Latest update from our client, Dr. Hepler: Spine Surgeon in Delray Beach – Different types of spinal surgery.

Does back pain stop you from enjoying an active south Florida lifestyle or make it hard to get around or work? Well you’re not alone. The latest studies show that, although we are living longer. We are living with more disability and neck and back pain is now the second most common cause (1, 2). Although many different conditions can cause back and neck pain. The good news is most causes are short lived and manageable if diagnosed and treated properly.

Start with finding the right spine surgeon in Delray Beach

The first and most important step to getting better is making a diagnosis with a trained spine specialist. Dr. Matthew Hepler is a fellowship trained adult and pediatric spine surgeon in Delray Beach with leading expertise in the diagnosis and treatment of spine  conditions. Following a thorough evaluation he can help make a diagnosis and formulate an effective treatment plan to get you back on your feet. Most of the time this can be done with non-operative treatments including a focused exercise regimen. Surgical treatment may give the best result for patients who fail to improve with a non-operative care. In this article, you will find some useful information about different types of spine surgery that are most commonly used in these cases. They include the following:

1. Spinal fusion

Spinal fusion is a procedure during which our spine surgeon in Delray Beachjoins (fuses) two or more vertebrae in the low back. This is usually done for conditions which involve instability or imbalance (fractures, spondylolisthesis, scoliosis, etc) or an unusually painful joint (disc degeneration, spondylosis). There are many different techniques used to facilitate a fusion (ALIF, XLIF, TLIF PLF, pedicle instrumentation, etc) depending on each patient’s unique medical and biomechanical conditions. Spinal fusion procedures are some of the most cost-effective surgical treatments available (Polly Spine 2007) when performed appropriately.

A fusion does, however, permanently restrict motion at the treated level and the surgeon must carefully analyze all variables to ensure a fusion is the best option and is performed in a way to offer the best and most endurable outcome. See our website for some of the fusion procedures that Dr Hepler, a spine surgeon in Delray Beach, Florida, performs.

2.  Laminectomy

All joints wear and tear with time producing “arthritis” as we age. In the back these arthritic changes can narrow the room for the spinal cord and nerves. This narrowing, called stenosis, can impair nerve function just like a clogged pipe decreases water flow. Spinal stenosis is the most common cause of back and leg pain in patients over 60 y.o. and can severely limit activity as it worsens. Early on, spinal stenosis is treated successfully with non-operative treatments, anti-inflammatories, pain medications, epidural injections, and physical therapy. As the stenosis becomes more severe, surgical treatment may be necessary to “unclog the pipe”.

The most effective, timely, and definitive means to treat spinal stenosis is through a laminectomy. The bone spurs and thickened ligaments are removed to relieve pressure on the nerves and resolve pain. This can often be performed with minimally invasive spine surgery and the patient often goes home the same day. A spine fusion may be necessary if significant instability is also present and in fact laminectomy and fusion are often performed together. Our spine surgeon in Delray Beach can help you determine if a laminectomy might be the right option for you.

3. Foraminotomy

The foramen are small openings that nerves pass through as they exit the spine and enter the body. Sometimes disc herniations or bony spurs will pinch the nerves as they pass through these foramina causing stenosis and nerve pain. If nerve pain persists despite non-operative treatment surgical treatment may be necessary. Foraminotomy is a procedure our spine surgeon in Delray Beach may recommend to relieve the nerve compression and pain. This involves removing the disc fragment, thickened ligaments, or bony spurs that compress the nerve thereby opening the space and relieving the nerve compression and pain. A foraminotomy can often be performed through a small 2 cm incision with minimally invasive spine surgery as an outpatient. Laminectomy and spine fusion are often performed in addition to a foraminotomy if there are other areas of stenosis or instability.

4. Kyphoplasty

As the population ages osteoporosis and osteoporotic fractures have become an increasingly common source of back pain and disability. Studies show nearly 1 million vertebral compression fractures occur each year. And are a source of worsening disability and mortality (2). Although many fractures may heal if diagnosed and treated early on many go on to produce worsening pain, kyphosis (hunchback), and increased mortality. Kyphoplasty is a minimally invasive spine surgery that stabilizes the fracture with a strong glue like material (methylmethacralate). This is often done under sedation with two small 4mm incisions and the patient goes home the same day. Patients often experience immediate pain relief, functional improvement, and better survival. Our spine surgeon in Delray Beach may recommend a kyphoplasty procedure to treat your back pain, hunchback (kyphosis), or instability. He can also treat the osteoporosis itself to decrease the risk for future fractures.

5. Disk replacement

A spinal disk is a strong elastic pivot between each vertebra. It makes the spine strong and stable while allowing motion. With time, a disk can weaken and start to cause back pain. In such cases, the doctor may decide that a disk replacement surgery might relieve the pain. During the procedure, the damaged – ‘herniated’ – disk is removed and replaced with an artificial joint. The disc replacement has been shown to decrease pain in properly selected patients while preserving joint motion; this might decrease the risk for later disc degeneration in adjacent spine joints. It is important to talk to our spine surgeon in Delray Beach about your options to determine if disc replacement might be the right surgical option.

6. Minimally Invasive Spine Surgery (MISS)

MISS is an alternative to a standard, open incision surgery. It is considered as effective as traditional “open surgery” with less dissection, blood loss, and operative time. MISS involves making small incisions and accessing the spine through specialized retractors or endoscopes. This can be performed in the front, anterior, part of the spine (XLIF, DLIF) or the back, posterior, part of the spine (TLIF). The advantages of such an approach include less soft tissue trauma, lower blood loss, decreased risk for infection and shorter hospital stays and faster rehabilitation. Dr Hepler, a spine surgeon in Delray Beach, can help you determine if a minimally invasive spine surgery is the right option for your back or neck pain.

Spine Surgeon in Delray Beach

If you are suffering from back pain, don’t hesitate and make an appointment with our spine surgeon in Delray Beach, Dr. Matthew Hepler. To find out more about Dr. Hepler, click here to view his profile. To make an appointment, visit our website or give us a call today – we look forward to seeing you soon!


  1. Global Burden of Disease Study 2015 Lancet. Vol 388, N0 10053, p1459-15444, October 8, 2016.
  2. Hepler M, Berven S, Watkins-Castillo S, et al. Spinal Deformity. The Burden of Musculoskeletal Disease in the US. 2015.


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