Treatments

Surgical Procedures

What is Cervical Disc Replacement?

Your cervical spine is made up of the seven bones, called cervical vertebrae, stacked on top of each other in your neck area. The natural cervical intervertebral disc is an amazing mechanical structure from an engineering perspective. It has the ability to absorb a large compressive load while still providing an impressive range of motion between the bones in the neck.

Cervical disc replacement image

The Cervical disc replacement process involves the insertion of an artificial cervical disc is a device inserted between two vertebrae in the neck to replace a damaged disc. The intention of the artificial disc is to preserve motion of the natural disc.

 

Reasons for the procedure

There are a number of important factors in considering cervical disc replacement surgery. It is important to remember that a disc replacement is a motion-preservation procedure and not a motion-creation procedure.

Loss of space between your cervical vertebrae from cervical disk degeneration, or wear and tear, is common. Cervical disks begin to collapse and bulge with age; this happens to most people by age 60. Some people have more cervical disk degeneration symptoms than others.

The symptoms may include:

  • Neck pain
  • Neck stiffness
  • Headache
  • Pain that travels down into your shoulders or into your arms
  • Weakness of your shoulders, arms, hands, or legs
  • "Pins and needles" or numbness in your arms

 

Risks of the procedure

Disk replacement surgery is a safe procedure, but all surgeries carry some inherant risks. These will be explained before the procedure.

As with all newer technologies, one important consideration with this procedure is that long-term studies and follow-up are needed to fully understand the potential risks and benefits of cervical disc replacement. You should discuss the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery with your surgeon.

Some potential risks of cervical spine surgery include:

  • Reactions to the anesthesia
  • Bleeding
  • Infection
  • Nerve injury
  • Spinal fluid leak
  • Voice change
  • Stroke
  • Difficulty breathing
  • Difficulty swallowing
  • Failure to relieve symptoms
  • Broken or loosened artificial disk
  • Need for further surgery

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.


 

What is a Kyphoplasty?

Kyphoplasty is a procedure in which bone cement is injected through a small hole in the skin into a fractured vertebra with the goal of relieving back pain caused by a spinal fracture, to stabilize the bone, and to restore some or all of the lost vertebral body height due to the compression fracture.

Reasons for Kyphoplasty Surgery

The vertebrae are a series of bones that make up the spine. If one suffers a fracture, it can put pressure on surrounding nerves. This can cause intense pain and disability. These bones could be repaired kyphoplasty procedure. A balloon is used to create a cavity in the bone and this is used to inject bone cement. The procedure is designed to relieve pain, but can also improve spinal deformities from the fractures.

 

Kyphoplasty illustration

Other treatment for vertebral fracture may include nonsurgical treatments (like bed rest, bracing, and pain medicines).

 

Risks and Complications of Kyphoplasty

Complications are rare, but no procedure is completely free of risk. If you are planning to have a vertebroplasty or kyphoplasty, your doctor will review a list of possible complications which may include:

  • Nerve damage or a spinal cord injury from malpositioned instruments placed in the back
  • Nerve injury or spinal cord compression from leaking of the PMMA into veins or epidural space
  • Allergic reaction to the solution used to see the balloon on the X-ray image as it inflates

 


 

What is Minimally Invasive Cervical Fusion?

A minimally invasive cervical fusion procedure is the permanent fusion of the lower three cervical vertebrae (vertebrae in the neck). During this procedure, the intervertebral discs at C5-C6 and C6-C7 will be removed. In their places, bone grafts are inserted and secured in place. Over time, a solid segment of bone will form between these segments in the lower portion of the cervical spine.

 

Reasons for the procedure

If you have been suffering from chronic neck pain and you have tried several types of non-surgical treatment options, as recommended by your doctor, but these have not worked; as you consider your surgical options, we invite you to consider minimally invasive cervical spine surgery.

Minimally invasive cervical spine surgery is a procedure that treats spinal conditions in the neck and upper back. It requires only a small incision for targeted access to the spine and does not require bulky hardware or muscle disruption.

Some of the most common conditions that would lead considering this procedure include herniated discs, collapsed discs and bone spurs, or a degenerative spine condition or injury that is causing compression of the cervical spinal nerve roots or the spinal cord.

 

Advantages of Minimally Invasive Cervical Fusion

Our minimally invasive cervical fusion procedure is a safer and more effective alternative to traditional open neck surgery. Our minimally invasive procedures are performed through a small incision in the neck or back, about 1-inch in length. Thanks to recent advanced medical technology, our surgeons to access the spine without altering the surrounding muscles and soft tissue. This allows for minimal scarring and shorter recovery time.

Because this minimally invasive surgery is performed through the front of the neck, instead of the back, it offers many benefits including:

  • Access to nearly the entire cervical section of the spine through an uncomplicated pathway that minimizes trauma to surrounding areas
  • Generally less post-operative pain, due to a smaller incision and less movement of associated tissue, muscles and nerves
  • Minimally invasive surgery typically means less blood loss, faster pain relief and shortened post-operative recovery times, so patients can get back to their daily life and work sooner

 

What is Minimally Invasive Decompression Surgery?

The process involves a small incision where the surgeon will remove the area of the bone or disc that is compressing a nerve in your spinal cord. This type of surgery is performed on patients who have a nerve compressed along their spinal cord, resulting in radiating pain.

 

Reasons for the procedure

Lumbar spinal stenosis is a common condition in elderly patients and may lead to progressive back and leg pain, muscular weakness, sensory disturbance, or problems with mobility. While nerve compression can be caused by a number of things, it is usually a result of one of the following spine conditions:

  • Spinal stenosis
  • Herniated disc
  • Bulging disc
  • Pinched nerve
  • Bone spurs
  • Sciatica
  • Arthritis of the spine
  • Facet disease
  • Foraminal stenosis
  • Annular tear

 

Minimally invasive decompression procedures:

  • Foraminotomy

    A foraminotomy is a decompression surgery that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. Conditions such as foraminal narrowing caused by bulging discs, herniated discs, scar tissue, bone spurs, thickening of the ligament and facet hypertrophy can be treated with a foraminotomy.

    Formainotomy image
  • Laminotomy

    Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side to relieve pressure on the spinal cord compressed by spinal stenosis. Conditions such as spinal stenosis that are caused by a herniated disc, bulging disc, bone spurs, hypertrophy of the ligament flavum, facet hypertrophy and scar tissue can be approached surgically by doing a laminotomy.

    Laminotomy image
  • Disectomy

    The surgical removal of herniated disc material that presses on a nerve root or the spinal cord. It involves removing the central portion of an intervertebral disc, which causes pain by stressing the spinal cord or radiating nerves.

 

What is our minimally invasive stabilization surgery?

During minimally invasive stabilization surgery the portion of the spine that is compressing the nerve root in the spinal cord and narrowing the spinal canal will be removed. An implant will immediately be placed in the now-free space to stabilize the spine and help prevent future spinal stenosis.

 

Reasons for the procedure

People who suffer from chronic neck and back pain and experience difficulty walking or standing for long periods of time. Back pain that is caused by a degenerative spine condition can prevent activities that bring enjoyment because the instability of the spine makes it difficult to move and twist without pain.

 

Types of minimally invasive stabilization procedures:


  • Anterior Cervical Fusion

    Anterior cervical discectomy and fusion is a surgery to remove a herniated or degenerative disc in the neck. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression.

    Cervical Fusion
  • Transforaminal lumbar Interbody fusion

    Is a spinal fusion procedure that fuses the front and back section of the spine through a posterior approach. In this procedure, bone graft, or a bone graft substitute, is placed between vertebrae in order to fuse them and create a stronger and more stable spine.

    Transformaminal lumbar Interbody fusion image
  • Oblique Lumbar Interbody Fusion

    Oblique lumbar interbody fusion is a technique for fusion of the lumbar spine that overcomes these complications: spine curvature, fractured vertebrae, bulging discs, spine instability and spondylolisthesis (slipping out of vertebra).

    The procedure is performed under general anesthesia. OLIF is similar in approach to direct lateral interbody fusion (DLIF), but overcomes the drawback of DLIF in its ability to reach the last lumbar vertebra. This is made possible by obliquely approaching the vertebra and avoiding the pelvic bone.

  • SI Joint fusion

    The procedure typically involves three small titanium implants inserted in a minimally invasive procedure across the SI joint, and is designed to create a durable construct to stabilize the SI joint.

    SI Joint Fusion Image
  • Anterior Lumbar Interbody Fusion

    The anterior lumbar interbody fusion (ALIF) is similar to the posterior lumbar interbody fusion (PLIF), except that in the ALIF, the disc space is fused by approaching the spine through the abdomen instead of through the lower back.

    Anterior Lumbar Interbody Fusion

 


 

Non-Surgical and Diagnostic Procedures

What is a Epidural steroid injection (ESI)?

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation. Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering of the spinal nerves and bony vertebrae.

Epidural steroid injection image

Reasons for the procedure

Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

  • Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
  • Spondylolysis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain.
  • Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
  • Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
  • Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

ESI should NOT be performed on people who have an infection or have bleeding problems. The injection may slightly elevate the blood sugar levels in patients with diabetes. It may also temporarily elevate blood pressure and eye pressure for patients with glaucoma. You should discuss this with your doctor.


 

What is Facet thermal ablation?

Facet joints are the joints in your spine that make your back flexible, and enable you to bend and twist. Facet Thermal Ablation uses a laser to deaden sensory nerves that are irritating the facet joins, causing pain.

During the facet thermal ablation procedure, surgeons vaporize irritated and painful nerves around the facets of the vertebrae, removing pain-inducing tissue in nerve branches above and below the affected facet joints on the spine.

facet thermal ablation image

 

Reasons for the procedure

The most common symptoms of this spine condition include:

  • Acute pain — Facet arthritis may cause localized pain in the neck or lower back where the joints are affected. The pain can be random and intermittent, ranging from almost constant to just a few times a month.
  • Persistent tenderness or pain — One of the most common symptoms of facet arthritis is a continual tenderness at the site of the arthritis.
  • Limited movement and flexibility — Often arthritis in the facet joints will cause limited movement and stiffness in the spine. You might experience more pain bending backward than forward.
  • Radiating pain — You may experience pain in your buttock and leg if your facet arthritis is in your lower spine. Likewise, if the facet arthritis is in your cervical (neck) spine, you may experience radiating pain in your shoulder and arm.

 

What is Pain Mapping?

Pain mapping uses the most advanced techniques and technology to pinpoint the precise source of your neck and/or back pain. Doctors will perform a series of precisely targeted injections to determine exactly where your pain originates. This allows us to provide temporary relief while establishing the root cause of the pain.

There are several different pain mapping procedures that can be performed, including:

  • Selective Nerve Root Blocks
  • Piriformis Injections
  • Occipital Nerve Blocks
  • Sciatic (Peripheral) Nerve Blocks
  • Sacroiliac Joint Injections/Blocks
  • Cervical/Thoracic/Lumbar Medial Branch Blocks
  • Discography
  • And Many More

 

Reasons for the procedure

The spine is a complex network of nerves, bones and discs, so nerve roots can sometimes be prone to compression or stenosis from herniated or bulging discs. Nerves in our upper and lower extremities originate from large spinal nerves that separate from the spinal cord in various places. They can be compressed by the bones of the spine themselves, such as with cases of degenerative disc disease. This often results in pain in the neck and lower back region that can radiate into the upper and lower extremities.

Our pain mapping techniques are performed in order to expertly pinpoint and isolate the nerve(s) that causes the pain. With this knowledge, we are able to create a more efficient plan of action to treat the pain.


 

What is Physical Therapy

Physical therapy, also known as physiotherapy, is a physical rehabilitation specialty that, by using mechanical force and movements, remedies impairments and promotes mobility, function, and quality of life.

Therapists examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, they work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

 

Reasons for the procedure

Physical therapy attempts to address the illnesses, or injuries that limit a person's abilities to move and perform functional activities in their daily lives. Functional movement is central to what it means to be healthy.

Physical Therapy img

 

What is a Sacroiliac joint injection?

The Sacroiliac Joint injection is performed under fluoroscopy for accuracy. Once the needle has entered the sacroiliac joint, a special contrasting chemical is injected into the joint to ensure proper needle placement and proper spread of medication.

Also called a sacroiliac joint block, it is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction.

Reasons for the procedure

The sacroiliac joints lie next to the spine and connect the sacrum with the hip on both sides. There are two sacroiliac joints, one on the right and one on the left. Joint inflammation and/or dysfunction in this area can cause pain. The purpose of a sacroiliac joint injection is two-fold: to diagnose the source of a patient's pain, and to provide therapeutic pain relief.

 

Sacroiliac Joint image


 

Spinal Cord Stimulation for Chronic Back and Neck Pain

A spinal cord stimulator (SCS) device is surgically placed under your skin and sends a mild electric current to your spinal cord.

Unlike most surgical procedures, spinal cord stimulation therapy is reversible. If a person decides at any time to discontinue the therapy, the electrical contacts, wires, and generator can all be removed and there are no permanent changes to the spine.

 

Reasons for the procedure

Spinal cord stimulation is a therapy that masks pain signals before they reach the brain. A small device, similar to a pacemaker, is implanted in the body to deliver electrical pulses to the spinal cord. It helps patients better manage their chronic pain symptoms and decrease the use of opioid medications.

This stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain, and so the amount of pain relief varies for each person. The goal for SCS is a 50 to 70% reduction in pain. Stimulation does not work for everyone. Some patients may find the sensation unpleasant. In other cases it may not cover the entire pain area.


 

What is Adult Stem Cell Therapy?

Stem cells are cells that are located within the body that have not yet transformed to perform a certain function. Stem cells are the body’s natural healers. Unlike other cells, they have the unique ability to transform into the other types of cells the body need for repairing damage joints in the back. As we age, the number of stem cells and their potency decline.

With stem cell therapy for back pain, we revitalize a patient’s stem cells and inject a concentrated dosage of them and PRP directly to the damaged area of the spine.

 

Reasons for the procedure

Once injected, the stem cells will begin restoring and rebuilding the diseased discs in the spine. The PRP, which contains a tremendous amount of growth factors, will stimulate the stem cells to maximize their effectiveness. The entire procedure only takes a few hours to complete, and patients will be able to leave the clinic and go back home immediately.

For most patients, a single stem cell injection is all that is needed to eliminate their back pain, and the pain relief can last for the rest of their life. For patients with a severe degenerative disease, additional stem cell injections may be needed.


 

About Us

The first in Texas to perform micro-endoscopic laser spine surgery with an incision as small as 3 mm, Dr. Won advises multiple international spine technology companies and has helped design many groundbreaking tools for the minimally invasive spine surgery industry.

Dr. Won also innovated the Pain Mapping procedures, this diagnostic study helps to pin point the pain generator so that we can provide the least invasive spine procedures, LuMINI.

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