The Adult Spine Division of CU Orthopaedics is a part of the Spine Center at the University of Colorado Hospital. The Spine Center provides comprehensive spine care to the citizens of the Rocky Mountain Region including neurosurgery and orthopaedic spine surgery, physical and rehabilitation medicine and alternative medicine therapies. The CU Orthopaedic Spine Division provides state-of-the-art surgical intervention from fellowship trained orthopaedic spine surgeons. Our surgeons are thoroughly trained and experienced in treatment of the cervical, thoracic, lumbar, and sacral spine.

Treatment of spine related pain typically involves use of conservative measures such as rest, physical therapy, medications, therapeutic injections, and alternative therapies; however, when these fail, surgery may be indicated. Some of the common procedures performed at the University of Colorado Orthopaedic Division are described below.

Common procedures
Minimally Invasive Spine Surgery
For many years, traditional spinal surgery has usually involved large incisions up and down the middle of the back, and spreading apart (or retracting) the back muscles to access the spine. This is commonly referred to as an open technique. The advantage of open techniques is that it provides the surgeon with easy access to the spine. The downside of open spine surgery is that retraction damages the back muscles and can cause significant post-operative pain and extended recovery.

While in many instances open techniques are preferred, more and more conditions are now surgically treated using new minimally invasive techniques. Minimally invasive spine surgery allows the surgeon to make smaller incisions in the skin and avoid large muscle retraction. The surgeon uses a scope inserted through a small incision. A tiny video camera and light are connected to the scope and send images from inside the body to a screen in the operating room. Small tubes are then inserted through other small incisions and surgical instruments are inserted through these tubes and used to perform the procedure.

Advantages of minimally invasive techniques
Minimally invasive spine surgery generally results in the same surgical outcome as with more traditional techniques. However, there are a number of advantages to minimally invasive techniques, including:

These minimally invasive techniques can be used for almost all of the spinal surgeries described below; however, the techniques must match the patient’s needs and sufficient experience with each technique is required for it to be successful.

Spine Fusion Surgery
In some instances, there is either too much degeneration or too much instability for disc replacement and spine fusion is required. Spinal fusion surgery is a common treatment for such spinal disorders as spondylolisthesis, scoliosis, severe disc degeneration, or spinal fractures. Again multiple methods for fusion are available and should be tailored appropriately based on the patient’s condition.

Endoscopic Lumbar Interbody Fusion: New and evolving technologies now allow us to perform lumbar interbody fusion surgery via the micro-open or endoscopic approach. The micro-open approach can be performed over multiple levels while the endoscopic approach is most appropriate for spine conditions affecting one level. The endoscopic approach to lumbar interbody fusion can be performed through several small punctures in the skin. The micro-open approach requires a small incision that is considerably smaller and less traumatic than the traditional open approach. In both cases, pedicle screw instrumentation is often used and can be performed by placing the screws through small incisions made through the skin.

The endoscopic or mini-open approach can reduce the patient's hospital stay. Postoperative pain is dramatically reduced and overall function is dramatically improved. Return to work and play can be greatly accelerated by utilizing these techniques.

ALIF: Anterior Lumbar Interbody Fusion involves fusing the spine across the disc space from the front. The surgical access for this procedure is traditionally done through an incision in the left lower abdominal area. This incision may involve cutting through and later repairing, the muscles in the lower abdomen. At the University of Colorado’s Orthopaedic’s Department Spine Division, a mini open approach is available that preserves the muscles and allows access to the front of the spine through a very small incision. This approach maintains abdominal muscle strength and function and is oftentimes used to fusion a few levels.

Many levels may need to be fused from the front of the spine when performing surgery for complex problems such as scoliosis. Unfortunately, the mini open technique does not allow access to multiple levels. Therefore, a more traditional approach may be needed to perform anterior fusion for scoliosis.

PLIF: PLIF stands for Posterior Lumbar Interbody Fusion. In this fusion technique, the vertebrae are reached through an incision in the patient's back (posterior).

The PLIF procedure involves three basic steps:
1. Pre-operative planning and templating. Before the surgery, the surgeon uses MRI and/or CAT scans to determine the size of implant(s) the patient needs.

2. Preparing the disc space. Depending on the number of levels to be fused, a 3-6 inch incision is made in the patient's back and the spinal muscles are retracted (or separated) to allow access to the vertebral disc. The surgeon then carefully removes the lamina (laminectomy) to be able to see and access the nerve roots. The facet joints, which lie directly over the nerve roots, may be trimmed to allow more room for the nerve roots. The surgeon then removes some or all of the affected disc and surrounding tissue.

3. Implants are then inserted. Once the disc space is prepared, a bone graft, allograft or BMP with a cage, is inserted into the disc space to promote fusion between the vertebrae. Additional instrumentation (such as rods or screws) may also be used at this time to further stabilize the spine.

TLIF: TLIF stands for Transforaminal Lumbar Interbody Fusion. This surgery is a refinement of the PLIF procedure and has recently gained popularity as a surgical treatment for conditions affecting the lumbar spine. The TLIF technique involves approaching the spine in a similar manner as the PLIF approach but more from the side of the spinal canal through a midline incision in the patient's back. This approach minimizes the nerve manipulation required to access the vertebrae, discs and nerves.

As with PLIF and ALIF, disc material is removed from the spine and replaced with bone graft inserted into the disc space(along with cages, screws, or rods if necessary). The instrumentation helps facilitate fusion while adding strength and stability to the spine.

Post Fusion Surgery: Recovery time is different for every patient, however, most patients are up and walking by the end of the first day after surgery. Most patients can expect to stay in the hospital for 3-5 days depending on their condition. Once released from the hospital, patients who have undergone a PLIF, ALIF, or TLIF procedure are given a prescription for pain medications to be taken if needed, as well as a detailed post-operative physical therapy/exercise plan to help ease recovery and return to a healthy life.

Spine Fractures
Fractures of the spine can be quite complex and often require surgical treatment for both decompression of the spinal cord and for stabilization of the spine. Every fracture is different and individualized treatment is carefully planned according to each patients needs. Brace treatment is often sufficient for most fractures; however, spinal canal compromise and spinal instability may require surgical treatment. Surgery may require anterior spine decompression, posterior stabilization or both.

Spine Infections
Spine infections may present from a variety of causes. Infections often affect the bones, discs, nerves, or all three. Though antibiotics and rest may be enough for treatment of early infections, surgery is required for those that progress. Typically this requires removal of the infected bones and disc spaces and stabilization of the spine to allow healing.

Spine Tumors
Spine tumors may originate in the spine or may be metastatic to the spine. These complex problems require a multidisciplinary approach including oncologists, radiation treatment specialists, and surgeons. Spinal surgery includes decompression of the spine as well as stabilization. Treatment is individualized based on the type of tumor and involvement of the spine.