Types of Spinal Surgery

In the modern era of high technology, with a predominantly sedentary lifestyle, the total deficit of physical activity and adverse ecological situation of the environment, diseases of the spine are significantly common among almost all age groups.

Unfortunately, not all spinal pathologies and their stages can be resolved only by conservative treatment methods. In many cases, surgery remains the single chance to regain health, restore active lifestyles and get rid of the pain. Despite the fact that spinal surgery is one of the most challenging and risky areas of orthopedics and traumatology, as of today, innovative and micro-invasive spinal surgery techniques have brought it to a whole new level of development. Modern operations technology can solve the problem as much as possible safe for the patient, significantly decreasing intraoperative risks and reducing post-operative recovery period.

Indications for spinal surgical intervention

Most diseases of the spine without treatment lead to serious consequences, a significant reduction in quality of life, chronic pain and even disability. The primary indications for spine surgery:

• Compression (squeezing) of the spinal cord or its roots with neurologic symptomatology (e.g., sensory loss or motor dysfunctions), or high risk of such complications, as well as severe pain. Usually, these happen in case of herniated disc or spinal canal stenosis
• Scoliosis, (with spinal deformation more than 40 degrees)
• Spinal deformation due to different etiologies, with rapidly progressing or disturbing the internal organs functions
• Tumours of spinal cord, spinal arachnoid and membranes, vertebral vessels and nerves in the spinal canal
• Spinal deformation with significant defects of appearance
• Injuries, the most frequent ones are compression fractures (occur in falls from height)
• Instability of segments of the spine due to various reasons
• Refractory Chronic Pain
• The inefficiency of conservative treatment for six months
• Disorders of Pelvic Organs
• Cauda Equina Syndrome
• Sequestration of Herniated Nucleus Pulposus

The main types of spinal operations

In modern orthopaedics, there are many methods of surgical interventions on the spine, as well as methods of surgical access to the affected area. Until recently, in most cases, surgeons used only open approaches to the vertebrae. Depending on the operated segment of the spine, they are divided:

• the posterior approach, in which a skin incision is performed from the back;
• the side approach - only applies to operations on the cervical spine, the surgeon thus accesses to the vertebrae from the right or left side of the neck;
• the front approach, when the access is performed through the abdominal cavity, it is mainly used for the lumbar.

The surgeon selects which access will be used depending on the location and the level of damage, as well as individual characteristics of the patient. Among the various existing methods and techniques of spinal surgery, it defines the following basic types of operations:

Discectomy is the operation on the intervertebral disc, in which a herniated part of a disk is removed. The principal aim of the operation is to reduce the pressure of the disc's cartilage tissue on the nerve roots, which causes irritation, inflammation and swelling. These processes result in severe pain, and in a case of prolonged absence of treatment - can cause a loss of sensitive and motor functions.

Laminectomy is the surgery on the vertebrae and the vertebral arch, which aims to remove the bone portion directly above the spinal roots. As a result, it forms more space around the nerve, decreasing pressure on the damaged part of the spinal root, which improves blood circulation, resolves an oedema of perineurium and thereby contributes to pain reducing. Another name for this operation is the Open Decompression.

Spinal fusion (or the arthrodesis) is the operation which performs fixed connection of several vertebrae. The primary aim of the procedure is a stabilisation of the affected segment of the spine and prevention of spinal cord injury, which may be caused by unstable vertebrae. The most commonly, it's used in cases of spinal fractures, degenerative diseases of bone and cartilage tissues of discs.

Vertebroplasty Procedure is surgery with the introduction of "bone cement" into the damaged vertebra. The procedure is performed through the skin with a special needle and it belongs to mini-invasive surgery. Therefore, it may be held using only local anaesthesia. The primary indications are compression fracture, osteoporosis, hemangioma, metastatic tumours.

Transplantation and Prosthetics of an intervertebral disc. In a case of massive destruction of discs, usually, patients are prescribed the arthrodesis - operation with direct connection of the fixed vertebrae. However, it significantly affects the biomechanical characteristics of the spine and restricts the movement of the patient. Therefore, transplantation of the intervertebral disc prosthesis can be an excellent modern alternative in such cases. Current mechanical implants mimic all functions, whereby the mobility of the spine can be saved. Moreover, today, there are clinical trials of the bioprosthesis, grown in the laboratory from patient's cartilage tissue.

Surgical treatment of scoliosis. An important object of spine surgery is a surgical correction of scoliosis. Indications for its is III-IV degree of the disease severity or its rapidly progressive course. Currently, the most effective method for the correction of scoliosis is the installation in the spine the specially designed steel structures. In modern orthopedics, there are a large number of such implants. Conventionally, these constructs can be divided into two types: dynamic and stable. Dynamic implants are usually used in the treatment of scoliosis in children. As the backbone of the child is constantly growing, the use of static structures in a couple of years after surgery can lead to loss of correction with an increase of deformation. The dynamic design of the implant can increase its length with the growth of the child, after the installation in the spine. Thus, correction can be independent of growth and do not require additional invasive procedures or surgery. Moreover, it is important that such constructions are almost invisible in appearance and do not break the traditional lifestyle, do not need to wear a corset and even allowed to play sports games.

Minimally Invasive Spine Surgery

Today, there are a number of techniques that allow minimizing the surgical trauma of soft tissues (not require extensive skin incision), to reduce intraoperative blood loss and significantly speed up the postoperative patient recovery. Some of these techniques are mentioned below.

Laser Vaporization

This minimally invasive surgical intervention can be used in cases of early stages of the protrusion and the herniated disc before sequestration. By this procedure, a surgeon inserts the special needle, the conductor through which he introduces the light-emitting diode. Through it, the laser light coagulates the inner part of the disk. It decreases the pressure inside the disc and thereby it reduced protrusion and compression of spinal roots.

Laser vaporization has significant clinical benefits such as less trauma, short duration of operation (at least one hour), a low risk of complications and shorter recovery period.

Nucleoplasty Procedure

The essence of this minimally invasive procedure is the introduction into the intervertebral disc the conductor through which it delivers the active substance or factor for disk plastics. It may be:

• Cold Plasma Nucleoplasty. A surgeon introduces cold plasma in the cartilage disc.
• The electrode for electrocoagulation of Nucleus Pulposus.
• Hemonukleoliz. A surgeon injects into the nucleus pulposus chymopapain, a substance with enzymatic action on the disk's cartilage tissue.

Following each exposure, a small part of disk's Nucleus Pulposus is destroyed and therefore, protrusion retracts back. All these types of Nucleoplasty Procedures are a short-term operation, which does not require general anaesthesia and a long period of postoperative rehabilitation.

Epiduroscopy

The Epiduroscopy is a therapeutic and diagnostic procedure which includes the direct study of the epidural space, and imaging of anatomical structures located in the area of the spine: spinal cord, yellow ligament, the anterior longitudinal ligament, blood vessels, nerve trunks and adipose tissue. The most importantly, that Epiduroscopy allows good visualisation of pathological changes as adhesions and seizures, signs of inflammation, fibrotic and stenotic processes. Therefore, it is an important component of minimally invasive spinal surgery.

The Epiduroscopy has significant clinical benefits such as, small access, minimal needs for anesthetic, the ability to perform the diagnostic and treatment procedures at the same time. For example, the placement of catheters for long-term chemotherapy for spinal cord tumours, electrodes for the coagulation of the nucleus at the Nucleoplasty Procedures, removal of scar-altered tissue, topical drug injection (e.g., painkillers or anti-inflammatory drugs). Also during the Epiduroscopy, a surgeon can take tissue specimens for histological examination material.

Endoscopic Spine Surgery

Endoscopic Spine Surgery is modern and safer alternative to open access to the operative parts of the spine and spinal cord. All manipulations are performed using a specialised endoscopic equipment. For the introduction of instruments into the patient's body and approaching them to the operated part of the spine a surgeon uses only three skin punctures. Doctors look for all manipulations through monitors in the operating room.

Such operations are most often used in protrusions and Herniated Discs and other degenerative changes in cartilage. Among the main advantages of endoscopic spinal surgery are:

• Minimal trauma
• Short term of rehabilitation
• Shortened period of hospitalisation (at least three days)
• Minimal anaesthetic needs
• Low risk of postoperative complications

Rehabilitation after Spinal Surgery

The recovery period after spinal operations is not less important process than the surgery. The course of rehabilitation should be individualized for each patient, depending on the disease, its severity and complications, as well as type of operation. Most recovery courses include:

• Gymnastics
• Massage
• Using of braces and corsets
• Physiotherapy and reflexology

It is important to remember that all allowed physical load and procedures must be prescribed by a doctor or a physiotherapist. An appropriately selected rehabilitation - is 70% success of the spine diseases treatment!


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