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Kyphoplasty is an elective surgery designed to achieve three main goals in patients suffering from painful vertebral compression fractures:
- Reduce or eliminate back pain.
- Prevent further collapse of the fracture, thus avoiding an increase in spinal deformity and progression of postural problems.
- Restore normal spinal alignment, thus improving the patient's posture.
Kyphoplasty is minimally invasive, percutaneous (requires no surgical incision), and can be performed under local anesthesia as an outpatient procedure. The duration of the procedure is usually between 30 to 45 minutes.
Spinal tumors may be cancerous or non-cancerous. The treatment of benign tumors depends on patient symptoms such as pain or lack of mobility, and may be treated with a watch-and-wait approach, various medications, radiation, or surgery. Cancerous tumors can be treated with radiation or chemotherapy with/without surgical resection and stabilization. Surgery can often be used to relieve pain, stabilize the spine, and to improve quality of life.
Brain Tumors- Primary and Metastatic
Brain tumors can be either benign (non-cancerous) or malignant (cancerous), and they can arise from the brain itself (primary) or originate from another organ in the body (metastatic). Depending on their location and the patient's symptoms, brain tumors can be treated with observation, open neurosurgical procedures, minimally invasive approaches, or stereotactic radiosurgery. Cancerous brain tumors are usually treated with surgery, chemotherapy, radiotherapy or a combination of these treatments.
The pituitary gland sits in a bony structure at the base of the skull, and is sometimes the site of the benign (non-cancerous) growths. It is especially suited to minimally invasive procedures due both to its location, and to the thin bone layer surrounding it, and therefore easily penetrated. Both benign and malignant tumors can cause many symptoms related to hormonal dysfunction, from abnormal thickening of bone to secretion of milk from the breasts in both males and females. They can also affect vision and can cause central and peripheral vision defects.
Minimally Invasive Spine Surgery
In selected patients, the minimally invasive approach can be used in spinal surgeries. MIS procedures can be used to treat certain types of spinal conditions, including degenerative or herniated disc disorders, lumbar (lower back) spinal stenosis, curvature of the spine such as kyphosis or scoliosis, spinal infections, instability of the spine, and compression fractures of the spine, such as those caused by osteoporosis (thinning of the bones). The minimally invasive approach typically uses one or two small incisions and the operative microscope to visualize the structures of the spine. MIS reduces patient down time and the risk of infection with typically excellent results. Postoperative recovery is significantly improved with these new approaches.
Hydrocephalus, CSF Shunting
Ventriculoperitoneal shunting is surgery to relieve increased pressure inside the skull due to excess cerebrospinal fluid (CSF) on the brain (hydrocephalus). This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours. A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the abdominal (peritoneal) cavity. Sometimes, it goes to the chest area. A valve (fluid pump) is placed underneath the skin behind the ear. The valve is attached to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.
Peripheral Nerve Decompression (Carpal Tunnel Release and Ulnar nerve decompression)
Carpal Tunnel: The carpal tunnel is the most common site for entrapment of the median nerve. The carpal tunnel refers to an area of the wrist that is covered by the transverse carpal ligament. The median nerve and several muscle tendons pass below this ligament on their way from the forearm to the hand. With repeated use or certain medical conditions, this ligament can become thick and push on the median nerve below. This compression of the nerve will often result in pain, numbness, and/or weakness in the hand.
Ulnar Nerve: The ulnar nerve is one of the main nerves that supply strength and sensation to the forearm and hand. It supplies most of the muscles that are within the hand and about half of the sensation. The nerve is often pinched at or just below the elbow in the cubital tunnel. This can result in pain, numbness, or weakness involving the forearm and hand.
Spinal Cord Stimulation
A spinal cord stimulator may be placed to help with lower extremity, upper extremity, and low back pain. This pain may be the result of nerve root scarring, reflex sympathetic dystrophy, or other causes. Often patients may have had one or more surgeries on the spine. A paddle of electrodes is placed on the back surface of the spinal cord, outside of the dura mater (the tough covering of the cord). The electrodes are connected to an electrical signal generator, and electrical impulses are used to stimulate the back of the cord, in an attempt to mask the pain the patient is experiencing. A small laminectomy (removal of bone covering the spinal cord) is performed to allow the surgeon access to the back of the spinal cord. Most patients and typically referred and managed long-term by a pain specialist, who also programs their stimulators after insertion.
Stereotactic Radiosurgery uses ionizing radiation (most commonly x-rays) to treat benign (non-cancerous) or malignant (cancerous) tumors in the brain. Modern radiosurgery is referred to as stereotactic radiosurgery (SRS), because a stereotactic device is used to hold the head in a carefully planned position for each treatment. This technology allows high doses of radiation to be delivered to the tumor with minimal exposure to surrounding healthy tissue.
Most of the time muscle/nerve/vascular disorders can be diagnosed without the need for a biopsy. However, a biopsy can be a necessary and valuable test in some patients, such as those suspected of having inflammation of their muscles/nerves/blood vessels. These procedures are typical performed as outpatient procedures under local anesthesia.
Carotid endarterectomy is an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or to cause irregularities in the normally smooth inner walls of the arteries.
To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid endarterectomy. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe and long-lasting treatment.