Spine Surgery

What is Spine Surgery?

Spine surgery is a surgical procedure to treat conditions of the spine such as structural abnormalities, infections, trauma, tumors, malformations, and degenerative spine conditions like stenosis and herniated discs. Spine surgery can be performed either by open surgery or minimally invasive techniques.

Open spine surgery involves making a long incision at the surgical site to expose the treatment area, providing the surgeon with the best possible view of the spine. Compared to minimally invasive techniques, this method requires a lengthier surgery and recovery period.

Minimally invasive spine surgery (MISS) involves making small, less than one-inch long, incisions to access the treatment area. It involves using special surgical instruments, devices, and advanced imaging techniques to visualize and perform the surgery through such small incisions. MISS is aimed at minimizing damage to the muscles and surrounding structures. MISS possesses numerous benefits over traditional open surgery that includes:

• Small surgical scars
• Reduced risk of infections
• Less blood loss during the surgery
• Less post-operative pain
• Quicker recovery
• Shorter hospital stay
• Quicker return to work and normal activities

Anatomy of the Spine

The human spine provides support to the body, allowing you to stand upright, bend and twist. The spine can be broadly divided into the cervical, thoracic, and lumbar spine. Twenty-four spinal bones called vertebrae are stacked on top of one another to form a spinal or vertebral column. Between two vertebrae there is a disc of cartilaginous tissue called the intervertebral disc. The intervertebral disc acts as a shock absorber and protects the spine from the strong forces of movement during activities such as jumping, running, and lifting. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body. Any damage or deformity to the bones of the vertebral column or to the discs present between the vertebrae can damage these nerves, leading to pain in the body part that the nerve supplies.

Indications for Spine Surgery

Your surgeon may recommend spine surgery when conservative treatment such as medications and physical therapy have failed to relieve pain and other associated symptoms of spine conditions, such as:

• Spinal fracture
• Spinal stenosis
• Scoliosis
• Kyphosis
• Spondylolisthesis
• Degenerative disc disease
• Disc injuries
• Disc herniation
• Spinal arthritis
• Bone spurs
• Enlargement of the nearby ligament
• Spinal degenerative problems

These conditions may necessitate different types of spine surgery as a treatment measure. These include:

• Laminectomy: Laminectomy, also known as decompression laminectomy, is a spinal surgery performed to relieve excess pressure on the spinal nerve(s) in the spine region. The purpose of laminectomy is to remove the lamina or roof of the vertebra and provide enough space for the nerves to exit the spinal canal (decompression).
• Disc Replacement: Disc replacement surgery is a procedure where the damaged intervertebral disc is removed and replaced with an artificial implant. The surgery relieves pain as well as restores the normal range of motion of the spine. Disc replacement surgery is an alternative to traditional spinal fusion surgery, which involves the permanent fusion of two vertebral bodies, eliminating movement between them.  
• Fusion Surgery: Spinal fusion, also called arthrodesis, is a surgical procedure in which two or more bones (vertebrae) of the spine are joined together to eliminate the movement between them. Bone grafts or bone graft substitutes are placed in between the affected vertebrae. This promotes bone growth and eventually fuses the vertebrae into a single, solid bone. 
• Corpectomy: A corpectomy is a procedure performed to relieve pressure on the spinal cord and spinal nerves by removing the source of the compression. The surgery involves two stages – decompression and fusion. To decompress the nerves, the presence of bone spurs, tumors, or fractures causing the compression are removed. This is followed by fusion, where deformed or diseased vertebrae are removed along with the intervertebral discs, and the adjacent vertebrae are then fused.
• Facetectomy and Foraminotomy: Facetectomy and foraminotomy are the most common spinal surgical procedures recommended for chronic pain due to spinal nerve compression. Foraminotomy is a decompression surgery involving the removal of bone and tissue obstructing the neuroforamen (an opening for the nerve roots to exit the spine and travel through the body) to release the pressure on the spinal nerve roots. In severe cases, the entire facet joint is removed which is referred to as facetectomy. The facet joints are the tiny joints situated at the upper and lower part of each vertebra, connecting one vertebra to the other. Each vertebra has four facet joints.
• Vertebroplasty: Vertebroplasty is a minimally invasive procedure performed to reduce or eliminate pain caused by vertebral compression fractures. It stabilizes the fracture and prevents further collapse of the vertebra, averting deformity. The procedure involves the injection of bone cement into the fractured vertebra under high pressure. After the vertebral body is filled completely with bone cement, the needle is withdrawn before the cement hardens.
• Cervical Laminoplasty: A cervical laminoplasty is an operative procedure that involves reshaping/repositioning the bone at the neck region (cervical spine) to relieve excess pressure on the spinal nerves. It can also be performed to relieve the symptoms of a narrowed spinal canal known as spinal stenosis.
• Cervical Disc Replacement: Cervical disc replacement surgery is a procedure where the damaged intervertebral disc is removed and replaced with an artificial implant. The surgery relieves neck pain as well as restores the normal range of motion of the neck.

Preparation for Spine Surgery

Preoperative preparation for spine surgery may involve the following steps:

• A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• You may need to undergo diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the surgery and to design a personalized plan based on the specifics of your spine anatomy.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
• You may be asked to avoid blood thinning medications such as aspirin for a specific period prior to surgery as they are known to increase your risk of bleeding.
• You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowels.
• You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
• You should refrain from alcohol or tobacco at least a few days prior to the surgery and several weeks after as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You are advised to arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Spine Surgery

In general, spine surgery procedure will involve the following steps:

• You will be placed on the procedure table in a face-down position under the influence of general anesthesia.
• Based on the type of surgery, your surgeon will make either one long incision for open surgery or a few small incisions for a minimally invasive surgery over the problematic segment of your spine to approach the treatment area.
• Your surgeon uses spinal instruments such as retractors to retract muscles and provide access to the spine.
• Miniature surgical instruments, microscope, endoscope, and image guidance are then used by your surgeon to carry out any of the different types of spine surgery discussed above and carry out the required repair as per your spinal condition.
• Surgical correction may be followed by spinal instrumentation, which involves the placement of fixation devices such as metallic screws, rods, or plates at the treatment area to stabilize the spine, accelerate bone fusion, protect the repair, and promote healing.
• Once satisfactory repair is confirmed, the instruments are withdrawn, and the incisions are closed with surgical tape or sutures and covered with a sterile dressing.

Postoperative Care and Recovery

Postoperative care instructions and recovery after spine surgery may involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover. 
• You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed for comfort.
• Application of cold compresses to the treatment area is also recommended to reduce swelling and pain.
• Antibiotics are also prescribed as needed to address the risk of surgery-related infection.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• Avoid lifting, bending, or twisting your back for the first few weeks. Do not lift anything heavier than 5 pounds during this period. Refrain from any strenuous activities such as housework, exercise, yard work, or sex for at least a month.
• Assistive devices such as a neck collar, corset, or brace may also be recommended to limit bending and assist with the healing of the operated region.
• You will be asked to start with an individualized physical therapy regimen after a defined period to help strengthen your spinal muscles and optimize spine function.
• You should be able to resume your normal activities in a couple of weeks but may have certain activity restrictions, such as driving.
• Complete recovery and return to work vary from patient to patient as it is related to a patient’s age and overall health status and the type of work one does.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Spine surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Bleeding
• Allergic/anesthetic reactions
• Hardware failure
• Bone graft migration
• Failure of vertebral fusion
• Blood clots or deep vein thrombosis (DVT)
• Injury to adjacent organs, nerves, or blood vessels