or down the column several levels, or even into the pelvic area and upper thighs. This is called a pseudo-sciatica, or false sciatica, to differentiate it from true sciatica that describes pain traveling down the entire thigh and leg. As an example, severe L4-5 facet arthritis, frequently has a pain referral pattern into the buttocks and upper sides of the thigh, over the hips. Many of these patients will seek treatment for hip arthritis or bursitis, sometimes for many months without success, until it is realized that their real problem is in the back. A Disc Herniation occurs when the central portion of the disc, the nucleus pulposus, bulges through the outer layer of the disc, called the annulus, and puts pressure on the spinal nerves. This type of problem is very common in the cervical and lumbar regions of the spine. The disc herniation can be described as bulging, extruded, or as a sequestered or free fragment. Bulging discs are still contained by the outer fibers of the disc, called the annulus, whereas extruded discs have a portion still attached to the inner fibers but have extended out past the annulus wall. Sequestered, or free fragments have lost all attachment to the disc and may even track out along a nerve root or the back of the adjacent vertebral bodies. Spinal Stenosis, probably the most common spinal problem treated, describes a progressive narrowing of the spinal canal. The normal spinal canal is mm. in front to back dimension and oval in shape, assuring plenty of room for the dural sac and the enclosed nerve roots to travel down the canal. The individual nerve roots exit the central canal at their respective vertebral levels. For example, the Left L3 nerve root branches off and exits the central canal at the L3 vertebral body through what is known as a foramen. The foramen is formed by the overlapping surfaces of the facet joints of adjacent vertebral levels. As the discs degenerate and the facet joints get arthritic, they bulge and generate osteophytes (bone spurs). In addition, the soft tissue capsules and surrounding ligaments 21

22

23 Why do discs degenerate or herniate? This is the most commonly asked question posed to spine surgeons. Intervertbral discs are composed of fibrocartilage and are visco-elastic, which means they can be compressed, tensioned and rotated. The central or middle fourth of the disc is much more watery and viscous, and is referred to as the nucleus pulposus. This is the portion that herniates, pushing through the outer ringed annulus and irritating the nerves. The previous drawing showed a paracentral herniated nucleus pulposus. The outer 2/3 of the disc is called the annulus and is a thicker, stiffer cartilage that is very good at resisting compression. Looking from the top, down on a disc, the annulus looks like the swirling cross section of an onion. Each layer is laminated to the next with fibers criss-crossing like the fibers of a steel belted radial. The result is a structure very good at resisting compression forces. Unfortunately this design is not good at resisting torsion and shear forces. The result in the human spine is a tendency to degenerate and herniate. These herniations can be described as contained, extruded or sequestered. The pictures below show the various forms and locations of herniated discs: Discs degenerate over time because as we age the vertebra and their endplates become less permeable to water and proteins, so that these key nutrients cannot get to the disc. A healthy disc has a relative composition of water, made up of hydrogen and hydroxyl protein linkages, of up to 80-85%. As we age, this hydration status deteriorates significantly, resulting in stiffer, less elastic discs eventually resulting in loss of disc height and bone spur formation. The loss of disc height affects the FSU, or functional spinal unit, by increasing the pressure on the facet joints and decreasing the space available for the nerve roots to exit the spinal canal. This is a cyclical, bad, positive feedback loop, as the increased facet joint pressure leads to further deterioration of the disc. The process can go on and on until the disc space and facet joints collapse completely. 23

24 Discs herniate because shear and rotational forces are poorly tolerated. Unfortunately a lot of the bending and twisting we do in daily living activities exert precisely those kinds of forces on the discs. One potential weak spot is along the lateral, or outside margin of the posterior longitudinal ligament (PLL) and its contact with the outer rim of the disc, the annulus. This is the paracentral location that is most common for herniated disc. Acute disc herniations are most common in the year old age group, whereas degenerative discs and spurs with facet arthritis are more common in the older age groups. In summary, the functional anatomy and the relationship of the nerves and spinal cord and sac to the bony structures follows a common thread throughout the spinal column. Understanding the basic structures and their relationships to each other, i.e. understanding the functional spinal unit or FSU, allows you to understand why certain things happen. Why does my left arm hurt? Why is my right thumb numb? Why does my low back hurt when I extend and rotate to the right? All these questions can be answered by understanding what is going on at specific functional spinal units. 24

25 Spondylolisthesis is a slippage of one vertebral level forward on an adjacent level. Because the spinal canal is simply made up of a stack of vertebra with space behind them, one level slipping forward can cut off the canal and pinch the nerve roots. This slippage can be the result of trauma, such as a pars fracture, which damages the linkage point between successive facet joint levels, or degenerative. The degenerative version is the most common. Scoliosis is an abnormal curvature of the spine. There are several subtypes, but one of the most common is degenerative lumbar scoliosis. Asymmetric disc degeneration or uneven settling of degenerative facet joints can tilt, or tip, one level to the left or right. Then, like the leaning Tower of Pisa, the entire column follows suit. Our muscles and ligaments serve as restraints to this and the typical compensatory curve is noted higher up the spinal column. Degenerative scoliosis is usually associated with degenerative disc disease, facet arthritis and spinal stenosis. Non-surgical treatments are the first and essential steps in managing these problems. The literature shows us that > 85% of herniated disc patients improve with non-surgical treatment. Degenerative disc disease and facet arthritis are usually managed with a comprehensive core strengthening and general fitness program, as well as with over the counter anti-inflammatory medications like Advil and Aleve. Spondylolisthesis, even if because of a pars fracture or defect, can be managed conservatively. Dr. Fabian has managed professional football and hockey players this way, as well as high level athletes in many other sports, including ski racers and PGA golf professionals. Physical therapy, chiropractic manipulation, massage therapy, acupuncture and spinal injection therapy, may all have a role in treating a particular problem. Unfortunately, in some cases conservative therapy fails to achieve the desired results. Patients with progressive loss of function, including progression of weakness, numbness and pain that limits daily activities, may lead the patient and the surgeon to discuss and agree to surgical options. 25

26 Common Spinal Operations The following are some of the most common surgeries performed in the spine. Your particular surgery will be determined by Dr. Fabian and his team depending on your particular situation and after consultation with you. Anterior Cervical Discectomy and Fusion This surgery is very common and is performed when a disc herniates, or a bone spur develops and compresses a nerve. Symptoms include neck pain and referred pain to the shoulder region and down the arm, including pain, numbness and arm and hand weakness. The surgery is performed from the front (anterior) side of the neck. This approach is considered very safe and results in minimal blood loss. The disc space in question is confirmed with an Xray marker and then the disc and/or bone spurs are removed. The disc space is then filled with an allograft (banked bone) machined dowel or synthetic spacer filled with bonegraft. At the Spine Center of Steamboat Springs, a unique hybrid technique is used to assure less pain to the patient with bone graft. Bone marrow and graft is harvested from the iliac crest at the pelvis with a small drill and then placed inside the pre-fabricated spacer/dowel. The bone graft grows into the adjacent vertebral bodies resulting in a fusion. An extremely low profile plate with screws is used to secure the segments being fused. This is so secure that for one and two level fusions, no postoperative bracing is required. For three level fusions or greater, a cervical collar is used for 4-6 weeks postoperatively. In some cases, the spinal cord compression may be so severe that an entire vertebra and the two adjacent discs have to be removed. This is called a corpectomy and requires longer term bracing. Posterior Cervical Fusion and Cervical Laminectomy This surgery is performed from the back (posterior) side of the neck. The posterior cervical fusion is often performed in conjunction with an anterior cervical fusion when multiple levels need to be addressed. This then represents a circumferential fusion. The fusion from the back can be accomplished using wire or cabling techniques or the use of what is called a lateral mass/trans-facet fusion with rods and screws. Bone graft is placed along with the 26

27 instrumentation to achieve the fusion. Cervical laminectomies are often performed when there is severe multi-level spinal stenosis. For a single or two level problem, a laminotomy, or partial removal of the lamina, can be performed. At a single level, this can be done with what is referred to as a key-hole foraminotomy. Lumbar Micro-discectomy or Endoscopic Discectomy This procedure is performed for herniated discs when they compress the spinal nerves and cause sciatica. Sciatica refers to the classic pain that radiates from the lower lumbar region down the thigh and leg, along the respective nerve level dermatome. A dermatome describes the regional distribution of a particular nerve root. The S1 nerve root for example, branching off at the L5-S1 disc level, supplies the lower, inside buttock, back of the thigh, the calf, and the heel, sole and 4 th and 5 th toes. The L5 nerve root supplies the upper outside buttock, the lateral (outside) thigh, the lateral leg below the knee, and then classically the instep and top of the big toe. Microscopic or loop magnification, with or without endoscopic techniques, is used to remove the portion of the disc that is compressing the nerve. Any associated bone spurs (osteophytes) are also removed to insure the path of the nerve root is free. At Yampa Valley Medical Center, over 98% of these procedures are performed on an outpatient basis, with the procedure typically less than 60 minutes in duration minutes after surgery, patients are ready to be discharged and walk out of the hospital! Dr. Fabian was one of the first surgeons in Ohio, as previous Director of the Ohio Spine Institute, to perform a microendoscopic discectomy in Minimally invasive techniques for this type of procedure continue to be refined. In these procedures, only a small portion of the overlying bone needs to be removed. The bony covering of the spinal is called the lamina. Partial removal of this one side is known as a hemi-laminotomy. Sometimes the outgoing channel for the nerve root needs to be widened in conjunction with this. This is known as a foraminotomy, or micro-foraminotomy. A related area of nerve compression is known as the lateral recess, this is opened by performing a partial facetectomy. 27

28 Lumbar Laminectomy This is done when the stenosis, or compression of the canal is global, involving both sides, or when the herniated disc is so large that a bigger exposure is needed to safely remove it. This is also very commonly an outpatient procedure. When greater than two levels need to be removed at the same time, patients are kept overnight as short-stay in-patients. Lumbar Fusion Lumbar Fusions are performed for several reasons, but the most common are instability of the segment, such as in a fracture or spondylolisthesis, and for degenerative disc disease with stenosis. In the case of the stenosis, sometimes so much of the lamina and facet joints need to be removed that this in itself can create instability. There are several methods to achieve lumbar fusion. Over the past 10 years there has been increased use of interbody fusion. Interbody fusion involves removing as much of the disc as is feasible and then replacing it with a spacer that allows bone graft to grow through and around the device. Because 80% of the weightbearing axis of the spine is through the front column of the vertebra and bone grows better in compression, the interbody region is the best place to fuse the spine. An interbody fusion can be accomplished from the front (anterior) or the back (posterior). From the front this is known as an anterior interbody fusion (ALIF) and from the back as a posterior interbody fusion (PLIF). The anterior interbody technique involves an approach via the abdomen. A general surgeon assists in the approach. Both techniques continue to evolve with the use of minimally invasive surgery (MIS). Dr. Fabian has been a leader in the development of minimally invasive spinal instrumentation and the Spine Center is on the cutting edge of this rapidly progressive field. It is hoped that MIS techniques will allow for faster rehab, shorter hospital stays and less blood loss and incisional pain. 28

29 Although stand-alone ALIF and PLIF procedures can be done, in most cases the interbody fusions are supplemented with pedicle screw and rod instrumentation or transfacet screws placed via a posterior approach and this further supplemented with a posterolateral fusion. The posterolateral fusion is the oldest technique and is still widely used in multi-level fusions, particularly in elderly patients and those with curvatures. For most of these cases, bone graft is taken from the iliac crest, a portion of the pelvic bone near the surgical site. Bone marrow aspirate and mesenchymal stem cells, both new technologies, are used by Dr. Fabian at the Center. In fact, in the Spring of 2011, The Spine Center of Steamboat Springs/New Mobility was only the third site in the United States where the new Pure-Gen mesenchymal stem cell technology was used. Along with these exciting new technologies, osteobiologic bone graft expanders are used, such as demineralized bone matrix (DBM) and calcium phosphate and calcium sulfate expanders. Allograft, or banked bone, is also used in selected cases. Dr. Fabian and his team discuss the use of such products prior to surgery. 29

30 Frequently Asked Questions About Lumbar Laminectomy Q. What is wrong with my back? A. You have a pinched nerve. This can be produced by one or more herniated discs and/or areas of arthritis in your back. The discs are rubbery shock absorbers between the vertebrae, and are close to nerves that originate in the spine and then travel down to the legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone spurs associated with arthritis may do the same thing. Q. What is required to fix the problem? A. The discs or bone spurs pressing on your nerve must be removed. This is done by making an incision (usually two or three inches long) in the middle of your lower back, moving the muscles covering your spine to the side, and making a small window into your spinal canal. The nerve is exposed, moved aside and protected; and the protruding disc or bone spur is then removed. This decompresses the nerve and, in most cases, leads to rapid improvement in nerve pain, numbness and/or weakness. Sometimes the abnormality may be more extensive, extending over several disc segments, requiring a longer incision for decompression. BEFORE AFTER Q. Who is a candidate for lumbar laminectomy and when is it necessary? A. The primary reason for this operation is pain that is intolerable to the patient. Sometimes increasing nerve dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain can be controlled by non-surgical means. If this doesn t happen, and if the pain and subsequent disability become intolerable, surgery is a reliable way to solve the problem. Since the patient is the one feeling the pain, the patient is usually the one who decides when he or she is ready for surgery. 30

31 Q. Who performs this surgery? A. Both orthopedists and neurosurgeons are trained in spinal surgery and both specialists may perform this surgery. It is important that your surgeon specialize in this type of procedure. Q. Is my entire disc removed? A. No, only the ruptured part and any other obviously abnormal disc material are removed. This generally amounts to no more than percent of the entire disc. Q. How long will I be in the hospital? A. Laminectomy patients are usually out of bed within an hour or two after their operation, and some can go home on the day of surgery. The remainder almost always goes home the next morning. Q. Will I need a blood transfusion? A. Transfusions are rarely needed after this kind of surgery. We do not recommend preoperative donation of your own blood. Q. What can I do after surgery? A. You may get up and move around as soon as you feel like it, and may drive short distances when you feel able. You should avoid bending, lifting and twisting for six weeks to allow for healing of the surgical area. Q. When can I go back to work? A. That depends on the kind of work you do, and how long you have to drive to get there. Surgical patients can return to sedentary (desk) jobs that they can reach with a drive of 15 minutes or less whenever they feel comfortable, (usually two or three weeks). You should not drive long distances (30 minutes or more) for about one month after surgery. If your job requires physical labor, you should consult Dr. Fabian. 31

32 Q. What is the likelihood that I will be relieved of my pain? A percent of patients get relief of their leg pain. Some patients (about 15 percent) will continue to have noticeable back pain in some situations, and may require additional treatment. Q. Could I be paralyzed? A. The chances of neurologic injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible. Q. What other risks are there? A. There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collections of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs) or heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure. Q. Will my back be normal after surgery? A. Though you may have excellent relief of pain, a disc is never completely normal after it has herniated, and if your problem has been caused by arthritis, the arthritis cannot be cured even if the bone spurs have been removed and the nerves decompressed. You may have more back pain than a normal person would have, and there is an increased risk of reherniation of the damaged disc. However, most people can resume almost all of their normal activities after recovering from surgery. Q. What should I do after surgery? A. You should resume low-impact activities as soon as possible, starting with walking. Try to walk a little farther each day, building up to a brisk three-mile walk each day by six weeks after surgery. Once your sutures are removed you may swim, which is very back-friendly. By two or three weeks after surgery you may try more vigorous activities such as an exercise bike or NordicTrack. Talk to Dr. Fabian about aerobics and jogging. Physical activity is good for you, if done properly. 32

33 Q. What shouldn t I do after surgery? A. In general, you should limit heavy lifting, bending, twisting and high impact physical activities, including contact sports. Consult your surgeon for details. Q. Could this ever happen to me again? A. Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no way to return the disc to normal again, which means recurrent herniations do occasionally occur. Also, adjacent discs may be abnormal, too, and could rupture in the future. Q. Should I avoid vigorous physical activity? A. No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill, using an exercise bike and swimming are all examples of exercise that is appropriate for spine patients. Frequently Asked Questions About Lumbar Fusion Q. What is wrong with my back? A. You have one or more damaged discs and/or areas of arthritis in your back. This produces pain, and may produce abnormal motion, or misalignment of your spine. Discs are rubbery shock absorbers between the vertebrae, and are close to nerves that travel down to the legs. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Q. What is required to fix the problem? A. Your condition requires both a nerve decompression (freeing the nerves from pressure) and a spinal fusion. In this case, both nerve decompression and spinal fusion would be done. Q. What is spinal fusion? A. A fusion is a bony bridge between at least two other bones; in this case, two vertebrae in your spine. The vertebrae are the blocks of bone that make up the bony part of the spine, like a child s building blocks stacked on top of each other to make a tower. Normally each vertebra moves within certain limits in relationship to 33

34 its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and move out of alignment, putting pressure on the spinal nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using pieces of bone called bone graft. The bone graft may be obtained from the patient, (usually from the pelvis), or from a bone bank. There are advantages and disadvantages to either source. The bone graft is either laid next to the vertebrae or actually placed between the vertebral bodies (the rubbery disc that normally lies between the vertebrae must be removed). In either case, the bone graft has to heal and fuse to the adjacent bones before the fusion becomes solid. Spine surgeons often use screws and rods to protect the bone graft and stabilize the spine while the fusion heals. Q. How is the operation performed? A. A four-to five-inch incision is made in the middle of the lower back. Muscles supporting the spine are pushed aside temporarily. The spinal nerve is exposed, moved aside and protected, and the ruptured disc or bone spur is removed to loosen the nerve. The fusion is performed as described above. The wound is then closed and dressings are applied. The operation typically takes a minimum of three hours and may be longer, depending on the complexity of the problem. Sometimes the spinal fusion is performed with an anterior approach. In this case, the surgeon would make a four-to five-inch incision in the lower abdomen, gently move the internal organs aside, and proceed with the surgery as described above. Q. Who is a candidate for lumbar fusion, and when is it necessary? A. When the back and nerve problems cannot be corrected in a more simple procedure and the pain persists at an unacceptable level, it is necessary to do a fusion. Some of the conditions which require spinal fusion are discussed in the answer to What is Spinal Fusion? Q. Could I be paralyzed? A. The chances of neurologic injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible. 34

Anatomy and Pathology of Spine Surgery By Henry F. Fabian Jr., M.D.

Anatomy and Pathology of Spine Surgery By Henry F. Fabian Jr., M.D. Anatomy and Pathology of Spine Surgery By Henry F. Fabian Jr., M.D. The human spine is an incredibly complex piece of machinery with a remarkable range of function and motion. If you have ever witness

More information

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis Copyright 2009 American Academy of Orthopaedic Surgeons Lumbar Spinal Stenosis Almost everyone will experience low back pain at some point in their lives. A common cause of low back pain is lumbar spinal

More information

Does the pain radiating down your legs, buttocks or lower back prevent you from walking long distances?

Does the pain radiating down your legs, buttocks or lower back prevent you from walking long distances? Does the pain radiating down your legs, buttocks or lower back prevent you from walking long distances? Do you experience weakness, tingling, numbness, stiffness, or cramping in your legs, buttocks or

More information

SPINAL FUSION. North American Spine Society Public Education Series

SPINAL FUSION. North American Spine Society Public Education Series SPINAL FUSION North American Spine Society Public Education Series WHAT IS SPINAL FUSION? The spine is made up of a series of bones called vertebrae ; between each vertebra are strong connective tissues

More information

Patient Guide to Lower Back Surgery

Patient Guide to Lower Back Surgery The following is a sampling of products offered by Zimmer Spine for use in Open Lumbar Fusion procedures. Patient Guide to Lower Back Surgery Open Lumbar Fusion Dynesys The Dynesys Dynamic Stabilization

More information

Orthopaedic Spine Center. Anterior Cervical Discectomy and Fusion (ACDF) Normal Discs

Orthopaedic Spine Center. Anterior Cervical Discectomy and Fusion (ACDF) Normal Discs Orthopaedic Spine Center Graham Calvert MD James Woodall MD PhD Anterior Cervical Discectomy and Fusion (ACDF) Normal Discs The cervical spine consists of the bony vertebrae, discs, nerves and other structures.

More information

.org. Herniated Disk in the Lower Back. Anatomy. Description

.org. Herniated Disk in the Lower Back. Anatomy. Description Herniated Disk in the Lower Back Page ( 1 ) Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as

More information

visualized. The correct level is then identified again. With the use of a microscope and

visualized. The correct level is then identified again. With the use of a microscope and SURGERY FOR SPINAL STENOSIS Laminectomy A one inch (or longer for extensive stenosis) incision is made in the middle of the back over the effected region of the spine. The muscles over the bone are moved

More information

Patient Guide to Neck Surgery

Patient Guide to Neck Surgery The following is a sampling of products offered by Zimmer Spine for use in Anterior Cervical Fusion procedures. Patient Guide to Neck Surgery Anterior Cervical Fusion Trinica Select With the Trinica and

More information

Information for the Patient About Surgical

Information for the Patient About Surgical Information for the Patient About Surgical Decompression and Stabilization of the Spine Aging and the Spine Daily wear and tear, along with disc degeneration due to aging and injury, are common causes

More information

.org. Fractures of the Thoracic and Lumbar Spine. Cause. Description

.org. Fractures of the Thoracic and Lumbar Spine. Cause. Description Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can

More information

Lumbar Laminectomy and Interspinous Process Fusion

Lumbar Laminectomy and Interspinous Process Fusion Lumbar Laminectomy and Interspinous Process Fusion Introduction Low back and leg pain caused by pinched nerves in the back is a common condition that limits your ability to move, walk, and work. This condition

More information

Herniated Lumbar Disc

Herniated Lumbar Disc Herniated Lumbar Disc North American Spine Society Public Education Series What Is a Herniated Disc? The spine is made up of a series of connected bones called vertebrae. The disc is a combination of strong

More information

If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time.

If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. You may be worried about your future, both in respect of finances and

More information

Lower Back Pain An Educational Guide

Lower Back Pain An Educational Guide Lower Back Pain An Educational Guide A publication from the Center of Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Ste 150 1630 Main St Ste 215 Annapolis, MD 21401 Chester, MD 21619

More information

A Patient s Guide to Artificial Cervical Disc Replacement

A Patient s Guide to Artificial Cervical Disc Replacement A Patient s Guide to Artificial Cervical Disc Replacement Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause pain and numbness

More information

Surgery for cervical disc prolapse or cervical osteophyte

Surgery for cervical disc prolapse or cervical osteophyte Mr Paul S. D Urso MBBS(Hons), PhD, FRACS Neurosurgeon Provider Nº: 081161DY Epworth Centre Suite 6.1 32 Erin Street Richmond 3121 Tel: 03 9421 5844 Fax: 03 9421 4186 AH: 03 9483 4040 email: paul@pauldurso.com

More information

SPINE SURGERY - LUMBAR DECOMPRESSION

SPINE SURGERY - LUMBAR DECOMPRESSION SPINE SURGERY - LUMBAR DECOMPRESSION Information Leaflet Your Health. Our Priority. Page 2 of 7 Introduction This booklet has been compiled by the physiotherapy department to help you understand lumbar

More information

Posterior Cervical Decompression

Posterior Cervical Decompression Posterior Cervical Decompression Spinal Unit Tel: 01473 702032 or 702097 Issue 2: January 2009 Following your recent MRI scan and consultation with your spinal surgeon, you have been diagnosed with a

More information

SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS?

SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS? SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS? The spinal canal is best imagined as a bony tube through which nerve fibres pass. The tube is interrupted between each pair of adjacent

More information

Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study

Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study Options for Cervical Disc Degeneration A Guide to the Fusion Arm of the M6 -C Artificial Disc Study Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine

More information

Herniated Cervical Disc

Herniated Cervical Disc Herniated Cervical Disc North American Spine Society Public Education Series What Is a Herniated Disc? The backbone, or spine, is composed of a series of connected bones called vertebrae. The vertebrae

More information

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a phenomenon that more commonly affects older males. It is associated

More information

Open Discectomy. North American Spine Society Public Education Series

Open Discectomy. North American Spine Society Public Education Series Open Discectomy North American Spine Society Public Education Series What Is Open Discectomy? Open discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine.

More information

SPINE ANATOMY AND PROCEDURES. Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132

SPINE ANATOMY AND PROCEDURES. Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132 SPINE ANATOMY AND PROCEDURES Tulsa Spine & Specialty Hospital 6901 S. Olympia Avenue Tulsa, Oklahoma 74132 SPINE ANATOMY The spine consists of 33 bones called vertebrae. The top 7 are cervical, or neck

More information

X Stop Spinal Stenosis Decompression

X Stop Spinal Stenosis Decompression X Stop Spinal Stenosis Decompression Am I a candidate for X Stop spinal surgery? You may be a candidate for the X Stop spinal surgery if you have primarily leg pain rather than mostly back pain and your

More information

Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, The Cervical Spine. What is the Cervical Spine?

Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, The Cervical Spine. What is the Cervical Spine? Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause pain and numbness in the neck, shoulders, arms, and even hands. This patient

More information

Herniated Disk in the Lower Back

Herniated Disk in the Lower Back Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological Institute Al Maryah Island

More information

Lumbar Disc Herniation/Bulge Protocol

Lumbar Disc Herniation/Bulge Protocol Lumbar Disc Herniation/Bulge Protocol Anatomy and Biomechanics The lumbar spine is made up of 5 load transferring bones called vertebrae. They are stacked in a column with an intervertebral disc sandwiched

More information

Lumbar Spine Anatomy. eorthopod.com 228 West Main St., Suite D Missoula, MT 59802-4345 Phone: 406-721-3072 Fax: 406-721-2619 info@eorthopod.

Lumbar Spine Anatomy. eorthopod.com 228 West Main St., Suite D Missoula, MT 59802-4345 Phone: 406-721-3072 Fax: 406-721-2619 info@eorthopod. A Patient s Guide to Lumbar Spine Anatomy 228 West Main St., Suite D Missoula, MT 59802-4345 Phone: 406-721-3072 Fax: 406-721-2619 info@eorthopod.com DISCLAIMER: The information in this booklet is compiled

More information

A review of spinal problems

A review of spinal problems Dr Ulrich R Hähnle MD, FCS Orthopaedic Surgeon, Wits Facharzt für Orthopädie, Berlin Phone: +27 11 485 3236 Fax: +27 11 485 2446 Suite 102, Medical Centre, Linksfield Park Clinic P.O. Box 949, Johannesburg

More information

Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF).

Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF). Patient Information. Lateral Lumbar Interbody Fusion Surgery (LLIF). Understanding your spine Disc Between each pair of vertebrae there is a disc that acts as a cushion to protect the vertebra, allows

More information

Minimally Invasive Spine Surgery For Your Patients

Minimally Invasive Spine Surgery For Your Patients Minimally Invasive Spine Surgery For Your Patients Lukas P. Zebala, M.D. Assistant Professor Orthopaedic and Neurological Spine Surgery Department of Orthopaedic Surgery Washington University School of

More information

Thoracic Spine Anatomy

Thoracic Spine Anatomy A Patient s Guide to Thoracic Spine Anatomy 228 West Main, Suite C Missoula, MT 59802 Phone: info@spineuniversity.com DISCLAIMER: The information in this booklet is compiled from a variety of sources.

More information

Patient Information. Posterior Cervical Surgery. Here to help. Respond Deliver & Enable

Patient Information. Posterior Cervical Surgery. Here to help. Respond Deliver & Enable Here to help Our Health Information Centre (HIC) provides advice and information on a wide range of health-related topics. We also offer: Services for people with disabilities. Information in large print,

More information

Advanced Orthopedics at Baltimore Washington Medical Center. Patient s Guide to Spine Surgery

Advanced Orthopedics at Baltimore Washington Medical Center. Patient s Guide to Spine Surgery Advanced Orthopedics at Baltimore Washington Medical Center Patient s Guide to Spine Surgery Patient Guide for Spine Surgery Thank you for choosing Advanced Orthopedics at BWMC for your spine surgery.

More information

Lower Back Pain. Introduction. Anatomy

Lower Back Pain. Introduction. Anatomy Lower Back Pain Introduction Back pain is the number one problem facing the workforce in the United States today. To illustrate just how big a problem low back pain is, consider these facts: Low back pain

More information

Spine Surgery - Wallis Ligament Stabilisation

Spine Surgery - Wallis Ligament Stabilisation Spine Surgery - Wallis Ligament Stabilisation An Information Leaflet Physiotherapy Department 0161 419 4060 August 2011 Every Patient Matters TO47 2 Introduction This booklet has been compiled by the physiotherapy

More information

What are Core Muscles?... 2. A Healthy Lumbar Spine...3. What is Low Back Pain?...4. Rehabilitation...6. Stages of Rehabilitation...

What are Core Muscles?... 2. A Healthy Lumbar Spine...3. What is Low Back Pain?...4. Rehabilitation...6. Stages of Rehabilitation... Table of Contents What are Core Muscles?... 2 A Healthy Lumbar Spine...3 What is Low Back Pain?...4 Rehabilitation...6 Stages of Rehabilitation...7 Pain Management....................... 8 Heat/Ice What

More information

Temple Physical Therapy

Temple Physical Therapy Temple Physical Therapy A General Overview of Common Neck Injuries For current information on Temple Physical Therapy related news and for a healthy and safe return to work, sport and recreation Like Us

More information

Treating Bulging Discs & Sciatica. Alexander Ching, MD

Treating Bulging Discs & Sciatica. Alexander Ching, MD Treating Bulging Discs & Sciatica Alexander Ching, MD Disclosures Depuy Spine Teaching and courses K2 Spine Complex Spine Study Group Disclosures Take 2 I am a spine surgeon I like spine surgery I believe

More information

Patient Information. Anterior Cervical Surgery. Here to help. Respond Deliver & Enable

Patient Information. Anterior Cervical Surgery. Here to help. Respond Deliver & Enable Here to help Our Health Information Centre (HIC) provides advice and information on a wide range of health-related topics. We also offer: Services for people with disabilities. Information in large print,

More information

How to Get and Keep a Healthy Back. Amy Eisenson, B.S. Exercise Physiologist

How to Get and Keep a Healthy Back. Amy Eisenson, B.S. Exercise Physiologist How to Get and Keep a Healthy Back Amy Eisenson, B.S. Exercise Physiologist Lesson Objectives Statistics of Back Pain Anatomy of the Spine Causes of Back Pain Four Work Factors Core Muscles Connection

More information

THE LUMBAR SPINE (BACK)

THE LUMBAR SPINE (BACK) THE LUMBAR SPINE (BACK) At a glance Chronic back pain, especially in the area of the lumbar spine (lower back), is a widespread condition. It can be assumed that 75 % of all people have it sometimes or

More information

Avoid The Dreaded Back Injury by Proper Lifting Techniques

Avoid The Dreaded Back Injury by Proper Lifting Techniques Avoid The Dreaded Back Injury by Proper Lifting Techniques If you ve ever strained your back while lifting something, you ll know the importance of lifting safely. Agenda Introduction About the Back The

More information

Neck Injuries and Disorders

Neck Injuries and Disorders Neck Injuries and Disorders Introduction Any part of your neck can be affected by neck problems. These affect the muscles, bones, joints, tendons, ligaments or nerves in the neck. There are many common

More information

Do you have Back Pain? Associated with:

Do you have Back Pain? Associated with: Do you have Back Pain? Associated with: Herniated Discs? Protruding Discs? Degenerative Disk Disease? Posterior Facet Syndrome? Sciatica? You may be a candidate for Decompression Therapy The Dynatronics

More information

https://www.laserspineinstitute.com/back_problems/foraminal_stenosis/e...

https://www.laserspineinstitute.com/back_problems/foraminal_stenosis/e... Questions? Call toll free 1-866-249-1627 Contact us today. We're here for you seven days a week. MRI Review Consultation Live help Call 1-866-249-1627 Chat Live Home Laser Spine Institute Laser Spine Institute's

More information

A Healthy Lumbar Spine... 2. A Problem Lumbar Spine... 3. Understanding Your Surgery... 4. Preparing for Surgery... 5. Day of Surgery...

A Healthy Lumbar Spine... 2. A Problem Lumbar Spine... 3. Understanding Your Surgery... 4. Preparing for Surgery... 5. Day of Surgery... Table of Contents A Healthy Lumbar Spine................. 2 A Problem Lumbar Spine................. 3 Understanding Your Surgery.............. 4 Preparing for Surgery.................... 5 Day of Surgery.........................

More information

Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF).

Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF). Patient Information. Anterior Cervical Discectomy and Fusion Surgery (ACDF). Understanding your spine Disc Between each pair of vertebrae there is a disc that acts as a cushion to protect the vertebra,

More information

SPINE AND NECK SURGERY: MAKING A DECISION THAT S RIGHT FOR YOU

SPINE AND NECK SURGERY: MAKING A DECISION THAT S RIGHT FOR YOU 1. GET THE FACTS: Back and neck pain affects 8 out of 10 people at some point in their life. Acute back and neck pain comes on suddenly and usually lasts from a few days to a few weeks. Chronic back and

More information

Patient information for cervical spinal fusion.

Patient information for cervical spinal fusion. Patient information for cervical spinal fusion. Introduction This booklet has been compiled to help you understand spinal cervical fusion surgery and postoperative rehabilitation. Anatomy The cervical

More information

Lateral Lumbar Interbody Fusion (LLIF or XLIF)

Lateral Lumbar Interbody Fusion (LLIF or XLIF) Lateral Lumbar Interbody Fusion (LLIF or XLIF) NOTE: PLEASE DO NOT TAKE ANY NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs like Advil, Aleve, Ibuprofen, Motrin, Naprosyn, Mobic, etc) OR ASPIRIN PRODUCTS

More information

Lumbar Spinal Stenosis

Lumbar Spinal Stenosis Lumbar Spinal Stenosis North American Spine Society Public Education Series What Is Lumbar Spinal Stenosis? The vertebrae are the bones that make up the lumbar spine (low back). The spinal canal runs through

More information

.org. Cervical Radiculopathy (Pinched Nerve) Anatomy. Cause

.org. Cervical Radiculopathy (Pinched Nerve) Anatomy. Cause Cervical Radiculopathy (Pinched Nerve) Page ( 1 ) Cervical radiculopathy, commonly called a pinched nerve occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal

More information

BRYAN. Cervical Disc System. Patient Information

BRYAN. Cervical Disc System. Patient Information BRYAN Cervical Disc System Patient Information 3 BRYAN Cervical Disc System PATIENT INFORMATION BRYAN Cervical Disc System PATIENT INFORMATION 1 BRYAN Cervical Disc System This patient information brochure

More information

Minimally Invasive Spine Surgery What is it and how will it benefit patients?

Minimally Invasive Spine Surgery What is it and how will it benefit patients? Minimally Invasive Spine Surgery What is it and how will it benefit patients? Dr Raoul Pope MBChB, FRACS, Neurosurgeon and Minimally Invasive Spine Surgeon Concord Hospital and Mater Private Hospital Sydney

More information

Low Back Surgery. Remember to bring this handout to the hospital with you.

Low Back Surgery. Remember to bring this handout to the hospital with you. Remember to bring this handout to the hospital with you. Table of contents Page Why do I need low back surgery?... 1 What kinds of low back surgeries are there?... 2 Before your surgery... 3 After your

More information

A Patient's Guide to Neck Pain (Overview)

A Patient's Guide to Neck Pain (Overview) Neck Pain Overview A Patient's Guide to Neck Pain (Overview) Introduction Over many years, our necks are subjected to repeated stress and minor injury. These injuries may not cause pain at the time of

More information

Information on the Chiropractic Care of Lower Back Pain

Information on the Chiropractic Care of Lower Back Pain Chiropractic Care of Lower Back Pain Lower back pain is probably the most common condition seen the the Chiropractic office. Each month it is estimated that up to one third of persons experience some type

More information

Options for Cervical Disc Degeneration A Guide to the M6-C. clinical study

Options for Cervical Disc Degeneration A Guide to the M6-C. clinical study Options for Cervical Disc Degeneration A Guide to the M6-C clinical study Each year, hundreds of thousands of adults are diagnosed with Cervical Disc Degeneration, an upper spine condition that can cause

More information

Anatomy of the Spine. Figure 1. (left) The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment.

Anatomy of the Spine. Figure 1. (left) The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment. 1 2 Anatomy of the Spine Overview The spine is made of 33 individual bony vertebrae stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright,

More information

Injury Prevention for the Back and Neck

Injury Prevention for the Back and Neck Injury Prevention for the Back and Neck www.csmr.org We have created this brochure to provide you with information regarding: Common Causes of Back and Neck Injuries and Pain Tips for Avoiding Neck and

More information

Consent for Lumbar Spine Surgery and Fusion at

Consent for Lumbar Spine Surgery and Fusion at STEPHEN MARANO, M.D. JAMES COOK PA-C Consent for Lumbar Spine Surgery and Fusion at Patient Name: Patient Diagnosis: Lumbar Spinal Stenosis (Narrowing of the canal where the spinal cord and nerves are

More information

Cervical Disk Surgery

Cervical Disk Surgery Cervical Disk Surgery Relieving Symptoms with Decompression and Fusion CONSIDER CERVICAL DISK SURGERY Do you suffer from nagging neck and arm pain or weakness caused by a disk problem in your upper (cervical)

More information

Sciatica Yuliya Mutsa PTA 236

Sciatica Yuliya Mutsa PTA 236 Sciatica Yuliya Mutsa PTA 236 Sciatica is a common type of pain affecting the sciatic nerve, which extends from the lower back all the way through the back of the thigh and down through the leg. Depending

More information

Back & Neck Pain Survival Guide

Back & Neck Pain Survival Guide Back & Neck Pain Survival Guide www.kleinpeterpt.com Zachary - 225-658-7751 Baton Rouge - 225-768-7676 Kleinpeter Physical Therapy - Spine Care Program Finally! A Proven Assessment & Treatment Program

More information

Hip Replacement. Department of Orthopaedic Surgery Tel: 01473 702107

Hip Replacement. Department of Orthopaedic Surgery Tel: 01473 702107 Information for Patients Hip Replacement Department of Orthopaedic Surgery Tel: 01473 702107 DMI ref: 0134-08.indd(RP) Issue 3: February 2008 The Ipswich Hospital NHS Trust, 2005-2008. All rights reserved.

More information

Anterior Cervical Decompression and Fusion or Anterior Cervical Corpectomy and Fusion

Anterior Cervical Decompression and Fusion or Anterior Cervical Corpectomy and Fusion Anterior Cervical Decompression and Fusion or Anterior Cervical Corpectomy and Fusion DO NOT TAKE ANY ASPIRIN PRODUCTS OR NON-STEROIDAL ANTI- INFLAMMATORY DRUGS (ie NSAIDs, Advil, Celebrex, Ibuprofen,

More information

ANTERIOR CERVICAL DECOMPRESSION AND FUSION

ANTERIOR CERVICAL DECOMPRESSION AND FUSION ANTERIOR CERVICAL DECOMPRESSION AND FUSION NOTE: PLEASE DO NOT TAKE ANY NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs like Advil, Celebrex, Ibuprofen, Motrin, Vioxx, etc) OR ASPIRIN PRODUCTS FOR 2 WEEKS

More information

Consent for Anterior Cervical Discectomy With Fusion and a Metal Plate at

Consent for Anterior Cervical Discectomy With Fusion and a Metal Plate at STEPHEN MARANO, M.D. JAMES COOK PA-C Consent for Anterior Cervical Discectomy With Fusion and a Metal Plate at Patient Name: Patient Diagnosis: Cervical Degenerative Disc Disease (wear and tear on the

More information

We ve got your back. Physical Therapy After Lumbar Fusion Surgery

We ve got your back. Physical Therapy After Lumbar Fusion Surgery We ve got your back Physical Therapy After Lumbar Fusion Surgery Physical therapy is an extremely important part of you recovery after spinal surgery. This booklet, prepared by the therapists who specialize

More information

There are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions

There are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions Low Back Pain Overview Low back pain is one of the most common disorders in the United States. About 80 percent of people have at least one episode of low back pain during their lifetime. Factors that

More information

Mike s Top Ten Tips for Reducing Back Pain

Mike s Top Ten Tips for Reducing Back Pain Mike s Top Ten Tips for Reducing Back Pain The following article explains ways of preventing, reducing or eliminating back pain. I have found them to be very useful to myself, my clients and my patients.

More information

The Petrylaw Lawsuits Settlements and Injury Settlement Report

The Petrylaw Lawsuits Settlements and Injury Settlement Report The Petrylaw Lawsuits Settlements and Injury Settlement Report BACK INJURIES How Minnesota Juries Decide the Value of Pain and Suffering in Back Injury Cases The Petrylaw Lawsuits Settlements and Injury

More information

Anterior Cervical Discectomy and Fusion

Anterior Cervical Discectomy and Fusion A Patient s Guide to Anterior Cervical Discectomy and Fusion 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is

More information

BACK PAIN: WHAT YOU SHOULD KNOW

BACK PAIN: WHAT YOU SHOULD KNOW BACK PAIN: WHAT YOU SHOULD KNOW Diane Metzer LOWER BACK PAIN Nearly everyone at some point has back pain that interferes with work, recreation and routine daily activities. Four out of five adults experience

More information

Lumbar Decompression Surgery Guide

Lumbar Decompression Surgery Guide Lumbar Decompression Surgery Guide TABLE OF CONTENTS: Page 3: Page 5: Page 7: Page 8: Page 9: Page 10: Page 11: Page 12: The Lumbar Spine Lumbar Surgery Before Surgery Medications Day of Surgery Evening

More information

Lumbar or Thoracic Decompression and Fusion

Lumbar or Thoracic Decompression and Fusion Lumbar or Thoracic Decompression and Fusion DO NOT TAKE ANY ASPIRIN PRODUCTS OR NON-STEROIDAL ANTI- INFLAMMATORY DRUGS (ie NSAIDs, Advil, Celebrex, Ibuprofen, Motrin, Naprosyn, Aleve, etc) FOR 2 WEEKS

More information

Cervical Spondylosis (Arthritis of the Neck)

Cervical Spondylosis (Arthritis of the Neck) Copyright 2009 American Academy of Orthopaedic Surgeons Cervical Spondylosis (Arthritis of the Neck) Neck pain is extremely common. It can be caused by many things, and is most often related to getting

More information

Spinal Anatomy. * MedX research contends that the lumbar region really starts at T-11, based upon the attributes of the vertebra.

Spinal Anatomy. * MedX research contends that the lumbar region really starts at T-11, based upon the attributes of the vertebra. Spinal Anatomy Overview Neck and back pain, especially pain in the lower back, is one of the most common health problems in adults. Fortunately, most back and neck pain is temporary, resulting from short-term

More information

LOW BACK PAIN. common of these conditions include: muscle strain ( pulled muscle ), weak core muscles

LOW BACK PAIN. common of these conditions include: muscle strain ( pulled muscle ), weak core muscles LOW BACK PAIN Most episodes of low back pain are caused by relatively harmless conditions. The most common of these conditions include: muscle strain ( pulled muscle ), weak core muscles (abdominal and

More information

Lumbar or Thoracic Fusion +/- Decompression

Lumbar or Thoracic Fusion +/- Decompression Lumbar or Thoracic Fusion +/- Decompression PLEASE DO NOT TAKE ANY NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs like Advil, Celebrex, Ibuprofen, Motrin, Vioxx, Naprosyn, Aleve, etc) OR ASPIRIN PRODUCTS

More information

James A. Sanfilippo, M.D. CONSENT FOR SPINAL SURGERY PATIENT: DATE:

James A. Sanfilippo, M.D. CONSENT FOR SPINAL SURGERY PATIENT: DATE: James A. Sanfilippo, M.D. CONSENT FOR SPINAL SURGERY PATIENT: DATE: 1. I have been strongly advised to carefully read and consider this operative permit. I realize that it is important that I understand

More information

Cervical Spine Surgery. Orthopaedic Nursing Seminar. Dr Michelle Atkinson. Friday October 21 st 2011. Cervical Disc Herniation

Cervical Spine Surgery. Orthopaedic Nursing Seminar. Dr Michelle Atkinson. Friday October 21 st 2011. Cervical Disc Herniation Cervical Spine Surgery Dr Michelle Atkinson The Sydney and Dalcross Adventist Hospitals Orthopaedic Nursing Seminar Friday October 21 st 2011 Cervical disc herniation The most frequently treated surgical

More information

Anatomy and Terminology of the Spine. Bones of the Spine (Vertebrae)

Anatomy and Terminology of the Spine. Bones of the Spine (Vertebrae) Anatomy and Terminology of the Spine The spine, also called the spinal column, vertebral column or backbone, consists of bones, intervertebral discs, ligaments, and joints. In addition, the spine serves

More information

Human Anatomy & Physiology

Human Anatomy & Physiology PowerPoint Lecture Slides prepared by Barbara Heard, Atlantic Cape Community College Ninth Edition Human Anatomy & Physiology C H A P T E R 7 The Skeleton: Part B Annie Leibovitz/Contact Press Images Vertebral

More information

Info. from the nurses of the Medical Service. LOWER BACK PAIN Exercise guide

Info. from the nurses of the Medical Service. LOWER BACK PAIN Exercise guide Info. from the nurses of the Medical Service LOWER BACK PAIN Exercise guide GS/ME 03/2009 EXERCISE GUIDE One of the core messages for people suffering with lower back pain is to REMAIN ACTIVE. This leaflet

More information

Low Back Injury in the Industrial Athlete: An Anatomic Approach

Low Back Injury in the Industrial Athlete: An Anatomic Approach Low Back Injury in the Industrial Athlete: An Anatomic Approach Earl J. Craig, M.D. Assistant Professor Indiana University School of Medicine Department of Physical Medicine and Rehabilitation Epidemiology

More information

The Newest Breakthrough In Non- Surgical Treatment of Herniated or Degenerative Discs

The Newest Breakthrough In Non- Surgical Treatment of Herniated or Degenerative Discs The Newest Breakthrough In Non- Surgical Treatment of Herniated or Degenerative Discs The DRX 9000 is Your Answer To Persistent Back Pain To People Who Want To Be Rid Of Lower Back Pain But Think They

More information

Balloon Kyphoplasty. Balloon Kyphoplasty is a minimally invasive procedure to treat vertebral body compression fractures.

Balloon Kyphoplasty. Balloon Kyphoplasty is a minimally invasive procedure to treat vertebral body compression fractures. Balloon Kyphoplasty Overview Balloon Kyphoplasty is a minimally invasive procedure to treat vertebral body compression fractures. The technique is designed to: Reduce and stabilise the fracture in a controlled

More information

Spine Anatomy and Spine General The purpose of the spine is to help us stand and sit straight, move, and provide protection to the spinal cord.

Spine Anatomy and Spine General The purpose of the spine is to help us stand and sit straight, move, and provide protection to the spinal cord. Spine Anatomy and Spine General The purpose of the spine is to help us stand and sit straight, move, and provide protection to the spinal cord. Normal List Kyphosis The human spine has 7 Cervical vertebra

More information

Anterior Hip Replacement

Anterior Hip Replacement Disclaimer This movie is an educational resource only and should not be used to manage Orthopaedic health. All decisions about the management of hip replacement and arthritis management must be made in

More information

Arthritis of the hip. Normal hip In an x-ray of a normal hip, the articular cartilage (the area labeled normal joint space ) is clearly visible.

Arthritis of the hip. Normal hip In an x-ray of a normal hip, the articular cartilage (the area labeled normal joint space ) is clearly visible. Arthritis of the hip Arthritis of the hip is a condition in which the smooth gliding surfaces of your hip joint (articular cartilage) have become damaged. This usually results in pain, stiffness, and reduced

More information

Spine University s Guide to Kinetic MRIs Detect Disc Herniations

Spine University s Guide to Kinetic MRIs Detect Disc Herniations Spine University s Guide to Kinetic MRIs Detect Disc Herniations 2 Introduction Traditionally, doctors use a procedure called magnetic resonance imaging (MRI) to diagnose disc injuries. Kinetic magnetic

More information

What is the function of the spinal column?

What is the function of the spinal column? What is the function of the spinal column? Stability The function of the human spinal column is above all to stabilise the head, the upper body, and walking upright. Primarily responsible for this are

More information

Advances In Spine Care. James D. Bruffey M.D. Scripps Clinic Division of Orthopaedic Surgery Section of Spinal Surgery

Advances In Spine Care. James D. Bruffey M.D. Scripps Clinic Division of Orthopaedic Surgery Section of Spinal Surgery Advances In Spine Care James D. Bruffey M.D. Scripps Clinic Division of Orthopaedic Surgery Section of Spinal Surgery Introduction The Spine - A common source of problems Back pain is the #2 presenting

More information

A Patient s Guide to Guyon s Canal Syndrome

A Patient s Guide to Guyon s Canal Syndrome A Patient s Guide to DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or

More information

Is Your Neck Or Back Pain Caused By A Herniated Disc?

Is Your Neck Or Back Pain Caused By A Herniated Disc? Is Your Neck Or Back Pain Caused By A Herniated Disc? The bones in your spine are called the vertebrae. The vertebrae are held together and in place by ligaments and small discs that act as shock absorbers.

More information