Spine Surgery

Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and prevents any movement between the fused vertebrae.

Cervical Spine Disorders – Surgery And Treatment

Cervical Spine Disorders:
Cervical Spine Disc Bulge
Cervical Spine Disc ProtrusionCervical spine disorders are a problem for many adults. The cervical spine contains many different anatomic structures, including muscles, bones, ligaments, and joints. Each of these structures has nerve endings that can detect painful problems when they occur.

 

Posterior Microdiscectomy for cervical spine:
This procedure is performed through a vertical incision in the posterior (back) of your neck, generally in the middle. This approach may be considered for a large soft disc herniation that is located on the side of the spinal cord. A high speed burr is used to remove some of the facet joint, and the nerve root is identified under the facet joint. The nerve root needs to be gently moved to the side to free up the disc herniation.

Posterior Cervical Laminectomy for Cervical Spine:
This procedure requires a small incision in the middle of the neck to remove bone spur formations or disc material. The foramen, the passage in the vertebrae of the spine through which the spinal nerve roots travel is enlarged, to allow the nerves to pass through.

Surgeon will remove a section of the lamina (the back bony part of the vertebrae) and ligament to find the exact area of the compression. An operating microscope is used to create an opening, and part of the lamina is removed to take pressure off the nerves and spinal cord. If needed, bone spurs, tissue and any disc fragments causing the compression are also removed.

Anterior Cervical Disectomy for Cervical Spine:
This operation is performed on the neck to relieve pressure on one or more nerve roots, or on the spinal cord.The Cervical Spine is reached through a small incision in the anterior (front) of your neck. If only one disc is to be removed, it will typically be a small horizontal incision in the crease of the skin. If the operation is more extensive, it may require a slanted or longer incision. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed. The space left between the vertebrae may be left open or filled with a small piece of bone through spinal fusion.

Anterior Cervical Corpectomy for cervical spine:
This operation is performed in conjunction with the anterior cervical disectomy. The corpectomy is often done for multi-level cervical stenosis with spinal cord compression caused by bone spur formations. In this procedure, the neurosurgeon removes a part of the vertebral body to relieve pressure on the spinal cord. One or more vertebral bodies may be removed including the adjoining discs. The incision is generally larger. The space between the vertebrae is filled using a small piece of bone through spinal fusion. Because more bone is removed, the recovery process for the fusion to heal and the neck to become stable is generally longer than with anterior cervical discectomy. Surgeon may select to use a metal plate that is screwed into the front of the vertebra to help the healing process.

Cervical Artificial Disc Replacement surgery:
This procedure allows us to decompress the nerves in your neck without compromising your ability to move your neck. Traditionally, orthopaedic surgeons treat neck pain caused by pressure on the nerves and spinal cord with fusion surgery, which unites affected vertebrae into one solid bone. This resolves pain, but replaces it with neck stiffness. Cervical artificial replacement not only resolves your pain, it preserves your neck range of motion. This unique motion-sparing technique also allows you to return to your normal activities faster and with fewer post-operative safety measures.

Spine Rehabilitation treatment:
Spinal rehabilitation is the discipline of medicine that guides the physical, psychological, and social recovery of individuals who have become partially or totally disabled because of spinal disease or injury. Because the muscles and joints of the spine are not easily observed, the need for rehabilitation from spinal disorders has been recognized slowly and rehabilitation gains have been more difficult to measure by objective standards. Manual or manipulative therapy may be effective for the treatment of pain and restoration of movement in the short term, but it has not been shown to be effective in the long term.

Lumbar Spinal Surgery

1. Lumbar stenosis
Lumbar spinal stenosis is a condition caused by narrowing of the spinal canal. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord.

2. Main Causes
Herniated discs / Disc Bulge / Disc Protrusion – As the discs in the back deteriorate they can herniate, meaning the disc swells, bulges, or ruptures. When this occurs some of the disc material can protrude into the spinal canal. A herniated disc, while painful, doesn’t always cause lumbar spinal stenosis.

Spondylolisthesis – Refers to the forward slippage of one vertebra over another in the spine. This can cause narrowing of the spinal canal and result in pinching of the nerves. Learn more about spondylolisthesis. Slip Disc – When a spinal disc moves from its place due to injury or sudden shock

3. Other Causes:

  1.  Back injuries – Can both cause spinal stenosis or can worsen already existing low-level symptoms.
  2.  Tumor growth – Can narrow the spinal canal, but the occurrence of spinal tumors is rare.
  3.  Bone spurs – As cartilage deteriorates between the joints of the back, small bone growths, called bone spurs, or osteophytes, can develop. Bone spurs sometimes develop due to arthritis in the spine.
  4.  Changes to ligaments – Changes can occur, especially to the ligamentum flavum, the ligament that runs along the inside of the spinal canal. This ligament can become thickened, taking up more space in the spinal canal. Or, as deteriorating discs lose some of their height, this ligament can buckle.
  5.  Enlarged facet joints – Enlargement of the facet joints in the spine can also cause narrowing of the spinal canal.

 

Lumber Spine Surgery /Treatment:

  1.  Laminectomy Spine Surgery : This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a “decompression.” Laminectomy is a surgical procedure to remove a portion of the vertebral bone called the lamina.
  2.  Microscopic Decompression of the nerve roots : Spinal/microscopic decompression is a surgical procedure performed to relieve pressure and alleviate pain caused by the impingement of bone and/or disc material on the spinal cord or nerves. This will be done using minimally invasive spine surgery.
  3.  Decompression and Spine fusion surgery : Here pressure over nerves is released with the help of microscope. Disc is excised and is replaced. Pedicle screws and rods are attached to the back of the vertebra and an interbody fusion spacer is inserted into the disc space from one side of the spine. The surgery is known as TLIF/ Spinal fusion surgery.
  4.  Spinal fusion Surgery : If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended. Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
  5.  Steroid injections for Spine Treatment : Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the “epidural space” can decrease swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness but not weakness of the legs.

Spinal Cord Injury

Spinal Cord Injury
The spinal cord is very sensitive to injury. Unlike other parts of your body, the spinal cord does not have the ability to repair itself if it is damaged. A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection.

Types of Injuries
Complete: If almost all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury.
Incomplete: If you have some motor or sensory function below the affected area.

CERVICAL (NECK) INJURIES
When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body. The symptoms may occur on one or both sides of the body. Symptoms can also include breathing difficulties from paralysis of the breathing muscles, if the injury is high up in the neck.

Cervical Herniated Disc
This type of cervical spine injury happens when the soft spinal discs bulge or rupture out of the spinal canal and put pressure on nearby nerve roots or the spinal cord. The culprit is usually some type of sudden force. Cervical Disc Degeneration

Over time, wear and tear on the cervical spine can injure it and cause the discs in the cervical spine to degenerate. The degeneration process can be exacerbated by a fall or twisting injury to the neck.

THORACIC (CHEST LEVEL) INJURIES
When spinal injuries occur at chest level, symptoms can affect the legs. Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.

Rib brushing/fracture
This injury is very common in contact sports such as football and rugby. It most commonly occurs as a result of a blow to the ribs.

Scheuermann’s disease (Osteochondrisis)
This is the most common cause of pain in the thoracic spine in adolescents, especially boys. It is a hereditary back disease in which the back becomes rounded due to the bodies of the vertebrae becoming wedged shaped.

Scoliosis (Curvature of the spine) This is a curvature of the spine in a sideways direction which causes the spine to be S-shaped. Symptoms with scoliosis are not always present. Symptoms include complications due to muscle weakness and joint “looseness” on the convex side and muscle tightness and spasm with joint tightness on the concave side.

LUMBAR SACRAL (LOWER BACK) INJURY
When spinal injuries occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder.

Non-specific Low Back Pain (NSLBP) Low back pain can be caused by structures being too tight (hypo-mobility) or too loose (hyper-mobility). The pain producing structures in the lumbar spine include the vertebra, the facet joints (links two vertebra together in your spinal column), intervertebral disc, ligaments, nerves and their protective coverings, muscles and their attachments.

Intervertebral Disc Degeneration / Sciatica
The intervertebral discs are composed of a soft, inner nucleus pulposus surrounded by a tough fibrous outer ring, the annulus fibrosus. With trauma and / or ageing, the annulus fibrosus can weaken and thin (disc degeneration or herniation), particularly with the repetitive combination of bending forwards while rotating the trunk i.e. lifting.

Spinal Canal Stenosis
Another commonly encountered cause of Lower Back Pain is spinal canal stenosis. It is a condition that is rare in young and middle-aged athlete’s, but may be seen occasionally in older athletes. The condition is caused by arthritic degeneration of the spine, resulting in the vertebra, facet joints, and ligaments which surround the spinal nerves of the spinal cord to become enlarged. In this manner, these structures may compress one or several spinal nerves, causing LBP, leg pain, and leg numbness while walking.

Signs and Symptoms:

  1.  Loss of movement
  2.  Loss of sensation, including the ability to feel heat, cold and touch
  3.  Loss of bowel or bladder control
  4.  Exaggerated reflex activities or spasms
  5.  Changes in sexual function, sexual sensitivity and fertility
  6.  Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
  7.  Difficulty breathing, coughing or clearing secretions from your lungs
  8.  Extreme back pain or pressure in your neck, head or back
  9.  Weakness, incoordination or paralysis in any part of your body
  10.  Numbness, tingling or loss of sensation in your hands, fingers, feet or toes
  11.  Loss of bladder or bowel control
  12.  Difficulty with balance and walking
  13.  Impaired breathing after injury
  14.  An oddly positioned or twisted neck or back

Treatment:
Spinal Decompression Surgery
Spinal decompression surgery is a general term that refers to various procedures intended to relieve symptoms caused by pressure, or compression, on the spinal cord and/or nerve roots. Bulging or collapsed disks, thickened joints, loosened ligaments and bony growths can narrow the spinal canal and the spinal nerve openings (foramen), causing irritation.

Discectomy
Discectomy is a surgery to remove all or part of a cushion that helps protect your spinal column. These cushions, called disks, separate your spinal bones (vertebrae).

Minimally invasive spine surgery
Minimally invasive spine surgery uses very small surgical incisions (often less than one inch) and specially designed surgical tools to treat spinal disorders. Because minimally invasive surgery is performed through small tubes, there is little disruption of normal structures. This reduces postoperative pain, speeds recovery, and leads to shortened hospital stays. Many minimally invasive spine procedures can be performed on an outpatient basis.

Foraminotomy Foraminotomy is a surgery that widens the opening in your back where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).

Spinal Fusion
Spinal fusion is a surgery to join together two bones (vertebrae) in the spine. Fusion permanently joins two bones together so there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.

Vertebroplasty
Vertebroplasty is performed by a radiologist, without surgery, and involves inserting a glue-like material into the center of the collapsed spinal vertebra to stabilize and strengthen the crushed bone. The material is inserted through anesthetized skin with a needle and syringe, entering the midportion of the vertebra under the guidance of specialized X-ray equipment. Once inserted, the material hardens to form a cast-like structure within the broken bone. Relief of pain comes quickly from this casting effect, and the newly hardened vertebra is then protected from further collapse.

Rehabilitation
The rehabilitation process following a spinal cord injury typically begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals typically work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition.