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Neuro-Spine

The field of spinal surgery is extraordinarily complex, encompassing a broad spectrum of diagnoses that range from trauma, to tumors, to infection. Not every patient’s treatment plan will involve surgery, but when surgery is indicated, Dr. Banister strives to use the least invasive approach possible in an effort to decrease postoperative pain, scarring, and recovery time. Dr. Banister has been trained in all manner of treatment for multiple spinal issues, and has more than 15 years’ experience providing superior care for the ailments listed below.

Conditions

Degenerative disk disease

Degenerative disk disease refers to the natural changes that affect the intervertebral disks as you age. Over time, these disks—which act as shock absorbers for the spine—may become brittle or thin. This can cause back pain, stiffness, or instability. Depending on the severity of the condition, medication may alleviate some of the pain. Other patients may respond to rehabilitation and simple lifestyle modifications. Still others will have severe degenerative disk disease that requires surgical intervention, such as spinal fusion or disk replacement surgery. Dr. Banister is experienced in performing anterior spinal fusions and complex cervical and lumbar fusions to treat degenerative disk disease.

Disk herniation

The disks that pad the spaces between vertebrae have two main parts—the spongy, shock-absorbing center, called the nucleus; and the fibrous outer layer of the disk, called the annulus. Disk herniation occurs when the annulus is naturally worn down with age and the nucleus breaks through. This herniation does not always cause pain or symptoms, but the herniated disk can sometimes exert pressure on the spinal cord or spinal nerves, causing pain, numbness, or tingling. The effects of a herniated disk can often be treated with medication and physical therapy, but surgery (such as anterior cervical diskectomy and fusion, lumbar disk microsurgery, or microdiskectomy) may be required, depending on the level of the herniation.

Neck and back disorders

The spine is an extremely complex, sophisticated part of human anatomy. With this complexity comes a host of structures that could be responsible for neck or back pain. This makes diagnosis a challenge, but Dr. Banister is committed to using all different types of diagnostic modalities to pinpoint the cause of the problem. Whether the problem is disk herniation, degenerative disk disease, spondylolisthesis, or another diagnosis entirely, Dr. Banister is able to manage and treat not only the symptoms of the disorder, but the underlying cause itself.

Sciatica

The term sciatica refers to the pain that comes from inflammation or irritation of the sciatic nerve, which is a large nerve that branches from the lower spinal cord, through the lower back, hip, buttock, and down the leg. The irritation is usually brought about because something is compressing the nerve—usually a herniated disk or bone spur on the spine. Sciatica is usually responsive to nonsurgical treatment such as anti-inflammatory or pain medications, physical therapy, or steroid injections. In serious cases, usually when the patient experiences leg weakness or incontinence, a surgical procedure called a microdiskectomy is required to alleviate nerve compression.

Spinal stenosis

Spinal stenosis is a painful condition that results from narrowing of the spinal canal. When this space is narrowed, it can compress the spinal cord and spinal nerves, resulting in pain or weakness in the lower extremities. Spinal stenosis can occur at any level in the spine, but it most commonly occurs either at the lumbar level (i.e., the lower back) or at the cervical level (i.e., the neck).

Patients with lumbar spinal stenosis may notice pain or weakness in the legs when walking. This pain is usually relieved by sitting or by flexing forward, as in when leaning over a shopping cart. Spinal stenosis at the cervical level can be very serious, sometimes causing paralysis or permanent loss of function. It is important for patients with spinal stenosis to receive prompt treatment, as some damage may be irreversible. Some cases of spinal stenosis can be treated with medication, lifestyle modifications, or epidural injections. For more severe cases, a surgical procedure called a laminectomy may be required to relieve the pressure on the spinal cord and spinal nerves.

Spondylolisthesis

Spondylolisthesis results when a defect in part of the spine causes one vertebra to slip over the one below it. It often presents as back pain, radiating leg pain, or foot numbness, as the slipped vertebra can compress the spinal cord or the spinal nerves. Although it can have many causes, it usually results from arthritis, degenerative disk disease, trauma, or infection. Spondylolisthesis can frequently be effectively managed with rest, physical therapy, and medication. In serious cases, a surgical procedure called an anterior spinal fusion may help reduce compression and stabilize the spine. Spinal fusion is only pursued in extreme cases, as it is a major surgery associated with an extensive healing process.

Vertebral compression fracture

A vertebral compression fracture is a fracture that results from trauma, usually after a fall from a great height in which the individual lands on the feet or buttocks. This type of fracture can also occur in patients with osteoporosis or in patients whose vertebrae may be weakened by another pathology (such as infection or bone cancer). Patients with a vertebral compression fracture may experience back pain, numbness, tingling in the lower extremities, incontinence, or urinary retention. The pain associated with vertebral compression fractures may be alleviated with conservative measures such as anti-inflammatory medication, rest, physical therapy, or bracing. In other patients, surgery may be warranted. Dr. Banister is experienced in performing vertebroplasty and kyphoplasty procedures, which are two of the more common surgical techniques for treating compression fractures of the vertebrae.

Surgical Procedures: Spine

Anterior cervical diskectomy and fusion

An anterior cervical diskectomy and fusion (ACDF) is often the surgical treatment of choice for a herniated disk at the cervical level. In an ACDF, the front of the vertebral column at the cervical level is accessed through a small incision made at the front of the neck. The herniated disk is removed and replaced with synthetic material, and a plate is placed over the vertebrae above and below the affected disk. This plate is affixed to the front portion of the spine, enhancing stability and greatly reducing the pain associated with a herniated cervical disk.

Anterior cervical spinal fusion

An anterior spinal fusion is often performed in patients with spinal instability or other disorders of the neck. In this procedure, a small incision is made at the front of the neck, and any damaged disk material is removed and replaced with a cage or synthetic bone graft. A small metal plate is placed over the unstable vertebral levels and is affixed to the front portion of the spine, offering increased stability and improved range of motion while the bones fuse. Depending on the extent of the weakness or instability, more than one level may be fused.

Complex cervical and lumbar fusions

Severe cases of spinal instability may be treated with complex fusion at the cervical or lumbar level. These procedures involve screw and rod constructions to increase stability at multiple levels. This type of procedure is only performed when absolutely indicated, as it is associated with extended recovery periods.

Kyphoplasty

Kyphoplasty may be indicated in patients with vertebral compression fractures. In this procedure, a flexible tube is inserted through a small incision at the patient’s level of injury. Once the tube reaches the fractured vertebra, a small balloon is inflated, elevating the fracture and restoring the height of the vertebra to its original position. The balloon is removed, and bone cement is injected into the space, stabilizing the spinal column.

Laminectomy

Laminectomy is the surgical method of choice in patients with spinal stenosis, or narrowing of the spinal canal. In this procedure, the back portion of a vertebra (called the lamina) is removed to allow the spinal cord room. This alleviates the pressure exerted on the spinal cord and causes significant relief from pain.

Lumbar disk microsurgery

Lumbar disk microsurgery is often required for patients with herniated disks at the lumbar level. This minimally invasive technique requires only a small incision, and the procedure itself involves removal of the herniated disk and implantation of synthetic disk material. In some cases, this procedure can be performed in an outpatient setting or with only one night’s stay in the hospital, with most patients returning to work in less than a month.

Microdiskectomy

A microdiskectomy is a minimally invasive technique for removal of a herniated disk. This surgery can be performed through a small incision. The procedure involves removal of the herniated disk and implantation of synthetic disk material. In some cases, this procedure can be performed in an outpatient setting or with only one night’s stay in the hospital, with most patients returning to work in less than a month.

Minimally invasive spine procedures

A minimally invasive spine procedure is any surgical procedure that involves a small incision, minimizes damage to the muscles that surround the spine, and features less scarring than traditional “open” approaches to spine surgery. Minimally invasive spine procedures are favored by practitioners and patients alike, as they produce better cosmetic outcomes, decrease the length of stay in the hospital after surgery, and generally involve expedited recovery times.

Vertebroplasty

Vertebroplasty is a procedure often used to treat vertebral compression fractures. In this straightforward outpatient procedure, bone cement is injected into the broken vertebrae. Once the cement hardens, it leaves the spine reinforced, supported, and stabilized.