Surgery handouts
Dr. Poulter is a fellowship trained spine specialist. He performs both minimally invasive and complex spine surgery to help correct your back pain.
Learn more about back surgery types, when back surgery is necessary and what to expect after your spine surgery. Download a handout for more information.
Cervical Foraminotomy
A foraminotomy is a minimally invasive surgical procedure to un-pinch the neck nerves by removing herniated disc material or bone spurs. It is used to treat patients with significant arm pain or dysfunction resulting from a pinched nerve in their neck.
The surgery is performed through a small incision in the neck. For surgery, patients undergo anesthesia and then gently turned onto their stomachs. A CT scan is taken to allow us to place a very small incision directly over the pinched nerves. We then pass a special dilator into the muscle. The dilator allows the muscle to be spread without being cut. We then place a small tube that holds the muscle open. Through this small opening, we look into the spine with a microscope and remove disk material or bone spurs that are putting pressure on the nerve. Once the nerve is free of compression, we remove the tube and the muscle comes back together. These openings are typically small, most are 18 mm in length.
CERVICAL FORAMINOTOMY HANDOUT
POST-OP HANDOUT
Lumbar Fusion with the ALIF Technique
A spinal fusion is a surgical technique that connects two bones of the spine together with a new bone. A fusion can be performed anywhere in the spine. A lumbar fusion refers to fusing two or more vertebrae in the low back. To achieve a fusion, an orthopedic spine specialist needs to open an area around the affected vertebrae and pack bone graft between the bones. The bones are often held together with screws or other implants that facilitate the healing of the fusion by holding the bones still with respect to one another. A fusion may be combined with other techniques, such as a decompression to un-pinch nerves, to achieve the needs of a specific patient. The ALIF procedure has the ability to restore the shape of the spine when there are collapsed discs, scoliosis or a slippage of vertebrae. In doing so, ALIF is often able to un-pinch nerves without requiring an additional decompression procedure.
LUMBAR FUSION WITH ALIF TECHNIQUE HANDOUT
LUMBAR FUSION POST-OP HANDOUT
Lumbar Fusion with Minimally Invasive PLIF Technique
A spinal fusion is a surgical technique that connects two bones of the spine together with a new bone. A fusion can be performed anywhere in the spine. A lumbar fusion refers to fusing two or more vertebrae in the low back. To achieve a fusion, a surgeon needs to open an area around the affected vertebrae and then pack bone graft between the bones. The bones are often held together with screws or other implants that facilitate the healing of the fusion. A fusion may be combined with other techniques, such as a decompression, to un-pinch nerves and achieve the needs of a specific patient. The minimally invasive PLIF is a significant improvement in the way we perform these fusion surgeries. With the advent of newly developed instruments that allow us to minimize the incision, we no longer need to cut the muscles in the back to perform the fusion. This minimally invasive surgery has dramatically reduced the discomfort and complications of a spine fusion.
LUMBAR FUSION WITH MINIMALLY INVASIVE PLIF TECHNIQUE HANDOUT
LUMBAR FUSION POST-OP HANDOUT
Lumbar Fusion with XLIF Technique
A spinal fusion is a surgical technique that connects two bones of the spine together with a new bone. A fusion can be performed anywhere in the spine. A lumbar fusion refers to fusing two or more vertebrae in the low back. To achieve a fusion, a spine specialist needs to open an area around the affected vertebrae and then pack bone graft between the bones. The bones are often held together with screws or other implants that facilitate the healing of the fusion by holding the bones still. A fusion may be combined with other techniques, such as a decompression, to un-pinch nerves and achieve the needs of a specific patient.
XLIF is a type of minimally invasive spine fusion. It allows us to access the front of the spine through a small incision in the flank. The XLIF procedure has the ability to restore the shape of the spine when there are collapsed discs, scoliosis or a slippage of vertebrae. In doing so, XLIF is often able to un-pinch nerves without requiring an additional decompression procedure. XLIF was created in 2003 and has proven to be a safe and effective technique for spinal fusion that allows for very little discomfort compared to earlier surgical techniques.
LUMBAR FUSION WITH XLIF TECHNIQUE HANDOUT
LUMBAR FUSION POST-OP HANDOUT
Lumbar Laminectomy
A laminectomy is a procedure to un-pinch nerves that is performed through a small incision in the back. For this spine surgery, patients undergo anesthesia and are then gently turned onto their stomachs. An X-ray is taken to allow us to place a small incision directly over the appropriate area of the spine. We then place a retractor into the muscle of the spine. The retractor allows the muscle to be spread without being cut. The retractor holds the muscle apart throughout surgery allowing us to visualize the spine. We use a microscope to clearly see the structures of the spine as we remove the bone covering the spinal canal and nerves. We remove bone one millimeter at a time using specialized tools designed to protect the nerves. Once we have created an opening to the spinal canal, any additional compression from bone spurs or herniated disc material is carefully removed. Once all of the nerves are free of compression, we remove the retractor and the muscle comes back together. A laminectomy can be performed at multiple segments of spine at the same time. If more than one segment is treated, we make a larger incision and repeat the process. When all of the laminectomies are completed, we then close the skin with sutures that dissolve.
LUMBAR LAMINECTOMY HANDOUT
LUMBAR LAMINECTOMY POST-OP HANDOUT
Lumbar Micro-Discectomy
A microdiscectomy is a minimally invasive spine surgery to remove herniated disc material and un-pinch nerves in the low back. It is used to treat patients with significant leg pain or leg dysfunction resulting from a ruptured disc in their low back. The surgery is performed through a small incision in the back.
LUMBAR MICRO-DISCECTOMY HANDOUT
LUMBAR MICRO-DISCECTOMY POST-OP HANDOUT
Multiple Level Anterior Cervical Discectomy and Fusion
An anterior cervical discectomy and fusion is a procedure to remove disc material or bone spurs that may be pinching the spinal cord or nerves and to fuse the affected areas of the spine.
The surgery is performed through an incision in the front of the neck. The esophagus and windpipe are gently held out of the way and a disc between the bones of the neck is removed. This allows us to clean away any material that is pressing on the spinal cord or nerves. We then need to place bone graft into the empty space where the disc once was to facilitate healing. This small amount of bone is taken from the front of the hip through a second small incision. Current techniques allow for us to use less bone, the once painful hip grafting surgeries are now a thing of the past. The bone is packed into a spacer or cage and placed into the disc space. We then stabilize the spine with a plate. This holds the spine still to allow it to fuse. We close the skin with dissolvable sutures and glue.
We utilize neuromonitoring to keep you safe during surgery. Neuromonitoring is a procedure where we monitor the function of your spinal cord throughout surgery. It gives us feedback while you are asleep to know that we have not done anything that compromises the function of your spinal cord.
MULTIPLE LEVEL ANTERIOR CERVICAL DISCECTOMY AND FUSION HANDOUT
MULTIPLE LEVEL ANTERIOR CERVICAL DISCECTOMY AND FUSION POST-OP HANDOUT
Single Level Anterior Cervical Discectomy and Fusion
An anterior cervical discectomy and fusion is a procedure performed to remove disc material or bone spurs that may be pinching the spinal cord or nerves and to fuse the affected areas of the spine.
The surgery is performed through an incision in the front of the neck. The esophagus and windpipe are gently held out of the way and a disc between the bones of the neck is removed. This allows us to clean away any material that is pressing on the spinal cord or nerves. We then need to place bone graft into the empty space where the disc once was to facilitate healing. This small amount of bone is taken from the front of the hip through a second small incision. Current techniques allow for us to use less bone, the once painful hip grafting surgeries are now a thing of the past. The bone is packed into a spacer or cage and placed into the disc space. We then stabilize the spine with a plate. This holds the spine still to allow it to fuse. We close the skin with dissolvable sutures and glue.
We utilize neuromonitoring to keep you safe during surgery. Neuromonitoring is a procedure where we monitor the function of your spinal cord throughout surgery. It gives us feedback while you are asleep to know that we have not done anything that compromises the function of your spinal cord.