Common Surgeries of the Vertebral Column and Spinal Cord

1. Discectomy

Removal of a herniated/prolapsed intervertebral disc that is compressing the thecal sac, nerve root, or cord.

Open discectomy: midline approach, small laminar fenestration (windowing) through ligamentum flavum, sac retracted, offending disc fragment excised.
Microdiscectomy: same principle via microscope/tubular retractor, smaller incision.
Percutaneous/endoscopic discectomy: needle/endoscope-based removal, minimally invasive, for contained herniations.
Anterior cervical discectomy (with fusion, ACDF): anterior neck approach for cervical disc herniation/myelopathy; disc removed and level fused with graft/plate.
Pre-op MRI + intra-op fluoroscopy mandatory to confirm correct level before opening. (Gray's Anatomy for Students, p. 90; Campbell's Operative Orthopaedics 15th ed.)

2. Laminectomy / Laminotomy

Removal of all (laminectomy) or part (laminotomy/hemilaminectomy) of the vertebral lamina to decompress the spinal cord or nerve roots.

Indications: spinal stenosis, disc prolapse, tumor, abscess.
Technique: troughs cut along lamina with high-speed burr, spinous process + bilateral laminae +/- medial facets removed en bloc for decompression.
Often combined with discectomy or fusion if instability is expected afterward. (Gray's Anatomy for Students, p. 90; Rockwood and Green's Fractures in Adults, 10th ed.)

3. Laminoplasty (usually cervical)

Motion-preserving alternative to laminectomy for cervical myelopathy (e.g., OPLL, congenital stenosis).

Lamina is hinged open (open-door or French-door technique) rather than removed, enlarging the canal while preserving posterior elements and some motion.
Preferred in neutral/lordotic cervical alignment; kyphotic spines do worse (cord cannot drift back).
Risk: transient C5 nerve root palsy (~majority resolve spontaneously within months). (Campbell's Operative Orthopaedics, 15th ed.)

4. Foraminotomy

Enlargement of the neural foramen (posterior or transforaminal approach) to decompress an exiting nerve root without removing the whole lamina or disc.

Cervical foraminotomy: posterior keyhole approach, often minimally invasive with tubular retractors/endoscope.
Used for foraminal disc herniation or osteophytic foraminal stenosis; preserves stability, avoids fusion in many cases.

5. Corpectomy

Removal of one or more entire vertebral bodies (plus adjacent discs) for severe canal compromise (retropulsed fracture fragments, tumor, multilevel OPLL/spondylosis).

Anterior or antero-lateral (costotransversectomy) approach.
Reconstruction with an expandable cage/strut graft plus instrumentation (plate/rods) since removing the body destabilizes the column. (Rockwood and Green's Fractures in Adults, 10th ed.)

6. Spinal Fusion (Arthrodesis)

Permanent union of two or more vertebrae using bone graft +/- instrumentation (pedicle screws, rods, cages, plates).

Indications: instability after fracture/tumor, degenerative mechanical pain, post-decompression instability, deformity.
Approaches:
- Posterior fusion (PLF/PLIF) - posterior elements fused, posterior lumbar interbody cage placed between vertebral bodies.
- Anterior fusion (ALIF) - disc removed anteriorly, cage/graft placed in the disc space.
- Transforaminal (TLIF) - unilateral posterior approach to interbody space, less thecal sac retraction.
- 360-degree (combined anterior + posterior) fusion - for severe instability. (Gray's Anatomy for Students, p. 103)

7. Vertebroplasty and Kyphoplasty

Minimally invasive, image-guided injection of bone cement (methyl methacrylate) into a fractured vertebral body.

Indication: painful osteoporotic or malignant (tumor-infiltrated) vertebral compression fractures, mainly thoracolumbar.
Vertebroplasty: cement stabilizes the fracture and reduces pain (heat of setting cement disrupts pain fibers).
Kyphoplasty: balloon inflated first to restore some vertebral height before cement injection. (Gray's Anatomy for Students, p. 90-91)

8. Scoliosis / Deformity Correction Surgery

Surgical straightening and fusion of the spine for progressive curvature (idiopathic, congenital, neuromuscular, or degenerative adult scoliosis).

Posterior instrumented fusion with pedicle screws/rods is most common; anterior release/fusion sometimes added for rigid curves.
Intra-operative neuromonitoring (SSEPs +/- motor evoked potentials) is used throughout to detect cord traction/ischemia during curve correction, since anterior spinal artery (motor tracts) and posterior spinal arteries (sensory/dorsal columns) have separate blood supplies. (Gray's Anatomy for Students, p. 91; Miller's Anesthesia, 10th ed.)

9. Osteotomy for Kyphotic Deformity (e.g., ankylosing spondylitis)

Wedge osteotomy (opening-wedge, closing-wedge, or polysegmental) of the lumbar spine to correct fixed kyphosis and restore forward gaze/posture in ankylosed spines; neurologic complication rate is low (2-4%) but real given the rigid, osteoporotic bone. (Rheumatology, 2-Volume Set, 2022, p. spinal surgery section)

10. Spinal Cord/Intraspinal Tumor Surgery

Resection of intramedullary, intradural-extramedullary, or extradural tumors via laminectomy/laminotomy for surgical access; goal is maximal safe resection with cord/root preservation, often under intra-operative neuromonitoring. (Bradley and Daroff's Neurology in Clinical Practice)

Quick comparison table

Surgery	Main Target	Bone Removed	Fusion Needed?
Discectomy	Herniated disc	Minimal (fenestration)	Usually no (yes if ACDF)
Laminectomy	Central canal stenosis	Lamina +/- facets	Sometimes
Laminoplasty	Cervical myelopathy	Hinged, not removed	No
Foraminotomy	Foraminal nerve compression	Minimal	No
Corpectomy	Vertebral body pathology	Entire body	Yes (reconstruction)
Spinal fusion	Instability/deformity	Variable	Yes (by definition)
Vertebro-/kyphoplasty	Compression fracture pain	None (cement injection)	No
Scoliosis correction	Curve deformity	Variable	Yes

A recent literature check (meta-analyses/systematic reviews, last 2 years) did not surface findings that contradict these standard descriptions - current research in this space is mostly comparative-outcomes data (e.g., minimally invasive vs open techniques) rather than changes to the fundamental procedures themselves.

Let me know if you'd like me to go deeper into any one procedure (e.g., step-by-step operative technique, complications, or recovery/rehab specifics).

This is a shared conversation. Sign in to Orris to start your own chat.