SPINE SURGERY

Back pain is one of the most common problems in our population. It affects all age groups starting from school children to old people. The reason behind this problem may be improper body mechanism, trauma, injuries to the spine, aging etc. It can also be the symptom of pressure on the nerves in the spine or to any part of the back. Most of the issues of back pain can be cured by proper medications, physical therapies and non-surgical treatments. When these kinds of treatments do not help you from back pain, surgery may be indicated. Some common conditions affecting the back are

  • Slipping of the disc called Disc Prolapse.
  • A curvature of the spine called Scoliosis.
  • A humpback deformity called Kyphosis.
  • The forward slippage of a segment of the spine called Spondylolisthesis.
  • Degenerative disc diseases
  • Because of a herniated disk, the irritation and inflammation of a nerve called Radioculopathy.
  • Narrowing of the spinal canal, called Spinal Stenosis.
  • Fractures of the vertebra caused due to injury.
  • Infections like Tuberculosis damaging the bones.

A variety of surgeries are performed depending on the injury to the spine. Some of them are

Discectomy
Foramenotomy
Laminectomy
Spinal Fusion
Disc Replacement
Vertebroplasty/ Kyphoplasty

Discectomy

This surgery is done in order to remove herniated disc material which press on the spinal cord or on a nerve root. It can be done open (Open Discectomy) or using a special microscope (Microscopic discectomy).

Indications:

Surgery is suggested when the patients have:

  • Very bad leg pain, weakness and numbness of the feet.
  • Leg symptoms do not get better after at least 4 weeks of nonsurgical treatment.
  • Results of a physical exam show that you have weakness, loss of motion, or abnormal feeling that is likely to get better after surgery

Surgery is considered an emergency if you have caudaequina syndrome. Signs include:

  • • loss of bowel or bladder control.
  • • weakness in the legs (usually both legs).
  • • numbness or tingling in the buttocks, genital area, or legs (usually both legs).
Surgery:

Under general anaesthesia, the herniated part of the disc that is pressing on the nerves is removed. Any loose fragments of the disc can also be removed during the surgery. The normal surgical time is about 1 to 1 ½ hours.

Post-surgery:

After the surgery, the patients usually have complete pain relief in the affected leg. Numbness and weakness take more time to recover. The patients are made to walk on the 1st day after surgery and are discharged on the 2nd day.

Complications:

Everything has its positive and negative side. Likewise, the discectomy surgery may not always be rewarding. There is a slight chance of getting the spine or nerves damaged. Another possible risk is with anesthesia. There can be risks of infection too.


FORAMENOTOMY

This is a decompression surgery which is done in order to expand the canal where the spinal nerve root exits the spinal canal. The term “foramenotomy” has been originated from the medical terms “foramen” and “otomy”. The term “foramen” means “passageway” and the term “otomy” means “to open”. It is done to the people who have a narrow nerve opening (foraminal stenosis). It takes off the pressure in the spinal column. It helps the spine to move flexibly. It can be performed on any level of the spine.

A set of nerves leaves the spinal cord through the openings in the spinal column. These openings are known as neural foramena. When this opening becomes too narrow, it will put pressure on the nerve. This is called foraminal spinal stenosis. The foramenotomy is performed when you have severe symptoms like:

  • Deep pain in the thigh, back, calf, lower back, shoulder, arms or hands. Usually, the pain will be steady and deep.
  • Pain while doing certain activities or when moving the body in different ways.
  • Muscle weakness, tingling, and numbness.

If you come across any of these symptoms, you will have to consult a doctor. The doctor may suggest you to have an MRI. It can diagnose your problem and can find whether the symptoms in you are caused by foraminal stenosis. Symptoms of foraminal stenosis worsens overtime slowly.

Surgery:

In this surgery, the surgeon shaves away some parts of the bone to open the foramen (nerve root opening). If there are any disk fragments, it will also be removed during this process. After the surgery, the surgeon may do a spinal fusion to make sure the stability of the spinal column is not compromised.

Post-surgery:

After the surgery, the patient is advised to wear protective brace and mobilize with support. Most probably, the patient can leave the hospital on the 2nd day of surgery. He/She will be able to do light physical activities after four weeks.

The surgery can relieve the symptoms to an extent. But, the patient may develop spine problems in the future.

Complications:

The surgery possesses certain risks too. They are:

  • Infections
  • Bleeding
  • May not relieve the symptoms
  • Damage to a spinal nerve
  • The problem may return back in the future


LAMINECTOMY

The surgical procedure to remove a portion of the vertebral bone (lamina) is known as laminectomy. It is also done in order to remove the bone spurs in the spine. It is minimally invasive, because it requires only small skin incisions. The procedure can take pressure off your spinal cord or spinal nerves. Usually, laminectomy is done as a treatment to the condition called spinal stenosis. Bones and damaged disks are removed during this procedure to provide space for the spinal nerve and column. The doctor may suggest laminectomy for you if you have symptoms such as:

  • Numbness or pain in the one or both legs
  • Heaviness or weakness in the legs or buttocks
  • Problems while controlling or emptying the bowel or bladder
  • Symptoms will be more visible or worse while you stand or walk

In order to diagnose the problem, the doctor may suggest tests such as MRI or CT. It will help the doctor to confirm if you have spinal stenosis or not. The doctor will recommend you for laminectomy if you have spinal stenosis. You will have to prepare mentally and physically for the surgery. For that, you may have to omit certain habits that can affect the surgery negatively. As a result, you will have to stop smoking, if you are a smoker. You may also have to stop taking some of your regular medicines. For this, you may also have to consult your regular doctor.

Surgery:

The surgery procedure starts with general anesthesia. After making incisions, the muscles, ligaments and skin are moved to side. The surgeon will look inside your back by using a microscope. He/she will remove a part or all of the lamina bones on one or both sides of the spine. Small disk fragments, other soft tissues or bone spurs will be removed after that. The surgeon may also do foramenotomy during the surgery, in order to widen the opening where the nerve roots exit from the spine. A spinal fusion may also be done in order to ensure the stability of the spinal column after the surgery. The surgery may take about one to three hours.

Post-surgery:

After the surgery, the patient is advised to wear protective brace and mobilize with support. Most probably, the patient can leave the hospital on the 2nd day of surgery. He/She will be able to do light physical activities after four weeks.

The surgery can relieve the symptoms to an extent. But, the patient may develop spine problems in the future.

Complications:

The surgery possesses certain risks too. They are:

  • Infection
  • Bleeding
  • May not relieve the symptoms
  • Damage to a spinal nerve
  • The problem may return back in the future


SPINAL FUSION

Spinal fusion (spondylodesis or spondylosyndesis) is the surgical method of joining two or more verebrae. It is done most commonly in the lumbar region of the spine, but it is also used to treat cervical and thoracic problems. In this procedure, the damaged and painful vertebrae are fused into a solid stable bone. Fusion of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the faulty vertebrae themselves, which is usually caused by degenerative conditions. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically scoliosis and kyphosis. But, the results may vary according to the individual. Some may not feel any improvement in their back pain even after the surgery.

Your doctor will decide whether you need the surgery after conducting a few tests. It may include imaging tests such as X-rays, MRIs and CTs.

Types:

  • Anterior lumbar interbody fusion (ALIF)- the disc is accessed from an anterior abdominal incision
  • Posterior lumbar interbody fusion (PLIF) – the disc is accessed from a posterior incision
  • Transforaminal lumbar interbody fusion (TLIF) – the disc is accessed from a posterior incision on one side of the spine
  • Transpsoasinterbody fusion (DLIF or XLIF) – the disc is accessed from an incision through the psoas muscle on one side of the spine

In order to diagnose the problem, the doctor may suggest tests such as MRI or CT. It will help the doctor to confirm if you have spinal stenosis or not. The doctor will recommend you for laminectomy if you have spinal stenosis. You will have to prepare mentally and physically for the surgery. For that, you may have to omit certain habits that can affect the surgery negatively. As a result, you will have to stop smoking, if you are a smoker. You may also have to stop taking some of your regular medicines. For this, you may also have to consult your regular doctor.

Surgery:

In this procedure, the vertebrae that need to be fused are exposed by the desired approach; the intervertebral gaps are fitted with a cage and filled with bone graft which enables fusion of the bones.

Post-surgery:

The patient may have to stay in the hospital for two to four days. During the first few weeks after the surgery, the doctor may suggest basic exercises such as routine walking with protective brace and stretching exercises. The patient will also be suggested to avoid hyperextension activities. Recovery may take weeks to months. Some of the studies say that the spinal fusion surgery may not completely relieve the pain.

Complications:

The surgery possesses certain risks too. They are:

  • Infections
  • Bleeding
  • May not relieve the symptoms
  • Damage to a spinal nerve
  • Non union
  • Reduced spine movement


DISC REPLACEMENT

Disc replacement is a surgical procedure in which degenerated intervertebral discs in the spine are replaced with artificial devices. They are performed in the lumbar (lower) or cervical (upper) spine. This procedure is used to treat chronic, severe neck and low back pain resulting from degenerative disc disease. It has been developed as an alternative to spinal fusion, with the goal of pain reduction or elimination, while still allowing motion throughout the spine. Another possible benefit is the prevention of premature breakdown in adjacent levels of the spine, a potential risk in fusion surgeries.


VERTEBROPLASTY/ KYPHOPLASTY

Vertebroplasty and kyphoplasty are similar spinal procedures in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. It was found to be effective in treating osteoporosis-related compression fractures of the spine. Evidence does not support a benefit of kyphoplasty over vertebroplasty with respect to pain, but the procedures may differ in restoring lost vertebral height. It is usually performed by a spine surgeon or interventional radiologist. It is a minimally invasive procedure and patients usually go home the same or next day of the procedure.

Indications:

  • Wedge compression fractures
  • Osteoporotic spine fractures
  • Benign or malignant tumor: hemangioma, multiple myeloma, metastatic lesion
  • Osteonecrosis
Surgery:

It is usually done under general anaesthesia but can it can also be done under local anaesthesia in medically unfit patients. In vertebroplasty, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra under fluoroscopic x-ray guidance. The injected bone cement quickly hardens and forms a support structure within the vertebra that provide stabilization and strength. The needle makes a small puncture in the patient’s skin that is easily covered with a small bandage after the procedure.

Kyphoplasty is a variation of a vertebroplasty which attempts to restore the height and angle of kyphosis of a fractured vertebra followed by its stabilization using injected bone cement. The procedure typically includes the use of a small balloon that is inflated in the vertebral body to create a void within the bone prior to cement delivery. Once the void is created, the procedure continues in a similar manner as a vertebroplasty, but the bone cement is typically delivered directly into the newly created void.

Post Surgery:

You will usually only need to stay in the hospital for a few hours. You may need to stay longer if you have pain. You will be made to walk on the next day of surgery with protective brace.

Complications:

The surgery possesses certain risks too. They are:

  • Minimal pain
  • Cement leakage
  • Decreased blood pressure
  • Infection