Spine Surgery
Back pain is the most common complaint any primary care physician in the United States will see. There are more than 800,000 surgeries for back pain performed in America, with a re-operation rate of approximately 20%. Can we do better? We are big proponents of adhering to an operative philosophy, rather than specific surgeries or technologies that tend to evolve over time. Our philosophy is simple: treat our patients like family and in doing so, provide for them the most appropriate, minimally invasive intervention to get them to being the healthiest they have ever been. Whether employing simple observation, conservative management and injections, decompression, neural stimulation, artificial disks, or multi-level fusions, we fit our diverse armamentarium to our patients rather than fit our patients into specific surgeries and technologies. See below for a small sample of what we offer.
MICROSURGICAL DECOMPRESSION
With a floating 10 x operative microscope and microinstruments we routinely use in Skull Base Neurosurgery, we continue to push the bounds and expand the horizons of modern spine surgery. In this example, our patient is suffering from a cervical disc herniation, considered in many circles as an automatic, “chip shot” anterior cervical discectomy and fusion (ACDF). While this is a valid approach, we always ask, can we do better? While an ACDF is a wonderful procedure and has much to offer, can we achieve the same benefits without changing the biomechanics of the spine and therefore avoid some of the drawbacks of cervical fusion? Watch this video of a minimally invasive posterior cervical microdiscectomy as Dr. Amandip Gill safely removes a large disc herniation impinging the C8 nerve root and the spinal cord. This particular patient awoke with resolution of his pain and sensory symptoms; his motor exam immediately improved from pre-op and he was back to normal at his 6 month follow-up. Our goal is to provide the simplest, most appropriate, and effective intervention for you.
ARTIFICIAL DISC REPLACEMENT
Artificial discs have been a wonderful addition to the spine surgeon’s repository of techniques, allowing for decompression and motion preservation instead of fusion. Recent articles have shown that specific subsets of patients who need an anterior cervical discectomy followed by placement of special cervical disc replacements have improved satisfaction, functional outcomes, and decreased re-operation rates as compared to those who are fused. Find out if you fall into this special category today!
CERVICAL FUSION
Dr. Gill likes to stress that fusion is not the enemy. Tailoring your surgery, from the instruments used to the techniques and implants employed, is what makes all the difference. Cervical fusions can be powerful techniques when properly employed. Watch this video in which we preserve lateral motion in a patient with severe atlanto-axial dislocation by employing a technically challenging alternative to the occipito-cervical fusion, the C1-C2 fusion via C2 pedicle screws.
THORACO-LUMBAR FUSION AND DEFORMITY CORRECTION
Doing a fusion in the thoracic and lumbar spine requires a special understanding of not just local anatomy but the special relationship of spinal components from the skull all the way down to the pelvis. Whether completing a minimally invasive transforaminal interbody fusion (TLIF) or a large thoraco-lumbar reconstruction, as the body acts in concert with its various components, maintaining a balanced spine from top to bottom is of the utmost importance. This is no harder than the accompanying case in which a severe fracture dislocation causes a complete L1-L2 lateral listhesis. Pay special attention to the post-operative images showing normal lumbar lordosis re-established with a double barrel corpectomy and thoraco-lumbar reconstruction, all done from the back with a single surgical approach. The patient was very fortunate and had a better than expected outcome, with a completely normal motor exam 6 months post-surgery.
SPINE ONCOLOGY
Tumors of the spine represent a special challenge. The spinal cord and nerve roots are surrounded by critical structures such as the heart, carotid arteries, trachea, esophagus, etc. that makes simply getting to the tumor quite a challenge. In addition, the spinal cord is arguably more sensitive to injury and manipulation than the brain itself. This makes tumors of the spine all the more difficult to resect. Having a microsurgical background as well as extensive training in deformity corrections gives Dr. Gill a unique combination of skills to tackle these pathologies. Just as with brain tumors, we wish to serve as your medical home, coordinating between neuro-oncology, hematology oncology, and radiation oncology. Watch as Dr. Gill resects a schwannoma from the cranio-cervical junction. Our patient, who was suffering from severe weakness and cranial nerve dysfunction, made a complete recovery in just 6 months!
Spinal cord stimulators and intrathecal pumps have been shown to be invaluable supplements in the neurosurgeon’s armamentarium, with some studies showing equivalent and at times, better results as compared to fusion. These techniques fit nicely into our surgical philosophy; we are here to treat not a disease or pathology, but our patients as unique individuals who need unique care plans tailored to their needs.
PAIN NEUROSURGERY