From HealthNewsDigest.com
Surgery
Innovative Cervical Spine Surgery Techniques
By
Jul 10, 2013 - 12:28:05 PM
(HealthNewsDigest.com) - NEW YORK, NY- More than 200,000 cervical spine
surgeries are performed in the United States annually to treat conditions ranging
from spinal deformity to degenerative disc disease.
Patients suffering from herniated disc can rest more easily knowing that there are
state-of-the-art procedures performed by highly respected New York-area spine
surgeon Ezriel Kornel, MD that can mean relief from the debilitating condition.
Dr. Kornel, a neurosurgeon with offices in Manhattan and White Plains, is a partner in Brain and
Spine Surgeons of New York, and is an Assistant Clinical Professor of Neurosurgery at Weill
Cornell Medical Center in New York. He is one of the foremost practitioners of minimally
invasive surgery and an expert in cervical spine surgery.
Because of Dr. Kornel's particular interest in cervical spine surgery, he is one of the first
neurosurgeons in the New York metropolitan area to replace damaged cervical discs with the
newly introduced artificial discs. Recently Dr. Kornel outlined two distinct surgical approaches
to repairing herniated disc within the spine. The bones in the spine are cushioned by sponge-like
discs, which act as shock absorbers. When discs become damaged, they can press on the nerve in
the spinal column and result in pain, numbness or weakness.
Dr. Kornel explains that there are two approaches to eradicating a herniated disc and restore a
patient to sound spine health: surgical fusion; and surgical disc replacement, also referred to as
surgical arthroplasty.
"When do we operate on a cervical disc? When there is a herniation of the disc, which means
that the disc is compressing the nerve or spinal cord in the neck," Dr. Kornel explains. When a
herniation occurs, the disc pushes into the spinal canal. "There is a mechanical problem there;
discs do not slip into place. Once they're out, they're out." Either they shrink on their own, or
they have to be removed. "When they're removed, one of the main ways in which we do that is to
go through the front of the neck, because the discs are in the front of the spine" Dr. Kornel
explains. The vertebral bodies are in the front, "which are the building blocks of the spine," he
says, "and in-between we have the discs. The discs are like a soft-boiled egg with a gelatinous
center. And there is a thick outer fibrous ring that holds them together. When a disc becomes
damaged it becomes more like a hard-boiled egg and the center becomes tougher; the outer part
becomes weaker."
When the disc herniates, Dr. Kornel points out, it pushes out of the disc bases itself and can
compress the nerve where it comes out of the spine or compress the spinal cord, which is sitting
in the spinal canal between the lamina and the vertebral bodies and discs. "To get to that disc we
have to go through the front of the spine. We make an incision along the skin crease in the front
of the neck. Usually one side or the other; I prefer to go from the left side. You have to move the
trachea and esophagus over to one side gently to get to the front spine, and move the muscles and
the carotid artery over to the other side in order to have a portal or small opening to visualize the
disc."
There are a variety of techniques to remove the disc, Dr. Kornel explains. "The one I prefer is to
cut into the surface of the disc, remove the portion of the surface and then use a high-speed drill
to drill out the remainder of the disc. Then I use a microscope to see the back end of the discs to
see the important structures - the spinal cord and the nerve. I want to make sure not to damage
the nerve or the spinal cord. Once the disc is out, I flatten out the edges of the end plates, which
are the portions of the vertebral bodies against the discs themselves, so that I can perform either a
fusion or an arthroplasty."
Dr. Kornel explains the rudiments of spinal fusion surgery: "We put something in place of the
disc that a person's bone can then grow through so that ultimately it's bone bridging to bone" he
says. "That means that there's no movement anymore at that disc level because it's all one solid
structure, from vertebrae to vertebrae. The advantage to that is that there is no further disc to be
herniated, and the patient will not have any further nerve or spinal cord compression once that
fusion has occurred."
With cervical fusion, Dr. Kornel places an interbody device, or a ‘cage' sandwiched between two
vertebrae. "Once we put that in, it is locked into place by small plates that slide into the cage,
then into the bone, and then lock into place so it can't move and it maintains the alignment of the
vertebrae," he shares. "There is a big channel in the middle, and we can use pieces of the
patient's own bone that we can obtain when we're removing the disc into there." A specially
prepared sterile donor bone paste, or allograft, can be used that promotes and stimulates the
patient's own bone to grow through the region. "Ultimately you've got a peg of bone going
through from one vertebrae to the other; that's a fusion. And that means your vertebrae do not
move at that particular segment, and the symptoms of the herniated disc are relieved."
Replacement with an artificial disc is the second option for repairing cervical herniation. "What I
particularly like to do now in the appropriate patient is to put in an artificial disc, or what we call
an arthroplasty," Dr, Kornel explains. "When we remove the disc, which is in the same manner
as we do with the fusion, rather than put in a cage as in fusion, we put in the artificial disc." The
advantage to this option is that it permits movement. "Why is movement important? Primarily
because it reduces the stress on the discs that are adjacent to the disc that has been damaged, and
those discs now do not have to do all the work," he says. "The artificial disc can then still do
some of the work, and hopefully limit the likelihood of further damage to subsequent discs." It
doesn't guarantee that there won't be other discs damaged, however. "There are many factors that
go into disc degenerating and herniating," he adds, "but certainly if you can reduce the stresses
on that disc, it does decrease the likelihood of further disc problems."
Is there a downside to opting for the artificial disc? It can fuse, Dr. Kornel says. "That's unusual,
but it can happen. "But if it does happen, then you're really no worse off than if you had a fusion
to begin with. These artificial discs have been shown to hold up very well, and in fact it is
extremely rare that they would have to be removed and replaced or fused." The times when
artificial disc replacement might not be the best course of action, Dr. Kornel notes, "is when the
joints of the spine are already damaged with arthritis and may have already fused themselves, in
which case there isn't any movement there anyway, or there is so much arthritis that the
movement is very limited to begin with; then there is no point in putting in an artificial disc
because you won't have sufficient movement to allow that artificial disc to be functional."
In terms of recovery time, the artificial disc procedure has been shown to offer a slightly quicker
recovery than with the cervical fusion option. "In either operation I don't feel the patient needs to
wear a neck brace or a collar," Dr. Kornel says. "Certainly with an artificial disc patients can
begin to move more normally a bit faster. Both result in relief of neck pain and relief of pain
related to pressure on the nerve. And both are very effective in relieving symptoms and allowing
patients to get back to a normal routine of life. The artificial disc does give us a bit more
possibilities that other discs will not be damaged in the future. It's still important," he concludes,
"to do appropriate neck exercises and work on maintaining proper alignment and posture of the
spine to prevent problems down the line."
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About New York Neurosurgeon Ezriel Kornel MD
Dr. Kornel has offices in New York City and Westchester County and is a principal of Brain &
Spine Surgeons of New York since 1990, Dr. Kornel is in the forefront of minimally invasive
neurosurgery (MIS). MIS is used to minimize the trauma of surgery and increase the speed of
recovery. Stemming from his interest in microsurgery, Dr. Kornel has become an expert in
minimally invasive endoscopic surgery of the spine as well as minimally invasive approaches in
the surgical treatment of brain tumors. Because of his particular interest in cervical spine surgery,
he is one of the first neurosurgeons in the New York metropolitan area to replace damaged
cervical discs with the newly introduced artificial discs. He was trained in Stockholm in the use
of the Gamma Knife and, when indicated, utilizes this stereotactic radio surgical technique for
the treatment of brain tumors as well as for the treatment of trigeminal neuralgia. He is the
director of the Institute for Neurosciences at Northern Westchester Hospital in Mount Kisco, NY
and is affiliated with many of the leading hospitals in the area. Dr. Kornel gained his initial
expertise during his neurosurgical residency at the George Washington University Medical
Center under the tutelage of Hugo Rizzoli, M.D., at the time one of the most renown and
respected neurosurgeons in the world. Dr. Kornel has numerous mentions in the biography of
James Brady, press secretary to President Reagan, because of his involvement in Mr. Brady's
care after his tragic gunshot injury. Highly personalized attention combined with the utmost
dedication to the ultimate well-being of his patients is what motivates Dr. Kornel in his efforts to
continue.
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