Spine Surgery

Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; ectomy means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc.

Different Approaches to treat Cervical Discectomy Spine Problem

Anterior Approach

The anterior approach allows the surgeon to have direct access to the degenerated disc without having to manipulate any nerve roots. Better correction of the collapsed disc to its native height can also be achieved by having a better leverage point to open the disc space. This can also help in restoring lordosis to the lumbar spine and to decrease fatigue of the surrounding posterior spinal muscles. No anterior or posterior muscle dissection is required to gain access to the front of the spine (unless the anterior approach is done in combination with a posterior approach for instrumentation). Avoiding injury to the recurrent laryngeal nerve (especially on the right side) and superior laryngeal nerve is a major consideration in the anterior approach to the lower cervical spine. The sympathetic trunk is situated in close proximity to the medial border of the longus colli at the C6 level (the longus colli diverge laterally, whereas the sympathetic trunk converges medially). The damage leads to the development of Horner’s syndrome with its associated ptosis, meiosis, and anhydrosis. Awareness of the regional anatomy of the sympathetic trunk may help in identifying and preserving this important structure while performing anterior cervical surgery or during exposure of the transverse foramen or uncovertebral joint at the lower cervical levels.

Posterior Approach

While anterior cervical discectomy or anterior corpectomy are excellent options for younger patients and those with inadequate cervical lordotic curve, dorsal procedures can often be used in patients with a well-maintained cervical lordotic curve. This can include patients with multilevel cervical spondylosis as well as those with OPLL. Cervical laminectomy and decompression can often be augmented by lateral mass fusion to correct instability or to prevent loss of future sagittal alignment. Laminoplasty is also offered as an alternative to lateral mass fusion. In patients undergoing posterior decompression surgery, there should be evidence of preoperative cervical lordosis of at least 10° and less than 7 mm of anterior-posterior OPLL for indirect decompression to be successful. The most significant advantage of a posterior approach is that it avoids the potential soft-tissue complications of the anterior approach. Furthermore, there is no risk of graft extrusion, but there is a decreased incidence of postoperative pseudarthrosis. It has additionally been proposed that OPLL is associated with a “dynamic myelopathy” in which the cervical spinal cord is progressively injured by repeated movement of the cord parenchyma over the ossified ventral mass. Arthrodesis and simple collar immobilization in these patients may serve to “stiffen” the cervical spine and decrease deleterious motion.

Minimally invasive cervical disc replacement surgery

Minimally invasive cervical disc replacement surgery entails inserting an artificial cervical disc between two cervical vertebrae after the inter- vertebral disc has been surgically removed in the process of decompressing the spinal cord or a nerve root. The intent of the device is to preserve motion at the disc space. It is an alternative to the use of bone grafts, plates and screws in pursuit of a fusion following procedures such a disc removal, which necessarily eliminates motion at the operated disc space in the neck.

Cervical disc replacement surgery is most typically done for patients with cervical disc herniations that have not responded to non-surgical treatment options and are significantly affecting the individuals’ quality of life and ability to function.

The advantages of Minimally invasive cervical disc replacement surgery

• Maintaining normal neck motion
• Reducing degeneration of adjacent segments of the cervical spine
• Eliminating the need for a bone graft
• Early postoperative neck motion
• Faster return to normal activity
• Postoperative neck braces are not required for disc replacement operations.

Nucleoplasty is a minimally invasive procedure designed to treat back pain or leg pain caused by contained disc herniations. It works by decompressing the nucleus of the disc. Similar to letting air out of a tire, removing tissue from the center of a disc causes a reduction of pressure within the disc. This in turn leads to a reduction in the pressure that the disc applies to other parts of the body, such as nerve roots or the spinal cord.

During the procedure, an instrument is introduced through a needle and placed into the center of the disc where a series of channels are created to remove tissue from the nucleus. As pressure is relieved, pain is reduced, consistent with the clinical results of earlier percutaneous discectomy procedures. There is little tissue trauma and recovery times may be improved in many patients. A herniated disc may occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine.

Candidates for Disc Nucleoplasty

You are a candidate for disc nucleoplasty if

• If you are suffering from chronic back pain, back fatigue and rest, medications, medical interventions like steroid injections and physical therapy has not been of help.
• If you suffer from disc herniation
• If you suffer from contained spinal disc herniation, i.e, pain radiating down the leg or arm accompanied by back pain not improving with medication and physical therapy.
• Inflammation and chronic pain, particularly in cases where the nerve roots are pinched or irritated.

How does the Disc Nucleoplasty procedure work?

Nucleoplasty requires the patient to lie on his/her stomach for the lumbar procedure or back for the cervical procedure. The procedure is performed under X-ray guidance to accurately place a needle into the disc. Sedation may be administered by your doctor. A small nick is made in the skin near the spine, and a needle is inserted. The decompression device, called a SpineWand, is then inserted through the needle into the disc and activated to remove tissue. The device and the needle are removed and the small nick is covered with a bandage.

Benefits of Disc Nucleoplasty for herniated or slipped disc, chronic lower back pain, Sciatica

• Minimally Invasive, Scarless , Minimal Pain & discomfort to the patient
• Procedure time is less than an hour
• Minimal Tissue trauma and no risk of complications that may result from open surgery
• Minimal pain and discomfort to the patient.
• Quick recovery and Quick relief

If you have been diagnosed with a spinal fracture caused by osteoporosis, cancer or benign tumors, balloon kyphoplasty is a treatment option you may want to consider. Balloon kyphoplasty is a minimally invasive procedure that can significantly reduce back pain and repair the broken bone of a spinal fracture. The procedure is called balloon kyphoplasty because orthopaedic balloons are used to lift the fractured bone and return it to the correct position. Before the procedure, you will have a medical exam and undergo diagnostic studies such as X-rays, to determine the precise location of the fracture. Balloon kyphoplasty can be done under local or general anesthesia—your physician will decide which option is appropriate for you. Balloon kyphoplasty takes about one hour per fracture treated. It can be done on an inpatient or outpatient basis, depending on medical necessity. After the procedure, you will likely be transferred to the Recovery Room for about an hour for observation. The aim of Kyphoplasty is to reduce the pain of fractured vertebra, to reinforce the weakened bone and to restore normal vertebral height.

When is Kyphoplasty recommended ?

Kyphoplasty is done on patients who experience painful symptoms or spinal deformities due to vertebral compression fractures resulting from osteoporosis. Kyphoplasty is also performed on patients who

• Are aged or are in poor health to tolerate open spinal surgery.
• Have too frail bones for surgical spinal repair
• Have a vertebral damage due to a cancerous tumor
• Are younger and have osteoporosis caused by a long-term steroid management or a metabolic disorder

Benefits of Kyphoplasty

Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as kyphoplasty. This procedure provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the “downward spiral” of untreated osteoporosis.

Additional benefits of kyphoplasty include

• Short surgical time
• Only general or local anesthesia required
• Average hospital stay is one day (or less)
• Patients can quickly return to the normal activities of daily living
• No bracing required

Tumor is abnormal mass of rapidly growing cells without any physiological function. That means it does not perform any function for the body but derives its nutrition from the body. It can occur anywhere in the body. The cause is unknown. Those tumors that are found in and around the spinal cord are known as spinal tumors. They may be primary tumors whose cells of origin is the spinal tissue, or they may be secondary tumors which have spread (metastasize) via blood stream from some other focus in the body. The spinal cord is covered by a layer of protective tissue called as meninges. The entire spinal cord is encased within the vertebral column.

Following are different types of Spinal tumours based on there cancerous or non-cancerous behavior.

Benign bone tumors are of following types:

• Giant Cell Tumor: Usually found in the sacrum
• Hemangioma: Usually found in the thoracic spine
• Osteoid Osteoma: Usually found to affect the lumbar spine’s posterior spinal column
• Osteoblastoma: Usually found to affect the spine’s posterior spinal column

Malignant bone tumors are classified as follows:

• Chordoma: Affects the sacrum and coccyx in the midline
• Osteosarcoma: affect the anterior vertebral body and it may also invade the Posterior spinal elements.

Malignant cartilage tumor:

• Chondrosarcoma: Found primarily in the thoracic, lumbar, and sacral spine

Malignant plasma cell tumors:

• Plasmacytoma is cancer of the white blood cells (plasma cells) which effects the thoracic spine and may also involve the spinal cord ot the nerve roots.
• Lymphomas are cancer of the body’s lymphatic system that may spread to the spine .Usually the anterior part (front) of the spinal column is affected
• Ewing’s Sarcoma: It affects the Sacrum or the nerves.

Symptoms of Spinal Tumour

Tumor may cause generalized symptoms in the body (like persistent low energy levels, unexplainable weight loss, lump formation, enlargement of lymph nodes, malaise, irregularities of menstruation in females etc as well as symptoms pertaining to the affected organ in the body.

There are various ways in which spine tumour may exhibit, but the most common symptoms of spinal tumour are as follows:

• Back pain radiating to the other parts of the body.
• Loss of sensation and muscle weakness especially in the legs.
• Difficulty in walking, sometimes leading to falling
• Loss of bowel or bladder function

Minimally Invasive Spinal Tumor Removal Surgery in India

Some Spinal Tumors, benign or malignant, require surgical intervention before or after non-operative treatments. When pain is unresponsive to non-operative treatment, neurologic deficit progresses, a specimen is needed, neural elements (e.g. nerves) are compressed, vertebral destruction exists, or when spinal stabilization is necessary – surgery is considered. The primary goals in surgery are to reduce pain caused by the spinal tumor, restore or preserve neurologic function, and provide spinal stability. The spinal tumor may be approached surgically from the front (anterior) or back (posterior) of the body.

Surgery may include tumor resection (partial removal) or excision (complete removal). When the tumor is removed (partially or completed) pain and neurologic problems may clear up. Spinal instrumentation and Fusion are procedures used to reconstruct and stabilize the spine. These procedures join and solidify the level (or levels) where a spinal element (e.g. vertebral body) has been damaged or removed.

Why surgery for Spine Tumor Removal?

• When the tumor is removed (partially or completely) pain and neurologic problems may clear up.
• To restore and preserve neurological function and provide spinal stability.
• Spinal Tumor surgery is generally indicated in case there is a localized tumor which can be removed with minimum damage to nerve and spinal cord,
• There is persistent neurological deficit and pain which is unresponsive to non operative treatment
• Surgery may include resection (partial removal) or excision (complete removal) of tumor.