Spine Surgery

Spine Surgery

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The spine (or backbone) runs from the base of the skull to the pelvis. It supports the body's weight and to protect the spinal cord

The spine is made up of a series of bones that are stacked like blocks on top of each other with discs in between to help absorb shock/load

 
Spine divided into three regions
  •  Cervical spine
  •  Thoracic spine
  •  Lumber spine

Below the sacrum there is small bone called coccyx

Functions of the Spine

The three main functions of the spine are to:

  •  Protect the spinal cord, nerve roots and several of the body’s internal organs.
  •  Provide structural support and balance to maintain an upright posture.
  •  Enable flexible motion.

Reasons You May Need Back Surgery

Your doctor may tell you to see an orthopedic surgeon if you have

  •  A slipped disk that isn’t getting better on its own
  •  Bone spurs in your spine (these are often caused by arthritis) that are putting pressure on your spinal cord
  •  A degenerative spinal condition like stenosis (narrowing of the protective bony canal around the spinal cord) that’s causing side effects, like weakness
  •  Weakness or numbness in your arms and legs
  •  Trouble walking or using your hands
  •  Lost bladder or bowel control because of a problem with the nerves in your back
  •  A spinal infection, or a high fever with back pain -- this can be a sign of a spinal infection
  •  A broken or dislocated bone in your back
  •  Tumour on the spinal cord

For instance, if a patient has significant neurogenic pain in the extremities and non-surgical management has not provided relief, surgical intervention is the best decision. For those with symptoms related to the spinal cord or nerve root compressions, such as significant weakness in the arm or leg or limb, we may recommend surgical intervention if non-surgical management was unsuccessful.

What are some types of back surgery?

  •  Vertebroplasty and kyphoplasty
  •  laminectomy
  •  Discectomy
  •  Foraminotomy 
  •  Nucleoplasty also called plasma disk decompression 
  •  Spinal fusion
  •  Artificial disk replacement.
 

In a laminectomy, the surgeon removes the lamina (the back part of the vertebra that covers and protects your spinal canal).

In most cases, doctors recommend laminectomy when a person shows signs of spinal stenosis or possible symptoms of a herniated disk or degenerative disc disease

Spinal stenosis occurs when the spinal canal narrows, putting pressure on the spinal cord or nerve roots. 

Reason for stenosis:

  •  Aging
  •  Arthritis (osteoarthritis and rheumatoid arthritis)
  •  Spinal injury
  •  Herniated or slipped discs
  •  One spur
  •  Tumor in sc

Depending on the location and severity, spinal stenosis can lead to: 

  •  Pain in the neck or lower back
  •  Numbness, aching, or tingling that radiates from the arms into the hands
  •  Numbness or aching that runs down the buttocks and into the legs
  •  Cramping or weakness in the hands, arms, legs, or feet
  •  Difficulty walking 
  •  Difficulty controlling bladder or bowel movements 

However, they may recommend a laminectomy if the symptoms persist despite the person trying other forms of treatment.

Procedure - Laminectomy

Generally, a laminectomy follows this process:

  •  An IV (intravenous) line may be started in your arm or hand.
  •  Once you are under anaesthesia, a urinary drainage catheter may be inserted.
  •  The anaesthesiologist will continuously watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  •  Then staff will clean the skin over the surgical site with an antiseptic solution.
  •  The surgeon will make a cut (incision) over the selected vertebra.
  •  The surgeon will spread the muscles apart.
  •  The surgeon removes the bony arch of the posterior part of the vertebra (lamina) to ease the pressure on the nerves in the area. This may involve removing bone spurs or growths, or removing all or part of a disk.
  •  In some cases, spinal fusion may be done at the same time. During a spinal fusion, the surgeon will connect 2 or more bones in your spine.
  •  The incision will be closed with stitches or surgical staples.
  •  A sterile bandage or dressing will be applied.

Discectomy Surgeon removes your damaged disk to relieve pressure on your nerves. He can perform the surgery in a couple of ways:

A discectomy (sometimes called a microdiscectomy, percutaneous discectomy, lumbar discectomy, herniated disc surgery, decompression surgery)

An open discectomy is done with a cut in the back or neck.

Microdiscectomy is done through a much smaller cut. Your surgeon inserts a thin tube with a camera on one end to see and remove the damaged disk.

Discectomy is surgery to remove herniated disc material that is pressing a nerve root or the spinal cord.

A microdiscectomy is a minimally invasive version of the surgery where part of the nucleus pulposus is removed traditionally or with a laser through a smaller incision (1-1.5 inches) with a microscope.

 A percutaneous discectomy involves removing part of the disc using a laser or suction through a small incision and probe.

A discectomy can be performed on various parts of the spine.

Condition treated with discectomy

  •  Bulging or herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus).
  •  Irritation and swelling occurs when this material squeezes out and painfully presses on a nerve
  •  Degenerative disc disease: As discs naturally wear out, bone spurs form and the facet joints inflame. The discs dry out and shrink, losing their flexibility and cushioning properties. The disc spaces get smaller. These changes lead to stenosis or disc herniation.

Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture. It is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.

During a spinal fusion, the surgeon connects two adjacent vertebrae in order to avoid pain caused by their movement against each other.

The surgeon uses small screws and rods to connect the vertebrae, and they are then left to naturally heal and fuse together.

The physician may also take a small bone graft from another part of your body to help the vertebrae to fuse.

Spinal fusion may help relieve symptoms of many back problems, including:

  •  Degenerative disk disease
  •  Spondylolisthesis
  •  Spinal stenosis
  •  Scoliosis
  •  Fractured vertebra
  •  Infection
  •  Herniated disk
  •  Tumour

These symptoms often are caused by compressed nerves in your spine. Nerves may become compressed for a variety of reasons, including:

Disk problems.

Bulging or ruptured (herniated) disks the rubbery cushions separating the bones of your spine can sometimes press too tightly against a spinal nerve and affect its function.

Overgrowth of bone.

Osteoarthritis can result in bone spurs on your spine. This excess bone most commonly affects the hinge joints on the back part of the spinal column and can narrow the amount of space available for nerves to pass through openings in your spine.

Why it's done

Spinal fusion permanently connects two or more vertebrae in your spine to improve stability, correct a deformity, or reduce pain. Your doctor may recommend spinal fusion to treat:

  •  Deformities of the spine. Spinal fusion can help correct spinal deformities, such as a sideways curvature of the spine (scoliosis).
  •  Spinal weakness or instability. Your spine may become unstable if there's abnormal or excessive motion between two vertebrae. This is a common side effect of severe arthritis in the spine. Spinal fusion can be used to restore spinal stability in such cases.
  •  Herniated disk. Spinal fusion may be used to stabilize the spine after removal of a damaged (herniated) disc

Patients with scoliosis and spondylolisthesis are usually good candidates for spinal fusion. If you do not have any of these conditions, smaller procedures such as a laminectomy that can be performed on an outpatient basis may be considered. Patients should only have a fusion performed if smaller procedures are not a good option.

Procedure

Generally, the procedure involves the following:

The surgeon makes an incision in one of three locations: in your neck or back directly over your spine, on either side of your spine, or in your abdomen or throat so that your surgeon can access the spine from the front.

  •  The bone grafts that actually fuse two vertebrae together may come from a bone bank or from your own body, usually from your pelvis. If your own bone is used, the surgeon makes an incision above your pelvic bone, removes a small portion of it, and then closes the incision.
  •  Fusion. To fuse the vertebrae together permanently, the surgeon places the bone graft material between the vertebrae. Metal plates, screws, or rods may be used to help hold the vertebrae together while the bone graft heals.

In selected cases, some surgeons use a synthetic substance instead of bone grafts. These synthetic substances help promote bone growth and speed the fusion of the vertebrae.

Spinal fusion is typically an effective treatment for fractures, deformities, or instability in the spine. But study results are more mixed when the cause of the back or neck pain is unclear. In many cases, spinal fusion is no more effective than nonsurgical treatments for nonspecific back pain.

Recovery from spinal fusion

After your spinal fusion, you’ll need to stay in the hospital for a period of recovery and observation. This generally lasts three to four days.

The doctor will want to observe you for reactions to the anesthesia and surgery.

Your release date will depend on your overall physical condition, your physician’s practices, and your reaction to the procedure.

While in the hospital, you’ll receive pain medication.

You’ll also get instructions about new ways you may need to move, since your flexibility may be limited.

You may need to learn new techniques to walk, sit, and stand safely.

Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. But these relatively new devices aren't an option for most people.

With artificial disc replacement, the procedure is designed to bring about pain relief by removing the painful disc, and motion at that spinal segment is maintained with the use of a prosthetic implant

Surgical Procedure

Most artificial disk replacement surgeries take from 2 to 3 hours.

Your surgeon will approach your lower back from the front through an incision in your abdomen. With this approach, the organs and blood vessels must be moved to the side. This allows the surgeon to access to the spine without moving the nerves.

During the procedure, your surgeon will remove the problematic disk and then insert an artificial disc implant into the disc space.

Some discs are made of metal, while others are a combination of metal and plastic, similar to joint replacements in the knee and hip. Materials used include medical-grade plastic (polyethylene) and medical grade cobalt chromium or titanium alloy.

Recovery

In most cases, will stay in the hospital for 1 to 3 days following artificial disk replacement. The length of your stay will depend upon how well-controlled your pain is and your return to function.

In most cases, patients are encouraged to stand and walk by the first day after surgery. Because bone healing is not required following artificial disk replacement, the typical patient is encouraged to move through the mid-section. Early motion in the trunk area may lead to quicker rehabilitation and recovery.

4 Spinal Disorders Treated Using MISS (minimal invasive spinal surgery)


Degenerative disc disease (DDD) usually develops gradually in older adults affecting the spine’s intervertebral discs.

Normal cellular age-related changes in the body can cause discs to stiffen, lose flexibility, strength, height and shape, and ability to absorb and distribute forces associated with movement.

These structural changes may increase the risk for disc herniation.


A herniated disc sometimes called a slipped disc or ruptured disc occurs when the gel-like inner core of an intervertebral disc brake through the protective outer layer of the disc.

Besides the damaged disc, the interior gel can irritate and inflame nearby spinal nerves and cause back pain.


Scoliosis is an abnormal sideward curve of the spine that may cause progressive spinal deformity.

A scoliotic curve may resemble an “S” or “C.” Most cases of scoliosis have no known cause


Spinal stenosis occurs when spinal nerve roots and/or the spinal cord become compressed. The nerve roots branch off the spinal cord and exit the spinal canal through passageways called neuroforamen.

spinal cord compression can cause symptoms such as pain, weakness, tingling sensations, and numbness. Sometimes, pain and symptoms travel into the arms or legs.

Device Technology

  •  Endoscope: A thin, fiberoptic tube with a light and lens, used to examine the interior of the patient’s body; provides minimally invasive access for diagnostic and surgical procedures. 
  •  Fluoroscope: An imaging device that uses x-rays to view internal body structures on a screen, intraoperatively.
  •  Laparoscope: An instrument that enables the visualization of specific structures within the body. A small surgical incision is made through which the laparoscope is placed. An array of tubes can be guided through the same incision, or other small incisions, permitting the use of probes and other instruments.
  •  Minimally invasive tubular retractor (MITR): The tubular retractor is used to create a tunnel down to the spinal column and can come in a variety of sizes, even as small as 1.4 cm in diameter (about 1/2 of an inch). in which the tubular retractor is passed through a tunnel in the muscles of the back, rather than stripping the muscles away from the spine, as is done in open procedures. This approach limits damage to the muscles around the spine and decreases blood loss during surgery.
  •  Portals: Devices that provide a passage through which the surgeon operates during endoscopic procedures. After the incision is made, dilators are used to reach the area of the spine that the surgeon is working on. Fluoroscopy is used to locate the right level at the time of surgery. During the procedure, instruments are used to continue the dissection through the portal. When the portal is removed, all the tissue falls back into place. In order to avoid damaging the tissue by moving instruments in and out of the passage, the portal or tubular retractor is placed into the incision to hold the tissue apart and left in place throughout the procedure. There are open and sealed portals. The portals used in the thoracic spine are usually 11 to 12 mm, while portals used in the abdominal cavity tend to be larger. All of the instruments and implants must be designed to fit through these small passages and perform surgical functions, once they reach the site
 

Below given costs are estimated, duration of treatment and the required medical test may be variable according to your medical condition.

Procedure Cost Range in India (USD) Days in India Required Medical Test
Laminectomy      
Discectomy      
Spinal Fusion Surgery $ – $ Hospital – Outside – India -rd  
Artificial Disc Implant $ – $ Hospital – Outside – India -