Discectomy is one of the more common surgical procedures used to
remove pressure on a
nerve root or the spinal cord from a bulging, herniated disc or bone
spur. During the
procedure the surgeon takes out a small piece of the lamina (the
arched bony roof of the
spinal canal) to remove the obstruction below. It can also be called
These procedures are usually performed in a hospital using general
anesthesia, but may
be performed in an outpatient surgical center in some cases.
Anterior Cervical Disectomy
Dr. Berti may use an anterior cervical discectomy to treat damaged
cervical discs, which may put pressure on nerve roots or the spinal
cord. It is called anterior because the cervical spine is reached
through a small incision in the front of the neck (anterior means
A posterior microdiscectomy is a minimally-invasive procedure used to
relieve pressure on a nerve caused by a herniated disc. Dr. Berti will
use a magnifying instrument to view the disc and nerves, allowing him
to remove the disc matter through a smaller incision, reducing the
damage to the surrounding tissue. It is called posterior due to the
through the back of the patient's body. A microdiscectomy is usually
performed on an outpatient basis.
Many diseases and lifestyle habits cause compression of the spinal
cord. A corpectomy is an invasive surgical procedure that removes a
portion of the vertebra and adjacent intervertebral discs in order to
decompress the cervical spinal cord and nerves. A bone graft with or
without a metal plate and screws is used to reconstruct the spine and
provide stability. It is often performed in association with some form
Anterior Cervical Corpectomy
In instances of severe cervical disease, such as when it
encompasses more than just the
disc space, Dr. Berti may recommend an anterior cervical corpectomy.
involves removing the whole vertebral body as well as the disc spaces
at either end to
completely decompress the cervical canal. This procedure is often
performed for multi-level cervical stenosis with spinal cord
compression caused by bone spur (also known as osteophytes) growth.
This is called anterior because the cervical spine is reached through
the front of the neck. The approach is similar to a discectomy
(anterior approach), although a larger and more vertical incision in
the neck will often be used to allow more extensive exposure.
Laminectomy and laminotomy are open surgeries performed to relieve
pressure on the spinal cord and/or spinal nerve roots by removing all
or part of the lamina. The lamina is the thin part of the bones that
make up the spine (vertebrae ), which forms a protective arch over the
spinal cord. A laminotomy removes a part of the lamina to make a
larger opening to relieve pressure; a laminectomy removes all of the
lamina on select vertebrae and may also remove thickened ligament
tissue. They are typically performed under general anesthesia.
Different terms are used to describe the laminectomy or laminotomy
depending on where in the body they are performed. For example, in the
neck, the term used is cervical laminectomy or laminotomy. The
choice of procedure depends on the location and severity of the spinal
requires treatment. Reducing pressure on the nerve roots often can
relieve leg or arm pain and allow resumption of normal daily
activities. Laminectomies and laminotomies are often performed in the
course of a number of operations on the spinal canal, such as removal
of a ruptured disc.
A lumbar laminectomy is used to relieve pressure on the lumbar spinal
cord or spinal nerve by widening the spinal canal. A small section of
the bony roof of the spine, the lamina, is removed to create more
space for the nerves. A surgeon may perform a lumbar laminectomy with
or without fusing vertebrae or removing part of a disc. It is also
known as open decompression.
Posterior Cervical Laminectomy
This surgical procedure is used to remove the pressure on the
spinal cord by opening the spinal canal from the back of the cervical
spine to make the spinal canal larger.
Facetectomy is an invasive surgical procedure that is performed to
relieve pressure on spinal nerves. The procedure involves exposing the
affected vertebra and removing one or both of the articulating facet
joints that are rubbing against the nerve. Sometimes a laminotomy is
performed in conjunction with a facetectomy. Most patients are given a
general anesthetic for the procedure.
Foraminotomy is an operation that widens or enlarges the opening or
foramen where a nerve root exits the spinal canal. Bulging,
herniated discs or joints thickened with age can cause narrowing of
the space through which the spinal nerve exits and can press on the
nerve, resulting in pain, numbness, and weakness in an arm or leg.
Small pieces of bone over the nerve are removed through a small slit,
allowing the surgeon to cut away the blockage and relieve the pressure
on the nerve. This may performed on any level of the spine, and most
patients undergo the procedure with general anesthesia.
Spinal fusion is an invasive surgical procedure used to strengthen
the spine, treat spinal instability, and prevent painful movements.
Spinal fusion is usually performed at the end of other surgical
procedures for the spine, such as discectomy, laminectomy, and
The spinal discs between two or more vertebrae are removed and the
adjacent vertebrae are “fused” together by bone grafts and/or metal
devices secured by screws. The patient's bones will grow over the
graft. Spinal fusion may result in some loss of flexibility in the
spine and requires a long recovery period to allow the bone grafts to
grow and fuse the vertebrae together.
Spinal disc replacement
Spinal disc replacement surgery is also called as “total disc
replacement, inter vertebral disc arthroplasty or, artificial disc
replacement”. In this procedure, intervertebral degenerated discs in
the spine are replaced with artificial (plastic or metal) discs in the
upper or lower spine. This procedure is used to treat severe, chronic
lumbar pain and cervical pain that resulted from degenerative disc
disorder. It allows more motion in the spine than some spine fusion
surgeries, and may prevent the breaking down of premature adjacent
spine levels. Not everyone is eligible for this procedure.
Minimally Invasive Spine Surgery
Dr. Berti is one of few neurosurgeons who specializes in
minimally-invasive spine surgery (MIS). Minimally-invasive procedures
take place through one or more short incisions, as opposed to
conventional, open surgery's deeper and longer cuts. These smaller
incisions lead to less post-operative pain, quicker recovery, less
blood loss, and shorter hospital stays.
Typically, in MIS, Dr. Berti inserts an endoscope through a small
incision into the area to be worked on. An endoscope is a long, thin
tube with a lighted camera on its tip. Dr. Berti can then monitor the
surgical site on a high-definition monitor. MIS requires specially
designed instruments, which are placed through the small incisions
made earlier. Not every patient is eligible for this procedure.
Pain management (Epidural steroid injections, Facet Blocks)
Dr. Berti explores all possible conservative, non-surgical procedures
to treat back pain before recommending surgery. His goal is to provide
safe pain relief for his patients. He offers epidural steroid
injections and facet blocks among others. These injections are used in
conjunction with a thorough physical therapy plan. These injections
are temporary solutions, effective from one week up to one year, that
help the patient with acute episodes of pain or with progressing in
their rehabilitation program.
Steroid injections are used in the cervical (neck), thoracic
(mid-spine), and lumbar (lower back) regions, and can also treat
radicular pain such as sciatica. The steroidal injection delivers
medication directly or very near to the source of pain, while also
avoiding the side effects caused by oral steroids. Injecting these
steroids directly can noticeably decrease the inflammation associated
with spinal stenosis, hernias, and degenerative disc disease, and is
thought to also flush out inflammatory proteins. The most commonly
performed injection is an epidural steroid injection.
Facet joints are two hinge-like joints of the spine that link
vertebrae together. They are located on the back of the spine. A facet
block or facet joint injection is a surgical procedure that involves
injecting a time-release steroid medication into the facet joint to
reduce inflammation, under imaging guidance. The facet block is
designed to relieve pain so that a patient can tolerate physical
therapy, and to diagnose the cause and location of the back pain.
Vertebroplasty and Kyphoplasty:
Vertebroplasty is one of the minimally-invasive procedures Dr.
Berti uses to strengthen and stabilize a spinal fracture, and relieve
pain caused by that fracture. The procedure is performed with the
patient sedated (either under general anesthesia or a local anesthetic
with intravenous sedation). The doctor will inject a specially
formulated acrylic bone cement into the diseased vertebra under x-ray
guidance. Vertebroplasty generally takes about one hour to perform per
Kyphoplasty is a newer, minimally-invasive procedure performed on
patients with compression fractures of the spine. The procedure is
similar to vertebroplasty, but adds one step before the cement is
injected into the vertebra. The patient is anesthetized, the bone is
drilled, and one balloon (called a bone tamp) is inserted into each
side of the vertebra. The two balloons are inflated with a contrast
medium and expanded until the desired height is reached, and then
removed. The spaces created by the balloons are filled with cement.
This procedure can restore height to the spine and can reverse
deformity of the spine. It works best on recent compression fractures.
A ventriculoperitoneal shunt is a surgery performed to relieve
increased inctracranial pressure caused by hydrocephalus. A shunt
system consists of the shunt, a catheter, and a valve. One end of the
catheter is placed within a ventricle inside the brain, or in the CSF
outside the spinal cord. The other end is usually placed within the
peritoneal cavity, or wherever the physician decides to place it for
CSF reabsorption. A shunt is a flexible and sturdy plastic tube.The
valve is located along the catheter and should regulate and maintain a
one-way CSF flow. This procedure is performed in an operating room
under general anesthesia.
A craniotomy is a cut that opens the skull (cranium). This
surgical procedure is used by neurosurgeons for a variety of
neurological conditions and diseases, including brain tumors,
arteriovenous malformations, swelling of the brain, and skull
fractures, and is often a first step in other complex procedures. A
craniotomy is performed under general anesthesia.
Stereotactic biopsy is a minimally-invasive procedure used to
remove a small amount of tissue from a tumor site. The tissue will be
examined by a pathologist under a microscope to diagnose the tumor. A
stereotactic biopsy is performed for deeper tumors in critical
locations with the use of a titanium stereotactic headframe and a
computer, which are used to create a reference for all imaging and
scants to a coordinate system, allowing for a precise approach. The
procedure generally takes around 1 1/2 hours.
In microsurgery, surgeons view the minute structures within the
body they operate on through a compound operating microscope.
Neurosurgeons can operate on delicate nerves, treat vascular
abnormalities, and tumors precisely with miniaturized instruments.
Stereotactic Radiosurgery (Gamma Knife, Cyberknife, LINAC)
Stereotactic radiosurgery (SRS) is an alternative to open-skull
brain surgery, spine surgery or microsurgery, offering significantly
fewer complications and lower risk than open surgery. It is an
advanced form of radiation therapy, focusing high-powered x-rays or
gamma rays onto a small area in contrast to traditional radiation
Stereotactic radiosurgery uses sophisticated 3-D computerized imaging
to precisely target and deliver narrow, highly concentrated doses of
radiation to the affected tissue. It is most commonly used in the
treatment of brain or spinal tumors and brain metastases from other
cancer types, and is generally restricted treating only small tumors
with well-defined edges. It is not considered a surgical procedure
because there is no incision involved, and no general anesthesia is
Radiation therapy requires a multi-disciplinary approach. The team of
treatment specialists may include a radiation oncologist, a
neurosurgeon, a medical radiation physicist, a dosimetrist, a
radiation therapist or radiation therapy nurse, and a neuro-oncologist,
among others. As your neurosurgeon, Dr. Berti will oversee the
treatment process and interpret the results of the procedure with the
There are many types of radiation therapy. Dr. Berti specializes in
Gamma Knife and CyberKnife.
Gamma Knife is a stereotactic radiosurgical treatment that safely
delivers a single, large dose of gamma radiation to the targeted brain
tumor or affected tissues in the brain with precision. The radiation
kills the cancer cells at a molecular level by disrupting its DNA,
thus interfering with the tumor's ability to survive.
Gamma Knife requires the use of a stereotactic, 3-D reference frame
which is attached to the patient's head. This frame provides a
reference which can be seen on the imaging equipment, which can
provide exact coordinates for the target. This frame keeps the
patient's skull perfectly still for further accuracy.
Approximately 201 sources of Cobalt-60are available in the Gamma Knife
treatment unit. Thousands of radiation beams can be generated from the
sources with a level of accuracy of more than 0.5 mm, or the thickness
of one strand of hair. An individual radiation beam is too weak to
damage tissue on its path to the target. The accurate intersecting of
all the beams on the target results in radiation sufficient to treat
the targeted area. A full dose of radiation can be delivered during a
single session. Lesions from 5 to 40 mm can be treated. This is an
outpatient procedure that takes roughly 30 minutes.
The CyberKnife Robotic Radiosurgery system is a safe, non-invasive
treatment alternative to conventional surgery for both benign and
malignant tumors throughout the whole body, including the spine and
brain. There is no incision, no blood, and it, too, is an outpatient
procedure. The treatment accurately delivers high doses of radiation
to tumors. The radiation kills the cancer cells at a molecular level
by disrupting its DNA, thus interfering with the tumor's ability to
survive. The precisely targeted beams destroy tumors painlessly,
without incisions, and spare the surrounding healthy tissue.
The CyberKnife uses a compact, lightweight linear accelarator (LINAC)
mounted on a robotic arm to deliver as many as 1,400 highly pinpointed
beams of radiation to control or destroy the tumor in conjunction with
a sophisticated Synchrony Respiratory Tracking System to monitor the
movement of the tumor and the patient's breathing pattern, helping the
surgeon maintain tighter control in real time and sparing even more
healthy tissue. This procedure should last from 30 to 90 minutes. The
patient may need to come back if the treatment is being delivered in
Microvascular decompression (MVD) is a surgical procedure Dr.
Berti employs to relieve abnormal compressions of cranial nerves for
some patients with trigeminal neuralgia when medication to provide
relief to patients does not work or causes serious side effects. MVD
is performed to relieve symptoms caused by the compression of a nerve
by an artery or a vein. When performing an MVD, your doctor will
perform a craniotomy, and insert a tiny surgical sponge between the
compressing blood vessel and the nerve, isolating the trigeminal nerve
from the pulsating effect and pressure of the blood vessel. It
requires general anesthesia.
Percutaneous stereotactic rhizotomy:
Percutaneous steretotactic rhizotomy (PSR) is an alternative,
minimally-invasive outpatient procedure performed to relieve the pain
caused by trigeminal neuralgia, glossopharyngeal neuralgia, and
cluster headaches. PSR involves the surgeon passing an electrode
inducer (hollow needle), into the selected nerve at the base of the
skull. A heating current passed through the electrode destroys a
portion of the nerve fibers- not the entire nerve- alleviating the
pain, but potentially resulting in facial numbness.
Percutaneous glycerol rhizotomy:
Percutaneous glycerol rhizotomy is a procedure performed under
local anesthesia. The doctor will insert a needle through your cheek
into a natural opening at the base of your skull (foramen ovale). The
needle will be maneuvered to the space surrounding the trigeminal
ganglion, where the trigeminal nerve divides into three branches, and
part of its root. Images are taken to confirm the proper placement of
the needle, and then the sterile chemical glycerol is injected. This
injures the nerve mildly, with minimal risk of permanent damage or
facial paralysis. This treatment will produce relief for a majority of
patients, but some may have a recurrence of pain later on.
Percutaneous balloon compression:
Another option for pain control, the percutaneous balloon
compression procedure is performed while the patient is under general
anesthesia. A needle is inserted into a small opening at the base of
the skull. This needle is threaded with a special small catheter with
an inflatable balloon attached at the end. The balloon is inflated
with enough pressure to compress and injure the trigeminal nerve root.
Balloon compression is a successful treatment for most people, and
lasts for some time. Some patients experience facial numbness. Many
patients develop weakness in the chewing muscles, at least
Motor cortex stimulation:
Dr. Berti may suggest using motor cortex stimulation (MCS) to
trigeminal neuralgia for a select group of patients. The patient
selection process includes a number of factors, assessing
cardiovascular risk, the patient's likelihood of positive outcomes
with the surgery, previous treatments, and mental health, among
MCS requires implanting electrodes over the primary motor cortex. One
or more electrodes are placed outside the dura (the outermost layer of
the meninges surrounding the brain and the spinal cord) over the motor
cortex via a small craniotomy or burr hole. These electrodes are
connected to an implanted, battery-powered neurostimulator. The
patient adjusts the electrical impulses with an external radio
transmitter to alleviate pain.