Spine Surgery: A comprehensive overview
Posted On: April 9, 2018
Posted By: Shalby Team
Category: Spine Surgery
When you encounter spinal cord injury, it means that that some part of your spinal cord or the nerves located at the spinal cord region has been damaged.
This damage can often lead to permanent changes in vigour, sensitivity and other vital body functions under the site of damage.
You can experience a spinal cord injury because of trauma, loss of blood, or compression due to tumor or infection.
Spinal cord injuries are characterized either as complete or incomplete. In case of complete spinal cord damage, you are likely to experience complete loss of sensitivity and muscle function in your body below the injury site. In case of incomplete spinal cord damage, you will have some function left below the injury site. In most of the cases both sides of your body will get equally affected.
There are various treatment modalities available to treat a spine injury, inclusive of medications, immobilization, physical therapies and surgery.
Mostly a spine surgery is needed for the removal of bone fragments, herniated disks, or fractured vertebrae that are identified to be squeezing your spine. A spine surgery can even be done with the objective of stabilizing your spine in order to prevent impending pain or impairment of any kind.
A Spine surgery will likely be recommended when the non-surgical treatment like medications and the physical therapies don’t help you in relieve the symptoms. Moreover, a surgery will only be considered in the cases where the precise reason of pain has been determined; which could be scoliosis, a herniated disc, or spinal stenosis.
No matter what kind of spinal cord injury you have encountered, you will be likely to face any of the following symptoms:
- Movement loss
- Altered or lost sensation, inclusive of your ability to feel touch, heat and cold
- Loss of your bowel or bladder control
- Excessive reflex activities or spasms
- Changes in your sexual function, sensitivity and fertility
- Pain or acute stinging sensation due to the damage to nerve fibers in the spinal cord
- Trouble in breathing, coughing or clearing the secretions from the lungs
Signs and symptoms requiring immediate medical attention
At times, the signs and symptoms of spinal cord damage would require immediate or emergency medical attention. Such signs include:
- Acute back pain or pressure in the neck, back or head
- Weakness, clumsiness or paralysis in any body part
- Numbness, loss of sensation or tingling in the hands, feet, fingers, or toes
- Loss of bladder or bowel control
- Difficulty with balance and walking
- Impaired breathing after injury
- Twisted neck or back
Before we get into the details about spine surgery, the procedure and other important things related to it; let’s first have a look at the different conditions that increase your risk of undergoing a spine surgery.
This condition refers to the problem associated with one of the discs (rubbery cushions) that are located between each of the bones, which together make the spine.
Your spinal disc is quite like a jelly doughnut that comes with a softer center and an equally tougher exterior. Herniated disc is also known as slipped disk or a ruptured disk which mainly occurs when the softer jelly comes out from a tear in the sturdy exterior.
A herniated disc is known for irritating the nearby nerves which can result in pain, insensitivity or weakness in your arm or leg. However, some people, while suffering from herniated disc, don’t get to experience any symptom because of the problem. In many cases, herniated disc requires no surgery as well.
Most of the time, you will experience herniated disks in the lower back (lumbar spine) but sometimes it can happen in the neck, which is the cervical spine. Some of the commonly known symptoms of a herniated disc happen to be:
Pain in the arms or legs: If the herniated disk occurs in the lower back, then you are likely to feel acute pain in the buttocks, calf and thigh. Sometimes, the pain can even occur in a part of your foot. When the herniated disc occurs in the neck, you will experience acute pain in arms and shoulders. Often, this pain shoots in the arms or leg upon coughing or sneezing, or while moving the spine in some positions.
Numbness or tingling: It is very common to have some sort of numbness or tingling sensation in your body parts that get affected by your nerves.
Weakness: Your body muscles that are served by the damaged nerves become weak which apparently leads to stumble, or impairment of the ability to lift or hold anything.
While these are the common symptoms you tend to experience during a herniated disc, sometimes you may suffer from the problem without really having any sign or symptom.
Causes of herniated disc
The most common cause that leads to herniated disc is the age-related wear and tear. It is a gradual process and is known as the disc degeneration. With growing age, the spinal discs tend to lose some of the water content present in them. Owing to this, the discs lose their usual flexibility and become prone to tear or rupture, triggered by even a petty strain or twist.
Many a times, people who suffer from herniated disc are never able to determine the precise cause of it. You can even encounter herniated disc when you use the back muscles to lift heavy objects, instead of using the leg and thigh muscles. Twisting or turning as you lift some heavy object can also cause herniated disc. Herniated disc rarely occurs because of a traumatic situation like a blow to back or a fall.
Risk factors involved
There are some risk factors that are known to increase your risk of suffering from a herniated disc and these include:
Body Weight: If you are obese or overweight, you will be at a risk because excess body weight leads to excessive stress on the discs present in the lower back.
Occupation: If the nature of your job is physically demanding then you will have a higher risk of problems in the back. Repeated lifting, pushing, pulling, bending obliquely and twisting can increase the risk of a herniated disk.
Genetics: In certain people, herniated disc is seen as a genetic factor wherein people tend to inherit the tendency of developing a herniated disk.
Known as the sideways curvature of the spine, scoliosis usually occurs during the growth spurts, right before puberty. The precise cause of scoliosis is not yet known but it is often associated with conditions like cerebral palsy and muscular dystrophy.
Most scoliosis happens to be mild, however, in some cases children suffering from scoliosis can develop spine deformities which go on to become more severe as the child grows. If it turns into severe scoliosis, then it can prove to be disabling. Severe spinal curve reduces the space within your chest, which makes it difficult for the lungs to work properly.
If the child happens to be suffering from mild scoliosis, then he or she will be monitored closely, normally with the use of X-rays that helps in seeing if the curve is becoming worse.
In most of the cases, a mild scoliosis will not require any treatment. Some children may be advised to wear a brace that helps in preventing the curve from worsening. In some other cases, there might be a need of scoliosis surgery which will work with the objective of keeping the scoliosis from aggravating and straightening the serious cases of scoliosis.
Symptoms of scoliosis
The commonly noticed signs and symptoms of scoliosis include:
- Irregular shoulders
- One shoulder blade appearing more prominent than the other
- Uneven waist
- One hip higher than the other
In case the scoliosis curve grows worse, as a result, your spine will also revolve or twist, along with curving side to side. This makes the ribs on body’s one side to stick out at a greater distance than the ribs on the other side.
Causes of scoliosis
The precise cause of scoliosis is not yet known but is believed that it occurs due to some hereditary factors as the disorder mostly run in families. Scoliosis types which are rare can occur due to:
- Neuromuscular conditions like cerebral palsy or muscular dystrophy
- Birth defects that can affect the development of the bones of your spine
- Injuries or infections of the spine
Risk factors associated with scoliosis
Age: The major signs and symptoms of scoliosis usually start during the growth spurts which happen right before puberty.
Sex: Scoliosis can affect both girls and boys but is has been seen that girls tend to be at a higher risk of curve worsening.
Family history: As stated above, scoliosis happen to run in families. However, it has also been observed that children diagnosed with scoliosis don't really have a family history of the condition.
Spinal stenosis is defined as the narrowing of the spaces in the spine, which tends to exert pressure on the nerves travelling through your spine. Spinal stenosis is known to affect mostly the lower back and your neck.
Some people suffering from spinal stenosis may not reflect any symptoms while others with this problem can have pain, numbness, and tingling and muscle weakness. The symptoms of spinal stenosis can deteriorate over time. The most common reason that leads to spinal stenosis happens to be the wear-and-tear that occur in your spine, related to osteoarthritis. In serious cases of spinal stenosis, your doctor is likely to recommend a surgery that will help in creating extra space for your spinal cord or nerves.
Many times, people suffering from spinal stenosis don’t experience any symptoms even though the condition is confirmed on MRI or CT scan. The symptoms of spinal stenosis diverge, based on the stenosis location and the nerves that get affected because of it. Symptoms associated with the affected nerves include:
If spinal stenosis affects your neck, the cervical spine, the symptoms include:
- Numbness or tingling in the hand, foot, arm or leg
- Weakness in hand, foot, arm or leg
- Trouble with walking and balance
- Pain in the neck
- If the case is very severe, then you can even experience dysfunction of the bowel or bladder (urinary urgency and unrestraint)
If spinal stenosis occurs in your lower back (lumbar spine), the symptoms include:
- Numbness or tingling in the foot or leg
- Fragility in your foot or leg
- Pain or contraction in one or both the legs after standing for longer duration or when walking, which normally subsides as you bend forward or sit
- Pain in the back
Causes of Spinal Stenosis
Your backbone runs from the neck to lower back and the bones of spine make the spinal canal, which functions to safeguard the spinal cord or nerves.
Some people have a small spinal canal, right from birth. However, most cases of the spinal stenosis happen when something goes wrong and narrows the open space in the spine. Some common cause of spinal stenosis may include:
Bone overgrowth: Damage that occurs due to the wear and tear from osteoarthritis on the spinal bones can lead to the formation of bone spurs that grow into your spinal canal. A bone disease type, known as Paget's disease, which normally affects the adults, can also lead to overgrowth of bones in your spine.
Herniated discs: The soft cushions present between the bones of spine work as shock absorbers amid the vertebrae, which tends to dry out with age. If there are cracks in your disc's exterior, it will let the soft inner material to getaway and exert pressure on your spinal cord or the nerves.
Thickened ligaments: The sturdy cords which help in holding the bones of spine together tend to become very stiff and thickened over time. These thickened ligaments then bulge into your spinal canal.
Tumors: Sometimes unusual growths can form within your spinal cord, the membranes covering the spinal cord or in the spaces between your spinal cord and the vertebrae. These are rare and detectable during the spine imaging done with an MRI or CT.
Spinal injuries: Accidents involving vehicles and other trauma type can lead to dislocation or fracture of one or more vertebrae. A bone that gets displaced due to spinal fracture can damage the contents of your spinal canal. Swelling of surrounding tissues that occurs immediately post a back surgery also tends to exert pressure on your spinal cord or nerves.
Risk factors of spinal stenosis
Spinal stenosis affects people who are above the age of 50. Degenerative changes are also known to lead to spinal stenosis in younger people, but in such cases, other causes are also considered. These conditions include any trauma, birth-related spinal deformity like scoliosis, plus a genetic disease which affects the bone and muscle development in your body. Spinal imaging can also discern these causes.
Spine Surgery: An Overview
In most cases, a spine surgery is done as an open surgery. This calls for opening the concerned site by making a long cut. This allows the surgeon to view and approach the spinal anatomy. However, thanks to the technology advancements, these days various spine conditions can even be treated with the help of Minimally Invasive Techniques.
A minimally invasive surgery for spine does not make use of long incisions, or any kind of open handling of your muscles and the nearby tissues which leads to shorter surgery time. When the surgery time is less, the postoperative pain is also less and the recovery also becomes speedy.
The Imaging Proces
During the process, the surgeons use computer-assisted imaging which guides them to view the surgery site with extreme clarity as compared to the conventional visualization techniques. Moreover, implants like the rods or screws are also inserted and placed with greater accuracy, something which is not perfectly achieved with traditional techniques.
In this imaging process type, images which are taken pre-operatively are then merged with images taken during the surgery process. This produces real-time glimpses of the structural positioning and orientation of the surgery site when the surgery is being performed. For imaging, the surgeons usually use the pre-operative computed tomography (CT) and the intra-operative fluoroscopy (real-time X-ray). These methods allow the surgeons to perform the surgery with a higher level of accuracy and safety.
However, the minimally invasive surgery is not fit for all patients suffering from a spine problem. For anyone to undergo a minimally invasive surgery for any spine problem, it is very important that all the pre-requisites are met.
Different Approaches to Surgery
Whether you plan to go for an open spine surgery or the minimally invasive surgery, the surgeon will access the spine from various directions. These accesses are known as surgical approaches, which include the following:
Anterior approach: This approach calls for surgeon accessing your spine from the front side of your body, via your abdomen.
Posterior approach: In this approach type, the surgeon will make the surgical incision in the back.
Lateral approach: In this approach, the surgeon will make the surgical path to the spine from your side.
Some of the Common Surgical Procedures
You may have to undergo a spine surgery owing to various conditions, and some of the commonly used surgical processes include:
Discectomy or Microdiscectomy: This involves the removal of herniated intervertebral disc. This surgery helps in removing the pressure from a compressed nerve. This surgery type comes under the minimally invasive category.
Laminectomy: In this surgery type, the surgeon will remove the thin bony plate present on the back of your vertebra, known as the laminae, which tends to increase the space in the spinal canal, thus relieving the pressure.
Laminotomy: The laminotomy surgery involves removing the portion of the vertebral arch (lamina) covering your spinal cord. When compared to the laminectomy process, a laminotomy is known for removing less bone. Both these processes are decompression procedures, which mean that the tissues compressing your spinal nerve are removed.
Foraminotomy: It calls for removing the bone or tissue located at the passageway, known as the neuroforamen wherein the nerve roots start from the spinal cord and move out from the spinal column.
Disc replacement: In this process, the injured or damaged disc is replaced with an artificial disc. Disc replacement is often seen as the alternative to fusion.
Spinal fusion: It is a technique which is used for joining the two vertebrae. Spinal fusion usually includes using bone graft with or sans instrumentation like rods or screws. There exist different bone graft types like using your own bone - known as autograft and the donor bone, called the allograft.
Your surgeon will analyse the spine injury or damage that has occurred; and based on the symptoms, the surgical approach will be finalized.
Spine is the vital support of your body as it allows bodily movements and the nerves associated with the spinal cord, helps in managing the functions of various muscles in the body.
Any injury or damage, no matter how mild or severe, can affect the functioning of your spine. This is why it is very important that you take proper care and never neglect any injury related to spine.
Timely diagnosis and treatment play a key role in restoring the functions and overall health of the spine.
At Shalby Hospitals, we provide highly effective treatment for spinal problems inclusive of spine surgery. Our experts, with the help of advanced technology and latest surgical approach, help in treating the problem with precision.
We have state-of-the-art critical care, ICU, surgical instruments, imaging machines, and operation theatres that are well-equipped with ultra-modern equipment. Our experienced and skilled surgeons perform safe and successful surgeries - using both open and minimally invasive surgery approach, whichever fits the case best.
We even specialize in providing pain free replacement of the intervertebral discs. The hospital has proficient experts to undertake physical therapy which helps patients in balancing and conditioning their spine effectively.
You can always rely on the expertise of Shalby Hospitals in treating various spine related ailments such as spine surgery, spine infection, keyhole spinal surgery, back pain treatment, and disc replacement. Patients from across the world are treated for Spine problems at Shalby Hospitals.
ABOUT THE AUTHOR
Shalby Hospitals (Shalby Limited) is recognised as a multispecialty hospital chain in the Indian healthcare industry. Dr Vikram I. Shah established the first hospital in 1994 in Ahmedabad, Gujarat. Dr. Shah has been felicitated by Ethicon India for the development…View
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