Spine Surgery

The fellowship-trained back and neck surgeon, Dr. Michael Dolphin at Orthopaedic Specialists, utilizes his specialized training to bring minimally invasive surgical options and top notch spine care to patients of southeast Iowa. Dr. Dolphin oversees the treatment of spinal disorders, with an emphasis on degenerative conditions, As the only spine surgeon in the Quad Cities offering outpatient back and neck surgery, performed at Mississippi Valley Surgery Center, Dr. Dolphin utilizes minimally invasive surgical procedures to reduce overall recovery time and scarring, allowing you to get back to your everyday routine as quickly as possible.

Working cohesively with Plaza Physical Therapy, Dr. Dolphin has developed a core strength exercise program for patients to continue their therapy while at home. Orthopaedic Specialist’s physical therapists are highly trained and experienced and work hand in hand with the surgeons to ensure the most appropriate and effective rehabilitation for patients. Therapy can improve many back and neck symptoms with exercise and stretching programs custom-tailored to your specific needs and injury. Physical therapy can be vital after surgical procedures, as well, to ensure the best possible results and continued improvement of your condition.

Lower Back and Neck Conditions
One of the most common health complaints in the United States is low back and neck pain. It is estimated that approximately 80% of the population will experience some sort of back or neck pain in their life, which in many cases, means an interruption of daily activities and living. Back and neck pain can be a symptom of many different causes, some acute and some chronic.

At Orthopaedic Specialists’ Back and Neck Center, they understand that back and neck injuries can cause major change in a patient’s life. Using physical therapy and medications, Dr. Dolphin is able to treat many back and neck problems conservatively. They believe strongly in the body’s ability to heal itself. This thought process branches from Dr. Michael Dolphin’s training as an osteopathic physician, which leads to our emphasis on exercise, nutrition and strengthening as the first step in treating lower back and neck symptoms. If these non-surgical methods prove ineffective, Dr. Dolphin is able to treat many back and neck symptoms with minimally invasive surgical options, many of which are able to be performed on an outpatient basis.


Herniated/Ruptured Disc

Lower Back Symptoms:

  • Electric type shooting pain that radiates down one or both legs
  • Weakness in one or both legs
  • Numbness and tingling in one or both legs
  • Loss of bowel or bladder control (which can in most cases be a sign of something more serious and should be evaluated immediately)

Neck Symptoms:

  • Electric type shooting pain that radiates down one or both arms
  • Weakness in one or both arms
  • Numbness and tingling in one or both arms
  • Burning that radiates to the neck, shoulder, shoulder blade or arm

What is a Bulging/Herniated/Ruptured Disc?

A herniated (sometimes referred to as ruptured) disc occurs when the spinal disc, which is the cushion between the vertebrae, bulges outside its regular position. As a result, a nerve(s) can become pinched, sending pain down a leg or arm. The condition can occur suddenly from trauma or over time from repetitive stress on the spine. There are also several conditions that can weaken the spinal discs such as smoking and being overweight.

 

 

 

 

 
Non-surgical Treatments

  • Anti-inflammatories
  • Oral medications can be used to reduce inflammation, thereby improving pain. By reducing pain, the hope is to allow patients to resume a more normal lifestyle while natural healing is given time to occur.
  • Physical therapy
  • Our team of spine physical therapists are trained to promote pain relief and educate the patient on techniques to reduce re-injury.
  • Epidural Steroid Injections (ESI)
  • Injections of an anesthetic along with a steroid medication. They can be used for both diagnostic and therapeutic reasons in the spine. Dr. Dolphin reviews every patients’ physical exam and imaging studies to determine the type of epidural steroid injection that will offer the patient the most relief.
Surgical Treatments

Minimally Invasive Microdiscectomy
Dr. Michael Dolphin performs minimally invasive outpatient microdiscectomy, which is designed to relieve pain from a disc bulge/herniation. This procedure is done for patients that have not responded to conservative treatment methods. The procedure removes the herniated part of the disc material that is pressing on the nerve or the spinal cord, retaining the unaffected disc for continued function. Once the part of the disc that is pinching the nerve is removed, the pain and numbness improve. Dr. Dolphin performs this procedure in lower back utilizing muscle sparing techniques and when indicated, utilizing tubular retractors to minimize tissue injure. His techniques have been perfected over 10 years and result in less damage to the muscles, allowing for a quicker return to normal activities.  Dr. Dolphin also performs a similar procedure for herniated discs in the neck. The patient is positioned in a sitting position and using a muscle sparing approach, the cervical disc herniation is removed. This relieves the pressure on the nerve(s) improving the numbness and radiating pain. The cervical laminoforaminotomy, is a minimally invasive procedure that relieves pain without performing a fusion, thus not causing any issues with decreased neck range of motion.

Posterior Cervical Laminoforaminotomy (Minimally Invasive)
Dr. Dolphin performs the posterior cervical laminoforaminotomy procedure for herniated discs in the neck. The patient is positioned in a sitting position, and utilizing a muscle sparing approach, the cervical disc herniation is removed. This relieves the pressure on the nerve(s) improving the numbness and radiating pain down the arm. The cervical laminoforaminotomy, is a minimally invasive procedure that relieves pain and numbness without performing a fusion. Compared to the cervical fusion, this allows for a completely normal range of motion after surgery as well as less chance for future neck deterioration.  When either a lumbar or cervical microdiscectomy procedure is complete, a few stitches are placed in the incision which is then covered with steri-strips and a water resistant dressing. This allows the patient to shower immediately. Patients can return to non-strenuous work within one to two weeks following surgery. However, more physically demanding professions, usually require 4-6 weeks before returning to full activity.

Anterior Cervical Discectomy with Fusion (Minimally Invasive)
Cervical disc herniations can also be removed through the front of the neck (anterior approach) to alleviate pain, numbness and tingling resulting from nerve root and spinal cord pressure. This procedure is utilized in situations where there is not only a disc herniation, but also arthritis, with bone spurs causing nerve compression. When performing this procedure, stabilization, of the disc space is then performed in the form of a fusion. Typically, a plate and screws made of metal, are inserted to provide immediate spine stabilization while the bone fusion is healing. Dr. Dolphin performs this procedure with a minimally invasive approach, through an incision approximately one inch in length, allowing for a quicker recovery and also the ability to do the procedure on an outpatient basis.


Spinal Stenosis

Low Back Symptoms:

  • Radiating pain or heaviness in the leg(s) with walking or standing
  • Low back pain
  • Numbness and tingling that radiates down the leg(s)

Neck Symptoms:

  • Neck stiffness and pain that becomes worse with activity
  • Weakness or numbness within the arm(s) or hand(s)
  • Pain in the back of head with headaches
  • Difficulty with balance

What is Spinal Stenosis?
Spinal stenosis is when the space within the spinal column narrows. This causes tightness around the nerves traveling within the spinal column. The condition is most common in people over the age of 50. The most common cause is spinal arthritis. As a result of the arthritis, ligaments can thicken and bone spurs can develop. These abnormalities crowd the nerves leading to pain and disability.

 
 

 

 

 
Non-surgical Treatments

While there is no cure for spinal stenosis, in some cases, medication, physical therapy (traction), injections or regular exercise can provide relief to patients. Over the counter medications such as Tylenol, Advil, Motrin or Aleve, may relieve pain. Epidural steroid injections, in many cases, provide a great deal of relief for patients. These may be temporary, but depending on the patients’ medical status and activity level, they may be appropriate.

Surgical Treatments

Laminotomy (Minimally Invasive)
Each vertebrae of the spine consists of a vertebral body on the front side and a bony canal on the back side. In between each of these is a disc. The back part of the spine or the bony canal, houses the spinal cord and nerves. The back side of the canal or “roof” of this canal is referred to as the lamina. Minimally invasive laminotomy involves the removal of a small area of this lamina on either one or both sides of the spinal nerves, to allow for decompression of the nerves. The procedure takes approximately 30 minutes and is done on an outpatient basis. Patients are allowed to return to activity as tolerated is immediately, letting their post-surgical pain guide them.

Laminectomy (Minimally Invasive)
Minimally invasive laminectomy is a surgical procedure that removes the entire lamina, or bony “roof” to the spinal nerves. The goal of this procedure is to alleviate pressure on the nerves. This procedure is one of the most successful procedures, when performed on the appropriate patient. The procedure takes approximately 1 hour. Patients are typically able to go home on the same day of surgery. Because of the minimally invasive approach used by Dr. Dolphin, patients are allowed to return to activity as tolerated, allowing their post-surgical discomfort to guide them.

Anterior Cervical Discectomy with Fusion (Minimally Invasive)
Cervical stenosis can be relieved through the front of the neck (anterior approach) to alleviate pain, numbness and tingling resulting from nerve root and spinal cord pressure. This procedure is utilized in situations where bone spurs are causing nerve compression. Careful surgical technique allows for removal of the bone spurs, relieving the nerve/spinal cord compression. When performing this procedure, stabilization, of the disc space is then performed in the form of a fusion. Typically, a plate and screws made of metal, are inserted to provide immediate spine stabilization while the bone fusion is healing. Dr. Dolphin performs this procedure with a minimally invasive approach, through an incision approximately one inch in length, allowing for a quicker recovery and also the ability to do the procedure on an outpatient basis.

Posterior Cervical Laminoforaminotomy (Minimally Invasive)
Dr. Dolphin performs the posterior cervical laminoforaminotomy procedure for isolated cervical stenosis caused by bone spurs in specific locations of the neck. The patient is positioned in a sitting position, and utilizing a muscle sparing approach, the bone spur is removed. This relieves the pressure on the nerve(s) improving the numbness and radiating pain down the arm. The cervical laminoforaminotomy, is a minimally invasive procedure that relieves pain and numbness without performing a fusion. Compared to the cervical fusion, this allows for a completely normal range of motion after surgery as well as less chance for future neck deterioration.


Spondylolisthesis

Lower Back Symptoms:

  • Pain in the lower back
  • Radiating pain or heaviness in the leg(s) with walking or standing
  • Numbness and tingling that radiates down the leg(s)

What is Spondylolisthesis?
When a vertebra misaligns from the rest of the vertebrae, slipping in front of or behind another vertebra, it is called spondylolisthesis. The condition typically can occur as the result of repetitive trauma, during adolescence, or can occur as a failure for certain parts of the spine to naturally grow together. Spondylolisthesis is easily diagnosed using plain x-ray and is graded based on the percentage of misalignment of the upper vertebra when compared to the vertebra below. If you have a severe grade of the condition, you may begin to walk differently and in more of a waddling manner. For patients that complain of pain, heaviness or numbness in legs, a MRI scan may be ordered to help identify any compressed nerves. If you have spondylolisthesis, it is likely that you have spinal stenosis at the location of your spondylolisthesis.

Non-surgical Treatments

Dr. Dolphin’s first approach to treatment of spondylolisthesis is typically conservative and based on the patient’s severity of symptoms. Rest or avoidance of activities that cause the discomfort, physical therapy, anti-inflammatory medications, or epidural steroid injections, are examples of common non-surgical treatments that Dr. Dolphin prescribes. For patients that fail conservative treatment options, then surgery may be an option, based on the type of spondylolisthesis.

Surgical Treatments

Laminotomy (Minimally Invasive)
Each vertebrae of the spine consists of a vertebral body on the front side and a bony canal on the back side. In between each of these is a disc. The back part of the spine or the bony canal, houses the spinal cord and nerves. The back side of the canal or “roof” of this canal is referred to as the lamina. Minimally invasive laminotomy involves the removal of a small area of this lamina on either one or both sides of the spinal nerves, to allow for decompression of the nerves. This alleviates the spinal stenosis associated with the spondylolisthesis. The procedure takes approximately 30 minutes and is done on an outpatient basis. Patients are allowed to return to activity as tolerated is immediately, letting their post-surgical pain guide them.

Laminectomy (Minimally Invasive)
Minimally invasive laminectomy is a surgical procedure that removes the entire lamina, or bony “roof” to the spinal nerves. The goal of this procedure is to alleviate pressure on the nerves. This procedure may be utilized in the treatment of spinal stenosis associated with spinal stenosis on select cases. The procedure takes approximately 1 hour. Patients are typically able to go home on the same day of surgery. Because of the minimally invasive approach used by Dr. Dolphin, patients are allowed to return to activity as tolerated, allowing their post-surgical discomfort to guide them.

Anterior Lumbar Interbody Fusion-ALIF
ALIF’s are frequently performed to treat several different types of spinal conditions. Including, but not limited to: instability of the spine, degenerated discs, one or more fractured vertebrae or in many cases, spondylolisthesis. Patients who experience low back pain as a result of degeneration, spondylolisthesis or who have not responded positively to non-surgical treatments, are typically good candidates for this procedure. During the procedure, you will be placed on your back and the incision, or approach, is made from the front or anterior of the body. A vascular surgeon aids in accessing the spine, by moving through and around the contents within the abdomen. Once these are protected, the disc space is identified and any remaining part of the disc is removed. The surfaces of the vertebrae on either side of the disc space are then re-aligned and prepared for a fusion. A spacer, filled with a bone graft material, is inserted within the disc space to aid in stabilization of the spondylolisthesis. Over time, the bone graft grows across the disc space and fuses or welds the two vertebrae together. This prevents them from slipping in the future.

eXtreme Lateral Interbody Fusion – XLIF (Minimally Invasive)
The XLIF procedure is another technique that Dr. Dolphin utilizes to stabilize and correct the spondylolisthesis. This procedure is performed through an incision on a patients side, thereby avoiding the contents of the abdomen or disruption of the muscles of the back. This is a truly innovative procedure that Dr. Dolphin has lectured on and provided insight to industry and other physicians learning this technique. It is minimally invasive, requiring a single 1 ½ to 2 inch incision. As a result of the minimally invasive nature of this procedure, patients may be discharged from the hospital the day after surgery.

Transforaminal and Posterior Lumbar Interbody Fusion
TLIF and PLIF procedures have been utilized for over a decade in the treatment of spondylolisthesis and other spine conditions. Dr. Dolphin has years of experience performing these procedures. When the pathology, or anatomy prevents a patient from having a minimally invasive approach, Dr. Dolphin may utilize these techniques to achieve an excellent outcome for the patient.


Michael Dolphin, DO

dolphin_front
Dr. Michael Dolphin is the head of Orthopaedic Specialist’s Spine Center. As the areas only spine surgeon performing outpatient spine surgery, Dr. Dolphin has developed protocols which allow for a rapid recovery and the ability to perform procedures such as microdiscectomy and cervical fusions on an outpatient basis, getting patients back to activity and home quicker with less pain. He has also been an integral part in the development of the spine program at Unity Point hospital in Bettendorf. He is the most experienced XLIF (which is a minimally invasive approach to spinal fusion) provider in the area and his patients are typically home within 24 hours after the procedure. As the leader of the spine center at Orthopaedic Specialists, Dr. Dolphin oversees the treatment of both back and neck disorders, with a particular emphasis on degenerative conditions.

Education and Background:
Dr. Dolphin is a graduate of the University of Albany, State University of New York in Albany, NY. He received his medical degree from New York College of Osteopathic Medicine in Old Westbury, New York and completed an internship at Community General Osteopathic Hospital in Harrisburg, PA. Upon completion of his internship, Dr. Dolphin completed his residency at Memorial Hospital in York, PA and completed his specialization training in spine surgery with Dr. Alan Levin and Dr. Aleksander Curcin during his fellowship at Sinai Hospital in Baltimore, MD.  Dr. Dolphin is Board Certified by American Osteopathic Board of Orthopaedic Surgery.

Dr. Dolphin is a member of the following professional organizations:

  • American Association of Orthopedic Surgeons
  • Iowa Orthopedic Society
  • North American Spine Society
  • Scott County Medical Society
  • American Osteopathic Academy of Orthopedic Surgeons
  • American Osteopathic Society
  • Iowa Osteopathic Medical Association
  • Society of Lateral Access

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