Dr. Peter Andrew Rozman, MD

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.

To determine if spinal cord stimulation may benefit someone, they will first undergo a trial period. During this period, a temporary electrode lead is placed subcutaneously above the spinal cord, and it is connected to an external stimulator that they will carry with them. The procedure is typically completed within an hour, and patients may return home the same day. After a few days or weeks, the trial stimulator will be assessed for effectiveness. If the trial is unsuccessful, patients may undergo a second trial period, or the leads will be removed, and other treatment options will be considered. If, instead, a patient's pain is relieved during the trial, they will undergo surgery for implantation of a permanent stimulator and leads.

The components of a spinal cord stimulation system include the stimulator, the leads, and the wire that connects the two. Implantation of permanent leads may be percutaneous (through the skin) or involve a surgical incision. The spinal cord stimulator is implanted subcutaneously in the abdomen or buttock. The stimulator is battery-powered and may be rechargeable. If the battery is not rechargeable, it will last around 2-5 years, and a patient will need surgery to replace it.Their doctor will program the neurostimulator following the procedure.

After spinal cord stimulator surgery, patients may be released from the hospital the same day or the next one. In the weeks following the operation, patients will need to work with their doctors to find the optimal settings for their neurostimulator. Activities such as driving, twisting, bending, raising one's arms, sleeping on one's stomach, or lifting heavy objects should be limited.

There are several different types of spinal fusion surgery available, mostly depending on where a patient's pain is located and whether his or her surgeon will perform the procedure through the back, front, or side. In general, a fusion is performed by packing the vertebrae to be fused with grafted bone. This bone may be taken from the patient's hip, may be donated from a cadaver, or it may be a manufactured synthetic material. The bone is placed along the vertebrae, and sometimes, the disc that lies in between the vertebrae is removed and replaced with grafted bone. The bone material will grow and cement the two vertebrae together. After the bone graft is placed, the vertebrae are sometimes held in place with rods, screws, plates, or cages, depending on the weakness of the spine and needs of the graft.

Spinal fusion is a significant surgery and can take three to four hours or more. Recovery is typically two to four days in the hospital. After surgery, it is important to remember that the fusion takes time to grow from the bone graft. So, the actual fusion is not complete for several months. Patients will probably feel somewhat better right away, but it may take a while to feel the full effects of the fusion as the bone grows into place. In the meantime, doctors might have patients wear a brace to protect their spine and keep it properly aligned.

Spinal fusion is not used for all kinds of back pain. Changing the way the spine moves can lead to strain on the other joints in the back, and fusion is only performed when the benefits outweigh the risks. Some spine disorders that are treated with fusion include:

• Curvature disorders, such as scoliosis and kyphosis
• Degenerative disc disease
• Spondylolisthesis, a disorder that causes vertebrae to slip over each other
• Significant spinal fractures that cause instability
• Weakened spine due to infection or tumor
• Some cases of spinal stenosis, a narrowing of the spinal column
• Chronic lower back pain (although the use of fusion to treat this is controversial)

Regardless of the diagnosis, there is always a possibility of 'failure' with spinal fusion, or of the surgery not fully solving the pain. This is more likely when fusion is used primarily to treat pain instead of structural problems. Patients can improve their chances of a successful outcome by stopping smoking, maintaining a healthy weight, moving their body every day, and following their doctor's instructions for any physical therapy that they are prescribed.