- Institute of Orthopedic Sciences
A column of vertebrae starting and extending from the skull to the end of the back, enclosing the spinal cord and providing support for the thorax and abdomen as well as the backbone.
The Spinal column is susceptible to wear and tear. You may have struggled with back pain for years together. You may be wondering if s surgery is the only treatment option. Sometimes surgery is the only option. However, the majority of back problems can be treated with non-surgical conservative therapies in their early stages itself.
Causes leading to the spine surgery :
Natural ageing, improper body mechanics, any trauma and structural abnormalities can injure our spine, leading to unbearable back pain and other symptoms such as leg pain and or numbness or even leg weakness that is persistent. Chronic and persistent back pain is a condition that generally requires a team of health professionals specialising in trauma and spine injuries to diagnose and administer proper treatment.
Spine surgery is traditionally done as an “open surgery” or the area or place that is being operated upon is opened with a long incision to allow the surgeon to view and access the anatomy while performing the surgery. In recent years however technological advances have allowed more back and neck and spine problems to be treated with a minimally invasive surgical techniques and are slowly replacing traditional surgeries.
Since minimally invasive spine surgery (MISS) does not involve a long incision it avoids significant damage that is done to the adjoining muscles that surround the spine and results in less pain after surgery and a recovery.
Types of surgery:
Spine fusion :
Spine fusions are done usually to treat injuries of the vertebra, protrusion or degeneration of the disc between the vertebra, any abnormal curvatures of the spine and weakness or instability of the spine caused by infections or tumours in the bones or adjoining tissues. This procedure stops motion at the painful vertebral segments, decreasing pain in that particular joint. There are various approaches to lumbar spine fusion surgery. Each and every procedure involves adding bone graft to the area of the spine causing the problem. This causes the area to fuse and stops motion in that particular segment. Metal rods and screws are quite often used to prevent motion more than the desired level and allow the bony fusion or exact alignment to form. Spine fusion may cause a minimal reduction in flexibility of the spine. However, some patients do report increased flexibility as they are relieved of back pain and spasm after successful surgery. Surgery followed by physiotherapy
Bone grafts :
Bone grafts are basic components of spine fusion and are used in two main ways during orthopedic/neurosurgical procedures
1. To stimulate the healing process of the bone, and 2. To provide holistic support to the skeleton by filling in the gaps between two bones that needs to be aligned.
When a bone is removed from a person’s very own living body, living bone cells can survive the transfer to the new location and continue to grow new bone. Bone taken from someone else will stimulate bone to heal and grow, but this usually takes a little longer time.
Bone graft is also used for the structure. In this particular instance, larger pieces of bone may be used to fill the gap between two bones if the surgeon removes a vertebra or disc they may use a bone graft to fill the space as bone is rigid, it will tend to hold the bones apart while the body fuses the bone graft at either end.
Bone graft taken from a donor (cadaver bone) is called allograft. Allograft is usually extracted from organ donors and carefully preserved in the bone banks .Allograft can come from many types of bones in various different forms since it is not taken from a live patient, it does not contain any living cells and has fewer chemicals to stimulate the growth of new bone.
The procedure :
In an open surgery, the doctor makes an incision that is usually between 5 to 6 inches and moves the adjoining muscles to visualize the spine. The surgeon can access the spine and then removes the diseased and damaged bone or in vertebral discs. The surgeon has the capacity to visualize and see and place screws, cages, and bone graft material necessary to stabilise the spinal bones and promote healing quickly.
During the surgery, a very small incision is done after which a tubular retractor is inserted through the skin passing from the soft tissues down to the spinal column. This creates a tunnel with access to the small area where the problem exists in the spine. The tubular retractor holds muscles wide open and is kept in position throughout the procedure.
The surgeon can access the spine using small instruments that fit through the centre of the tubular retractor. Any bone or disc material that is removed exists through the retractor and any other devices necessary for fusion such as small screws or small rods are inserted through the retractor. Some surgeries require more than one retractor. In order to see where to place the incision and insert the retractor, the surgeon is always guided by fluoroscopy. This method displays real-time x-ray images of the patient’s spine on screen throughout the surgery and provides valuable inputs. The surgeon also uses an operating microscope which magnifies the view through the retractor. After the procedure is done the tubular retractor is removed and the muscles return to their original position. This limits the muscle damage that is more commonly seen in open surgeries.
Advantages and disadvantages of the surgery:
One of the major drawbacks of open surgery is that the pulling or the retraction of the muscle can damage the soft tissue. Although the goal of muscle retraction is to help the surgeon see the problem area, it affects the anatomy surrounding the surgical area. As a result, there is a greater risk for muscle injury, and patients may experience pain after surgery that is entirely different from the back pain felt before surgery, and the recovery becomes slow. MISS consumes less time to compared to a traditional surgery, the pain and discomfort are less and the patient can go home early.
As with any operation or surgery, there are potential risks associated with MISS. The risks are:
- Infection : antibiotics are administered to the patient before, during and often after surgery to minimise the risk of infections related complications.
- Bleeding : you may lose some blood during or after the surgery, usually the blood loss is insignificant.
- Pain at grafts sites : a small percentage of patients may experience persistent nagging pain at the graft site.
- Recurring symptoms : some patients are subject to experiencing a recurrence in their original symptoms.
- Pseudarthrosis : patients who smoke regularly are more likely to develop a pseudarthrosis condition wherein there is less bone formation than required. If this occurs a second surgery may be required to obtain the desired result.
- Nerve damage : in very rare cases the adjoining nerves may be damaged.
- Blood clots : Another rather uncommon complication is the formation of blood clots in the legs. It may pose a significant amount danger if they break off and travel to the lungs endangering the patient’s life.
Minimally invasive procedures are safe and time-tested and you need to stay in the hospital for a day or two only followed by physiotherapy at home.
If you had a fusion procedure it may take several months before the bone is solid although your comfort level starts improving much faster. During the resting and healing, the spine which has undergone must be kept in proper alignment as suggested.
KIMS is the top-most orthopedic hospital in Hyderabad with specialist orthopedic doctors, surgeons who have great experience in treating spine related problems. The best neck and spine clinic in Hyderabad is KIMS hospital. Eminent doctors, physicians, state of the art infrastructure, environment-friendly operation theatres and above all treatment with empathy make KIMS hospital, Secunderabad the ultimate choice. Eminent Spine surgeons of Hyderabad like Dr A Srinivasa Rao and Dr I Vishwanath Reddy and team have immense expertise in dealing spine related problems and achieved major breakthroughs in their treatment .