Procedures we offer:
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What is Prone Transpsoas Lateral Interbody Fusion (PTP LIF)?
Dr. NaPier is a nationally renowned expert on PTP LIF having presented at national meetings and published his own outcomes in peer reviewed journals. He remains at the forefront of the field, lecturing on innovative techniques and working with equipment manufacturers to design the safest and most effective surgical equipment.
Click here to see if you are a candidate!
Click here to watch a demonstration of Dr. NaPier performing PTP LIF!
Click here to watch Dr. NaPier lecturing on PTP LIF at Seattle Science Foundation!
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What is Anterior Cervical Discectomy and Fusion (ACDF)?
Overview:
Anterior Cervical Discectomy and Fusion (ACDF) is a very common minimally invasive surgical procedure that Dr. NaPier performs to treat nerve root and spinal cord compression and to stabilize the bones in the neck. This surgery was first described in 1958, and it remains a gold standard operation for most degenerative pathology in the cervical spine because it is very reliable and safe.
Patients who experience the following symptoms may benefit from ACDF surgery:
Severe pain, numbness, or tingling that radiates from the neck into the shoulder, arms, or hands
Upper extremity weakness
Severe neck pain
Gait imbalance (wobbly gait) or hand dysfunction
Cervicogenic headaches
Procedure:
The procedure involves making a small, cosmetic incision in the neck and moving the throat to the side in order to expose the front of the spine. The worn-out disc is removed along with any disc fragments or bone spurs that may be causing pressure on the nerves or spinal cord. A metal cage is inserted into the disc space in order to stabilize the arthritic joints between bones and allow the injured nerves to heal.
Recovery:
This procedure is usually performed in an ambulatory surgery center with the patient going home the same day or the following morning. For multi-level or larger cases the patient may spend 1-2 nights in the hospital. Most patients have significant relief of symptoms within the first several weeks of surgery.
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Artificial disc replacement is a minimally invasive surgical procedure Dr. NaPier performs to treat nerve root and spinal cord compression. Artificial disc replacement is a safe and extremely well-studied surgical procedure.
Patients who experience the following symptoms may benefit from ADR surgery:
Severe pain, numbness, or tingling that radiates from the neck into the shoulder, arms or hands
Severe neck pain
Upper extremity weakness
Gait imbalance (wobbly gait) or hand dysfunction
Procedure:
The procedure involves making a small, cosmetic incision in the neck and moving the throat to the side in order to expose the front of the spine. The worn-out disc is removed along with any disc fragments or bone spurs that may be causing pressure on the nerves or spinal cord. The disc is then replaced with an arthroplasty device that mimics the natural motion of the disc. This is very similar to a hip or knee replacement in that the arthroplasty device preserves motion between the two bones it connects. Patients who have severe arthritis in the facet joints in the back of their spines or significant spinal instability are not good candidates for disc arthroplasty.
Recovery:
This procedure is usually performed in an ambulatory surgery center with the patient going home the same day or the following morning. Most patients have significant relief of symptoms within the first several weeks of surgery.
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Laminectomy/Laminotomy/Microdiscectomy/Foraminotomy
Lumbar decompression surgery is a very common surgery that relieves pressure on nerve roots caused by disc herniations, bone spurs, or arthritis of the spine. There are many different names for this surgery depending on the exact area location and cause of nerve compression within the spinal canal.
Procedure:
Typically this surgery is performed in a minimally invasive fashion in which Dr. NaPier will make a small incision and utilize microsurgical techniques to drill away bone spurs and remove herniated disc material in order to clean out the spinal canal. The major principle is to do the smallest surgery possible in order to achieve the goal of neurologic decompression in order to allow for faster recovery and less post-operative pain. Patients who experience the following symptoms may be a candidate for lumbar decompression surgery:
Neurogenic Claudication (pain, numbness, tingling, heaviness or weakness of the legs that is worse when standing and relieved by sitting down or leaning forward on a shopping cart)
Pain, numbness, or weakness that shoots down the legs to the thigh, calf, or foot
Foot drop or leg weakness
This surgery is typically performed on an outpatient basis in an ambulatory surgery center for one to two-level cases, with the patient going home a few hours after surgery. Multi-level surgeries may be performed in a hospital with a 1-2 night stay.
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What is Lumbar Microdiscectomy with Annular Closure (Barricaid)?
Lumbar disc herniations are the most common cause of sciatica, especially in working age patients. Dr. NaPier performs a high volume of outpatient microdiscectomy surgeries with excellent results. The biggest problem with microdiscectomy surgery is recurrent disc herniation, which can occur in 7-15% of patients. In this case the gelatinous material inside of the disc (nucleus pulposus) reherniates through a defect in the fibrous crust of the disc space (annulus pulposus). Barricaid is an annular closure device that cuts the rate of reherniation in half. It also may allow earlier return to work in the case of work related injuries and sport in the case of athletes. If you have sciatica, contact Dr. NaPier’s team today to see if you are a candidate for microdiscectomy with Barricaid.
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What is Anterior Lumbar Interbody Fusion (ALIF)?
Anterior Lumbar Interbody Fusion is a minimally invasive fusion technique that powerfully corrects spinal nerve root compression, instability, and deformity caused by degeneration or slippage of lumbar discs.
Patients who experience the following symptoms may be a candidate for ALIF surgery:
Pain, numbness, or weakness that shoots down the legs to the thigh, calf, or foot
Foot drop or leg weakness
Pitched forward posture or inability to stand for long periods of time
Severe lower back pain
Persistent or recurrent pain after lumbar fusion surgery
Persistent or recurrent pain after lumbar laminectomy or microdiscectomy
Dr. NaPier performs these surgeries together with an experienced general surgeon in order to maximize safety and precision. The general surgeon makes a small transverse incision in the abdomen and exposes the front of the spine. Dr. NaPier then removes the degenerated or worn disc and replaces it with a large titanium cage that provides immediate stability. This large cage also corrects spinal alignment and opens up collapsed nerve root tunnels like a car jack is utilized to change a tire.
ALIF provides powerful indirect decompression by opening up a collapsed nerve root and taking pressure off of nerves that are compressed by collapsed nerve tunnels due to disc degeneration or a slipped disc.
Many patients go home the day after ALIF surgery. Because of the wide range of uses of the ALIF, some patients will stay in the hospital longer depending on what other procedures the ALIF is combined with. Some patients who undergo isolated ALIF surgery may go home the same day. A very high level of function is possible after ALIF surgery. Tiger Woods won the Masters golf tournament in 2019 at age 43, two years after L5-S1 ALIF surgery.
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Lateral Lumbar Interbody Fusion is another minimally invasive fusion technique with a broad range of applications. This technique was first described in 2006 and has been refined to treat many degenerative pathologies of the thoracolumbar spine. This surgery is remarkable in that it allows Dr. NaPier to perform a spinal fusion surgery without disrupting the important stabilizing muscles of the lumbar spine which leads to faster recovery and less postoperative pain.
Patients who experience the following symptoms may benefit from LLIF:
Pain, numbness, or weakness that shoots down the legs to the thigh, calf, or foot
Foot drop or leg weakness
Pitched forward posture or inability to stand for long periods of time
Severe lower back pain
Persistent or recurrent pain after lumbar fusion surgery
Persistent or recurrent pain after lumbar laminectomy or microdiscectomy
Dr. NaPier makes a small incision in the patient’s side and uses electrical monitoring of nerve signals in order to navigate a safe passageway through the fibers of the psoas muscle to the side of the lumbar spine. The degenerated, arthritic disc is removed and replaced with a large footprint porous titanium cage that provides immediate stability. This cage can also correct spinal alignment and open up collapsed nerve root tunnels.
Many patients will go home the day after a single-level LLIF surgery. Because of the wide range of uses of the LLIF, some patients will stay in the hospital longer depending on what other procedures are performed with the LLIF.
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Transforaminal lumbar interbody fusion is another minimally invasive fusion technique that can be performed through a traditional posterior approach. This surgery is advantageous when nerve or blood vessel anatomy prohibits a safe lateral or anterior approach or when direct removal of posterior bone spurs or synovial cysts is required.
Patients who experience the following symptoms may benefit from TLIF:
Pain, numbness, or weakness that shoots down the legs to the thigh, calf, or foot
Foot drop or leg weakness
Pitched forward posture or inability to stand for long periods of time
Severe lower back pain
Persistent or recurrent pain after lumbar fusion surgery
Persistent or recurrent pain after lumbar laminectomy or microdiscectomy
Dr. NaPier will either make a midline or two small paraspinal incisions and remove bone spurs and the posterior facet joint in order to access the disc space. Nerves are carefully retracted to the side and the degenerated disc is removed and replaced with a titanium cage. This cage is supported by pedicle screw fixation.
Many patients will go home the day after a single level TLIF surgery. Because of the wide range of uses of the TLIF, some patients will stay in the hospital longer depending on what other procedures are performed with the TLIF.
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In a balanced spine, the head rests directly over the pelvis, which rests directly over the feet. A patient with a balanced spine is able to remain balanced and stand upright with minimal effort. Unfortunately as we age discs collapse and tilt resulting in a posture that is pitched forward (sagittal imbalance) and sideways (degenerative scoliosis). These conditions are broadly referred to as adult spinal deformity. Many times adult spinal deformity is the result of age related degeneration of the spine, but frequently spinal deformities are caused by prior spine surgeries that did not restore balance to the spine.
The more pitched forward a patient’s posture is, the more disabled he or she becomes. Recent studies have demonstrated that Adult Spinal Deformity has a similar impact on physical function to cancer, diabetes, heart disease, and rheumatoid arthritis. Initially, patients may be able to compensate for spinal imbalance by rotating their buttocks underneath their pelvis, extending their hips, or bending their knees, but ultimately patients will develop fatigue in this inefficient posture. The goal of spinal deformity surgery is to reduce pain and improve function by restoring balance to the spine.
Patients who experience the following symptoms may benefit from Spinal Deformity Correction:
A feeling of pitched forward posture
Severe fatigue or lower back pain and inability to stand upright for long periods of time
Persistent or recurrent pain after lumbar fusion surgery
Persistent or recurrent pain after lumbar laminectomy or microdiscectomy
Pain, numbness, or weakness that shoots down the legs to the thigh, calf, or foot
Pain that is present when standing and goes away when lying down
Foot drop or leg weakness
Dr. NaPier is trained extensively in both traditional, posterior based spinal deformity correction including spinal osteotomies as well as minimally invasive deformity correction utilizing anterior column reconstruction.
In accordance with his practice philosophy, Dr. NaPier will attempt to treat your symptoms nonoperatively. If you are unable to achieve acceptable pain control or physical function with nonoperative treatment, then he will try to implement the least invasive surgical solution possible to help you achieve your goals.
Spinal deformity correction surgeries are typically performed in a hospital setting with one to two days of surgery and a 3-5 day hospital stay.
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Posterior cervical fusion is a technique that is utilized to stabilize the bones in the cervical spine. This is usually used in conjunction with a decompressive laminectomy in patients with cervical myelopathy or spinal cord dysfunction due to multilevel spinal cord compression. This is a traditional surgical technique that is reserved for cases in which a minimally invasive solution is not available. This compression is usually caused by age related degeneration or trauma.
Patients who experience the following symptoms may benefit from Posterior Cervical Decompression and Fusion:
Gait imbalance (wobbly gait)
Hand dysfunction (difficulty with handwriting or buttoning shirt)
A feeling of a pitched forward neck or inability to maintain a level gaze
Persistent pain or pitched forward posture after cervical spine surgery
Severe neck pain with or without radiation to the arms, shoulders, and/or hands
Posterior cervical fusion involves making a midline incision in the back of the neck and using microsurgical technique to relieve pressure on the spinal cord and spinal nerve roots. The unstable, arthritic, or deformed bones are then stabilized with screws and rods until they fuse into a single mass of bone.
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What is Minimally Invasive Posterior Cervical Fusion (MIS PCF)?
Percutaneous or Minimally Invasive Posterior Spinal Fusion is a minimally invasive technique in which spinal fusion and nerve root decompression can be achieved at single or multiple levels with only a one-centimeter incision and minimal disruption to the neck muscles and paraspinal tissues.
Patients who experience the following symptoms may benefit from MIS PCF:
Neck pain radiating to shoulders, arms, and/or hands
Neck or arm pain after prior ACDF surgery due to failure of fusion or breakdown at the adjacent level
Neck or arm pain with a history of difficulty swallowing or prior anterior cervical surgery
Neck or arm pain requiring 3 or more level anterior cervical discectomy and fusion
The surgery is performed through two, 1 cm incisions on each side of the back of the neck. Dr. NaPier uses biplanar fluoroscopy to safely implant fusion cages into the facet joints of the affected level or levels. These cages provide immediate stability and also decompress nerves by increasing the height of collapsed nerve tunnels.
Many patients will go home several hours after a single-level MIS PCF surgery. Because of the wide range of uses of the MIS PCF, some patients will stay in the hospital overnight or for multiple nights depending on what other procedures were combined with the MIS PCF.
Dr. NaPier has been performing MIS PCF safely and effectively since 2019 and frequently teaches other surgeon this technique.
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Cervical Laminoplasty is a motion sparing procedure that treats cervical myelopathy or spinal cord dysfunction by relieving spinal cord compression while preserving spinal motion and avoiding fusion. This surgery is especially effective in patients with congenital stenosis of the cervical spine.
Patients who experience the following symptoms may benefit from Cervical Laminoplasty:
Gait imbalance (wobbly gait)
Hand dysfunction (difficulty with handwriting or buttoning shirt)
Neck pain radiating to shoulders, arm, and/or hands
Dr. NaPier will make a midline incision and perform a limited dissection of cervical paraspinal muscles to expose the cervical lamina. He will then drill a trough in one side of the lamina with a high-speed burr and hinge open the lamina like an open door. This door is permanently held open with a small fragment plate.
This surgery is typically performed in an inpatient setting with a 1-2 day hospitalization. Patients are encouraged to move their necks immediately postoperatively and do not wear a hard cervical collar.
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The Sacroiliac joint is the largest joint in the body and provides the important connection between the spine and the pelvis. Sacroiliac joint dysfunction is present in up to 30% of patients with chronic lower back pain and up to 43% of patients with new onset or continued pain after lumbar fusion. SI Fusion is a minimally invasive surgical technique that treats pain due to sacroiliac joint dysfunction by stabilizing the sacroiliac joint.
Patients who experience the following symptoms may benefit from SI Fusion:
Severe lower back pain
Persistent lower back pain after lumbar fusion surgery
Lower back pain radiating to the hip or groin that improves temporarily with SI Joint injection
Lower back pain radiating to the hip or groin
Pain when rising from a seated to a standing position
A feeling of clicking or locking of the back and hip
Pain with prolonged sitting
Dr. NaPier will make a small one-inch incision and utilize fluoroscopy to place three triangular porous titanium implants across your SI Joint to provide immediate stability and allow your own bone to grow through the implant and fuse the joint, eliminating any painful inflammation associated with the movement of the joint. This surgery is usually performed on an outpatient basis at an ambulatory surgery center, with the patient going home a few hours after surgery.
Please click here for a procedural illustration of SI Fusion
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There are many reasons why a patient may experience persistent or worsening symptoms after spine surgery. This does not necessarily mean that the prior surgery was a failure.
Pain after spinal fusion surgery can be caused by:
Pseudarthrosis or fusion failure: persistent motion or fusion failure. The goal of any spinal fusion surgery is to obtain a solid bridge of bone (fusion) between adjacent bones. When a solid bridge of bones does not form the patient may experience a reoccurrence or worsening of preoperative symptoms after an initial period of relief.
Flatback Syndrome or Sagittal Imbalance: suboptimal alignment resulting in painful postural compensations and inability to stand upright for long periods of time.
Post laminectomy syndrome: Initial relief of nerve pain due to decompression of overgrown ligament and bone spurs with eventual return of symptoms, usually due to collapse and or slip of vertebrae (spondylolisthesis)
Dr. NaPier has extensive training and experience in the diagnosis and treatment of persistent pain after spine surgery, failed back syndrome,pseudarthrosis, flatback deformity and sagittal imbalance.
This is a complex evaluation where Dr. NaPier will listen to your concerns, perform a physical examination to assess the function of your spine and nerves. Dr. NaPier will then review imaging studies including Xray, CT, MRI and sometimes SPECT scan. Dr. NaPier will then work with you to develop a customized treatment plan.
Revision spine surgery is often more complex than primary spine surgery and Dr. NaPier will discuss the risks and benefits extensively with you before recommending revision spine surgery. In certain cases, minimally invasive revision spine surgery may allow for faster recovery and less post operative pain.