At CPNI we have developed a comprehensive program for the treatment of patients with symptomatic cervical, thoracic, and lumbar disc disease, degenerative spondylosis, and spinal stenosis. The program focuses on proper initial diagnosis and a comprehensive treatment program beginning with conservative measures, including physical therapy, medications such as anti-inflammatories, and when appropriate, therapeutic epidural injections of corticosteroids. When these measures are inadequate to resolve the patient’s complaints, or when neurological deficits do not resolve or progress, we rely upon minimally invasive spinal surgery for the vast majority of patients. Such procedures are often performed on an outpatient basis, with patients returning home the same day. For lumbar surgery, spinal-block is often preferred to the use of general anesthesia when clinically appropriate.

Cervical Disc Disease

For patients presenting with cervical disc disease and spondylosis causing radiculopathy, minimally invasive posterior microdiscectomy and foraminotomy are usually the technique of choice. When an anterior discectomy and fusion are necessary, the patient remains hospitalized overnight for airway observation. If cervical radiculomyelopathy is present, more extensive surgeries are chosen, by either an anterior or posterior approach as indicated, and intraoperative neurophysiological monitoring is often employed to enhance the safety of the procedure.

For thoracolumbar surgery, such as disc herniations and spinal stenosis, minimally-invasive techniques generally avoid complete laminectomy, with preservation of the stabilizing facets and interspinous ligaments. For example, bilateral lumbar decompression via a unilateral hemilaminectomy approach is a mainstay technique, which minimizes muscular retraction, pain, blood loss, and instability, while maximizing the decompression. Such methods are appropriate for many patients regardless of age, and often allow for the same-day discharge home, early mobilization, and minimal morbidity. Since 2004 we have increasingly used mini-open transforaminal lumbar interbody fusion to decompress and stabilize selected patients with instability or spondylolisthesis. Here, too, intraoperative neurophysiological monitoring is used to enhance surgical safety.

Rehabilitation

Following all of these surgical interventions, comprehensive physical therapy and rehabilitation are coordinated with our team of physical medicine and rehabilitation specialists, using our new rehabilitation gym and state-of-the-art Archibald/Ehrenberg Rehabilitation Terrain Park at California Pacific’s Davies Campus.