Spinal Surgery

Introduction

 

Spinal surgery is used to treat; disc related problems ie disc prolapse, disc degeneration, infection, tumour or deformity. We will nearly always consider surgery as the last option behind the physical therapies, physiotherapy, osteopathy and chiropractic. Non operative pain control or injection techniques such as caudal epidurals and facet joint injections to give a ‘window of opportunity’ to allow further physical therapy are considered next.

The time when spinal surgery is considered before these therapies is when there is a serious pathology such as tumour or infection or when there is serious concern about nerve function such as in cauda equina syndrome.

 

Cervical and Lumbar Disc Replacement Surgery

Conventional spinal fusion surgery that stiffens the spine carries prolonged recovery from work and activities and is associated with adjacent level disc degeneration from added stress to the discs.

 

Cervical and lumbar disc replacement surgery is a relatively new treatment for people who have suffered from degenerative discs causing years of severe and debilitating pain in their spine. In this procedure, the surgeon inserts an artificial disc replacement composed of high-density plastic sandwiched between two metal plates in place of the removed disc in order regain normal motion.Grooved teeth in the plates' outer sides keep the disc in place, as does the natural pressure of the spine. The artificial disc helps the spine maintain its natural flexibility and shock absorption.

 

The procedure reduces midline spinal pain, recovery times and hospital stays is much reduced as compared to fusion and it also allows for the patient to lead an active and productive life due to the maintenance of normal spinal motion with an associated lower rate of additional surgery for degeneration of adjacent disc segments.

The hospital stay for disc replacement surgery is approximately 2 days. Patients can begin rehabilitation and return to daily activities much quicker than with fusion surgery.

 

Minimally Invasive Spine Surgery

 

Minimal access spinal surgery (MASS) or more commonly known as ‘keyhole surgery’ has been developed with the aim of reducing ‘collateral damage’ to muscles, ligaments and soft tissues that is typically associated with traditional open spinal surgery whilst obtaining the same clinical outcomes of traditional open procedures.

The technique has been developed to complement minimal invasive spinal surgery (MISS) as this often does not allow for direct visualisation of the spine. In that regard both of these techniques DO NOT alter the indications or goals of surgery.

 

Depending on the condition being treated, a mini-open exposure reduces the size of the wound to approximately 2 to 5 cms long, and with the aid of a self retaining frame-based retractor allows for a complete exposure of the desired area of the spine.

 

Both MISS and MASS can be employed to treat sciatica, disc herniations, spinal stenosis, disc degenerations, tumour, trauma, tumour, infection, scoliosis, and kyphosis. Surgeries range from discectomy, decompression, disc replacement, anterior spinal fusion (ALIF), posterior spinal fusion (PLIF and TLIF), and anterior-posterior spinal fusion (AP fusion). During spinal fusion, pedicle screws and interbody cages can be effortlessly placed into the spine with the use of X-ray control and with minimal tissue damage.

 

The major benefits of MASS and MISS include:

• Reduced post-operative incision pain
• Improved mobilisation
• Reduced blood loss
• Minimised respiratory difficulties
• Early discharge from hospital (often as day surgery in regards to discectomy, decompression and some types of spinal fusion)
• Enhanced rehabilitation and early return back to activities and work
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With significant advances in modern day instrumentation and surgical techniques, there is a limited role for traditional open spinal surgeries.

 

Kyphoplasty and Vertebroplasty

 

Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful, progressive Vertebral Compression Fractures (VCFs).A VCF is a fracture in the body of a vertebra, which causes it to collapse. In turn, this causes the spinal column above it to develop an abnormal forward curve, otherwise known as a kyphosis or ‘Dowager’s hump’.

 

VCFs may be caused by osteoporosis (an age-related softening of the bones) Osteoporotic fractures are common in the elderly and particularly in postmenopausal women, but they can also be associated with other factors such as chronic steroid usage or cancer involvement. With Kyphoplasty, the fractured vertebra is accessed through a small incision in the patients back, a hand drill is used to create a channel through which one or two balloon-like devices can be inserted into the vertebral body.