Spine Surgery

Most back and neck pain including many cases caused by disc herniations or spinal stenosis improves with time and non-surgical treatment. Spine surgery is considered when symptoms persist, neurological function is threatened, or the spine has become unstable.

Surgery may be recommended when:

• Conservative treatment has failed — Symptoms persist despite appropriate non-surgical care, including physical therapy, anti-inflammatory medications, activity modification, and, when appropriate, epidural steroid injections or other image-guided procedures.
• Neurological deficits are present or worsening — Progressive weakness, significant numbness, difficulty walking, or loss of bladder or bowel control may indicate ongoing nerve or spinal cord injury that requires timely surgical treatment.
• Spinal cord compression (myelopathy) is present — Conditions such as cervical myelopathy or thoracic spinal stenosis can cause progressive loss of balance, hand coordination, and strength. Early surgery is often recommended to prevent permanent spinal cord damage.
• Spinal instability is present — Conditions such as spondylolisthesis, fractures, tumors, infections, or spinal deformity may require surgery to restore stability and protect the spinal cord or nerves.

Your Atlantic Brain and Spine team carefully reviews your symptoms, neurological examination, imaging, and treatment history before making a recommendation. When surgery is appropriate, fellowship-trained neurosurgeons and orthopedic spine surgeons work together to determine the procedure that offers the best opportunity for long-term pain relief, neurological recovery, and spinal stability. Surgery is recommended only when it is expected to provide meaningful benefit over continued non-surgical care.

Cervical spine surgery addresses conditions of the neck vertebrae the seven bones from the base of the skull to the top of the chest. Common cervical procedures at Atlantic Brain and Spine include:

• ACDF (Anterior Cervical Discectomy and Fusion): The most commonly performed cervical operation. Removes a herniated disc from the front of the neck and fuses the adjacent vertebrae to relieve arm pain and myelopathy. Same-day or overnight in most cases.
• Cervical Arthroplasty (Disc Replacement): The motion-preserving alternative to ACDF for appropriate patients. Replaces the damaged disc with an artificial implant that maintains movement at the treated level, reducing adjacent segment stress long term.
• Cervical Laminoplasty: Hinges the lamina open to create more space for the spinal cord without removing bone. The preferred approach for multilevel cervical myelopathy in well-aligned spines.
• Posterior Cervical Laminectomy with Fusion: Removes the lamina from behind and adds instrumented stabilization. Used for severe multilevel stenosis or where kyphosis correction is needed alongside decompression.
• Cervical Posterior Foraminotomy: A keyhole approach from the back of the neck to decompress a single nerve root without fusion. Preserves full cervical motion at the treated level.
• Cervical Corpectomy: Removes a damaged vertebral body from the front of the neck for severe stenosis, tumor, or trauma not addressable by discectomy alone.

Lumbar spine surgery is the most commonly performed category of spine surgery. Atlantic Brain and Spine performs all lumbar procedures using minimally invasive techniques when anatomy and complexity permit:

• Lumbar Discectomy / Partial Discectomy: Removes a herniated disc fragment compressing a nerve root. Outpatient procedure; rapid recovery. The most commonly performed lumbar operation.
• Lumbar Laminectomy: Removes the lamina and thickened ligamentum flavum to decompress the spinal canal in lumbar stenosis. Open or minimally invasive depending on extent.
• Minimally Invasive Lumbar Decompression: Achieves the same decompression as open laminectomy through a 7 mm to 2.5 cm incision. Same-day discharge in most cases.
• TLIF (Transforaminal Lumbar Interbody Fusion): Decompresses and fuses the lumbar spine through a posterior approach. Performed open or minimally invasive (MIS-TLIF). The standard fusion for spondylolisthesis and degenerative disc disease.
• ALIF (Anterior Lumbar Interbody Fusion): Approaches the disc from the front for superior cage sizing, disc height restoration, and lordosis correction. Used for L4-L5 and L5-S1 disease.
• LLIF (Lateral Lumbar Interbody Fusion): Approaches the disc from the flank, avoiding both the back muscles and abdominal vessels. Excellent for multilevel mid-lumbar disease.
• Lumbar Corpectomy: Removes a vertebral body to decompress the lumbar canal from the front. Used for burst fracture, tumor, and severe OPLL.
• Pars Repair Surgery: Fixes a stress fracture of the pars interarticularis without fusion. The motion-preserving choice for young athletes with spondylolysis and a healthy disc.

Thoracic spine surgery treats conditions of the 12 mid-back vertebrae. Because the thoracic spinal cord has limited tolerance for compression, thoracic myelopathy often requires prompt intervention:

• Thoracic Laminectomy: Removes thoracic laminae to decompress the spinal cord from behind. Fusion is typically added to prevent post-operative kyphosis. IONM is essential throughout.
• Thoracic Corpectomy: Removes a vertebral body in the thoracic spine for burst fracture, tumor, or calcified disc. Reconstructed with an expandable cage and posterior pedicle screw fixation.

The ABS spine team manages cases that go beyond routine decompression or single-level fusion:

• Complex Spine Surgery: Adult spinal deformity, multilevel reconstruction, revision surgery, spinal tumor resection, and spinal trauma. Preoperative planning with full-spine standing X-rays, robotic guidance, and IONM throughout.
• Motion-Preserving Spine Surgery: Cervical and lumbar artificial disc replacement and decompression-only procedures that maintain natural spinal movement and reduce adjacent segment stress.
• Minimally Invasive Spine Surgery (MISS): The full family of tubular retractor, percutaneous screw, and endoscopic techniques — less muscle disruption, less blood loss, shorter hospital stay, faster recovery.
• Spinal Cord Stimulation (SCS): Implantable neuromodulation for chronic neuropathic pain after spine surgery, CRPS, and persistent radicular pain that has not responded to other treatments.

Atlantic Brain and Spine integrates the most current surgical technology into its spine program:

• Robotic guidance: Used for pedicle screw placement in fusion procedures improving screw accuracy and reducing radiation exposure to patients and the surgical team.
• Intraoperative neurophysiological monitoring (IONM): Motor evoked potentials and somatosensory evoked potentials are monitored continuously during all procedures involving the spinal cord, providing real-time warning of any functional compromise.
• Intraoperative navigation and fluoroscopy: Real-time imaging confirms implant position during surgery, reducing the need for post-operative revision.
• Minimally invasive and endoscopic instrumentation: Tubular retractors, percutaneous screw systems, and working-channel endoscopes allow the team to accomplish open surgical goals through dramatically smaller incisions.