Different Types of Spine Surgery

A non-surgical approach to manage nerve root pain with spinal injection is offered to patients who are not responding to medical treatment. It is a Daycare or OPD procedure done under local anesthesia In C-Arm guidance. The involved nerve is desensitized with steroid and local anesthetic agent is used to block the source of pain. The procedure is relatively risk free with no side effects.

Minimally Invasive Spine Surgery (Minimal Access Surgery)

Minimally invasive spine surgery aim is to limit the skin incision and muscle injury during surgery Precision planning allows a seamless, targeted surgery. This is done using precision tools such as microscopes and endoscopes the magnification. effect of these tools allows to protect neuralogical structures and minimises complications. The patient is mobile within 24-hours post the surgery Technological advancements (3D C-arm/ Neuro-navigation/ robotics) allow ease of implant (screw) placement while protecting the vital structures. This has significantly improved the outcome of spine surgery and improved patients confidence.

Slip/Prolapsed Disc

Slip disc represents compression of the spinal nerve, caused by a herniated intervertebral disc. The patient may complain of radicular pain and/or numbness and muscle weakness may ensue. A Microscopic discectomy surgery aims to free the compressed nerve via 20 mm mini-incision. This key-hole procedure provides instant relief of patient's symptoms. Patients are typically discharged on the same or next day.

Lumbar Canal Stenosis

A condition associated with narrowing of the space for nerves in lumbar spine due to degenerative changes. The patient complains of pain and/or heaviness in legs while walking a few steps (Claudication) and requires to sit/stand to get relief of symptoms. The symptoms progress over time. The degree of disability worsens as the walking standing time reduces with time Surgery entails microscopic decompression Instrumentation is decided as per instability.

Lumbar Spondylolisthesis

It is a condition in which one vertebra slips over the other in forward (antero-listhesis) or backward (retrolisthesis) forward. The spinal nerves are compressed due to this malalignment of spinal vertebrae. A fusion surgery re-aligns the spine with the help of screws and rods to decompress the nerves. A minimal invasive technique allows the patient to resume his/her routine daily activities within 24 hours. The normal mobility functions recover soon after. 

Cervical Surgery (Decompression/Fusion Motion Preserving Surgery)

Cervical nerves can get compressed due to variety of causes such as Herniated Disc, Injury, Degenerative Stenosis, Infection and Ossified Ligament The patient complains of severe or intractable disabling pain A progressive weakness in the hand and legs (Myelopathy) that eventually causes paralysis is common. Surgery from the front (anterior approach) involves removal of the offending disc This is replaced with a fusion device (cage/plate) or select cases a mobile device (Disc Replacement). When many levels in the neck are involved the surgery is done from behind (posterior approach A laminectomy the gold standard procedure.

Spine Infection (TB)

Spine is the next common site of TB infection after lungs (Chest). The commonest presentation is disabling pain. This is treated early with anti-tuberculosis medications. If treatment is delayed, a progressive destruction of the spine can result in instability, deformity (bending) and paralysis (weakness of spinal cord). The surgery then aims at decompression of the spinal cord and complex reconstruction of the spinal column with rods, screws and inter-body cage.

Scoliosis

The scoliosis is a sideway (Coronal) curvature of the spine, while Kyphosis is a forward bending (Sagittal Plane) of the spine. Most deformities are seen during growth spurt before puberty (Idiopathic). Non-idopathic curves (Congenital/Syndromic/Neuromuscular) can present at early age and progress rapidly.

Curves less than 60 degrees are a cosmetic problem due to unacceptable shape of the trunk (rib hump). Mechanical fatigue pain and breathlessness due to pressure on the heart and lungs can occur when curves are more than 60 degrees.

Conservative treatment with bracing is reserved for mild curves or early onset curves. Surgical correction aims to correct the deformity and create a more pleasing shape of the trunk by reducing the rib hump. A careful counselling of the child and the parents is of paramount importance. Neuro-monitoring is used to monitor the spinal cord function during surgical correction. This has helped to reduce the incidence of spinal cord injury. Advanced radiological (30 C-Arm) and computerised navigation technologies help to accurately position the screws on a deformed spine.

Also Read About scoliosis and Hip Replacement

Tumour

Primary spine tumors (originating in the spine) are rare. Most common types are giant cell tumor, aneurysmal bone cyst, chordoma, osteoid osteoma and osteoblastoma. The surgery for primary tumor aims at resection when possible. This is combined with adjuvant therapy (Chemotherapy/Radiotherapy) Secondary tumors (Metastasis) originate in some other site. Common sites are Prostate, Thyroid, Breast, Lungs, Kidneys, GI tract and Uterus. Surgical treatment for spinal metastasis aims at palliation of pain, decompression of spinal cord to prevent paralysis and instrumentation for instability of the spinal column. A team approach including Medical Oncologist, Radiotherapist & Spine Surgical Team would require for planning the treatment as per the tumour type.

Atlanto-Axial (C1-C2) or Occiput Cervical Surgery

The upper part of the neck that supports the head called as a Cranio-Vertebral Junction. It controls the head movements. The critical nerves and blood vessels to the brain pass through this complex. Injury to the spinal cord due to instability of the joints commonly occurs at C1 and C2 joints (Atlantoaxial Dislocation) A progressive paralysis ensues Stability can be restored by surgery. The C1-C2 or Occiput-Cervical Fixation is the procedure of choice. It is done from the back side of the neck with due care to safeguard the vital nerves and blood vessels.

Traumatic Fracture

Vehicular accidents and work place injuries constitute most of the spine fractures. A fall from a height can result in one or more injuries to the spine together with other limbs and other organs. The spinal injury becomes serious when the fractured bone compresses the spinal nerves causing pain and paralysis. The aim of surgery is to restore the spine stability and shape, decompress the nerves and start early rehabilitation This helps in early return to activity Modern physiotherapy techniques are important in achieving these goals.

Osteoporotic Fracture

Reduction in bone mass occurs with age. When severe, it results in fractures after a trivial exertion or injury. Most osteoporotic fractures heal with rest, bracing and medications. When the healing is delayed, these fractures can collapse further causing prolonged pain and even paralysis due to compression of nerves.

In complicated fractures, a Vertebroplasty or Kyphoplasty (Cement Injection) significantly controls pain and allows early restoration of function. This is vital in frail and elderly patients to avoid medical complications due to pain and bed rest. When the nerves are compressed. a complex spine reconstruction procedure is performed as per merit. A significant advancement is the use of minimally invasive surgery to achieve these goals in these frail patients.

Biopsy

Introduction of a 5-6 mm diameter needle in to the spine to acquire a bone or soft tissue sample using fluoroscopy is called biopsy. This provides a diagnosis (Infection/Tumour) to plan correct treatment strategy. Spinal biopsy is done as a day care procedure under local anaesthesia through a suture less technique.

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