Spine Surgery

It is a type of minimally invasive back spine surgery used in cases of vertebral fracture.

Purpose Of A Kyphoplasty Is To:
•Stop the pain associated with the fracture
•Stabilize the vertebra
•Restore vertebral body height

Kyphoplasty is successful with patients who suffer vertebral fracture due to diminished bone strength. This usually means people with osteoporosis, or age related bone loss. Sometimes, however, younger people with conditions affecting bone strength may benefit from Kyphoplasty. Steroids also weaken the bones of young people who take them and predispose them to compression fractures.

Most of the time patients who undergo Kyphoplasty, experience pain relief within two weeks after the surgery. Function is generally improved, as well. Often, vertebral height is increased, but this result is not as dependable as the pain relief and function improvement measures.

A clinical evaluation including diagnostic imaging, blood tests, a physical exam, spine x-rays and Magnetic Resonance imaging will be done to confirm the presence of a compression fracture to be treated with Kyphoplasty. You may be given bone-strengthening medication during treatment.

How Does The Procedure Work?
In kyphoplasty, a balloon is first inserted through the tube and into the fractured vertebra where it is inflated to push the bone back to its normal height and shape. The balloon is then removed and the cement is inserted into the cavity created by the balloon.

How Is The Procedure Performed?
This procedure is often done on an outpatient basis. However, some procedures may require admission.

Before the procedure, a local anaesthetic will be injected into the muscles near the site of the fracture. A very small nick is made in the skin at the site. Using x-ray guidance, a hollow needle called a trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. The balloon tamp is first inserted through the needle and inflated, pushing the bone back to its normal height and shape and creating a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon. Although not a common practice, a CT scan may be performed at the end of the procedure to check the distribution of the cement. This procedure is usually completed within one hour. It may take longer if more than one vertebra is being treated. Approximately one hour after the procedure, you should be able to walk.

Kyphoplasty Is Not Appropriate For:
•Patients with young healthy bones or those who have suffered a fractured vertebra in an accident.
•Patients with spinal curvature such as scoliosis or kyphosis that results from causes other than osteoporosis.
•Patients who suffer from spinal stenosis or herniated disk with nerve or spinal cord compression and loss of neurologic function not associated with a VCF.

Spine Decompression:

Spinal decompression surgery is a general term that refers to various procedures intended to relieve symptoms caused by pressure, or compression, on the spinal cord and/or nerve roots. Bulging or collapsed disks, thickened joints, loosened ligaments and bony growths can narrow the spinal canal and the spinal nerve openings, causing irritation.

Symptoms of spinal nerve compression include Pain, Numbness, Tingling, Weakness, and Unsteadiness. In severe cases, pressure on the spinal nerves can cause paralysis and problems with bladder and / or bowel function.

Common Techniques For Decompression Are:
•Diskectomy: Involves removing a portion of a disk to relieve pressure on the nearby nerve roots.
•Laminotomy or laminectomy: Involves removing a small part of the bony arches of the spinal canal, called the lamina. During a laminotomy, just a section of the lamina is removed. During a laminectomy, the entire lamina is removed. Removing the lamina increases the size of the spinal canal, relieving pressure.
•Foraminotomy or foraminectomy: Both procedures are performed to expand the openings for the nerve roots to exit the spinal cord by removing some bone and other tissue. A foraminectomy generally refers to a procedure that removes a large amount of bone and tissue.
•Osteophyte removal: This involves removing bony growths called Osteophyte or bone spurs.
•Corpectomy: This is surgery to remove the body of a vertebra, as well as the disks.

A combination of techniques may be used; and in some cases, fusion of the vertebrae also is needed to stabilize the spine.

Walking is started after 24-48 hours.

You will stay in the hospital for four or five days, depending on the extent of your spine surgery. You will be given medication to control pain. Rehabilitation will include a program of physical therapy.

Nucleoplasty:

Nucleoplasty is a minimally invasive procedure for treating patients symptomatic with low back and leg pain caused by a herniated disc that have not improved after approximately three months of conservative therapy such as rest, pain medication, physical therapy. It is also done in cases of positive MRI for contained disc herniation or bulge, positive discogram reproducing patient's symptomatic pain and contained disc herniation which measures less than 30% of the diameter of spinal canal.

Nucleoplasty is performed on an outpatient basis, with minimal anesthesia requirements. Fluoroscopic guidance is employed as an introducer needle is placed at the nucleus/annulus junction. A SpineWand is introduced through the passage way, and advanced into the disc nucleus. The tissue is then removed by either creating channels (lumbar spine) or spheres (cervical spine). It takes approximately one hour for the procedure. After sufficient tissue is removed, a bandage is placed on the skin and the patient is discharged home. Patients are then usually placed on a routine rehabilitation program. Nucleoplasty has little to no post-procedure pain.

A rehabilitation protocol is recommended, but not necessarily required for Nucleoplasty. An appropriate rehabilitation procedure incorporates progressive use of stretching and strengthening exercises, followed by staged return to more normal activities.

Cervical Disc Replacement:

Cervical disc replacement is indicated for a person with symptomatic cervical disc, i.e. which may be causing arm pain, arm weakness or numbness with some degree of neck pain. These symptoms may due to a herniated disc and/or osteophytes compressing adjacent nerves or the spinal cord. This condition typically occurs at cervical spine levels C4-5, C5-6, or C6-7.

The standard surgical approach for a disc replacement is an anterior approach to the cervical spine. The affected disc is completely removed including any impinging disc fragments or osteophytes. The disc space is distracted to its prior normal disc height to help decompress (relieve pressure) on the nerves. This is important because when a disc becomes worn out, it will typically shrink in its height, which can also contribute to the pinching on the nerves in the neck.

Unlike a fusion procedure, the artificial disc surgery does not have the potential complications associated with taking a bone graft from the hip thereby eliminating the issue of bone graft healing. The disc replacement also reduces the chances for adjacent segment disease, since the artificial disc allows for more normal neck motion and absorbs some of the daily stresses of the neck.

The length and type of activity restrictions following surgery are also much less with disc replacement.

Lumbar Disc Replacement:

Lumbar disc replacement is emerging as a new treatment option for some types of low back pain.

Degenerative disc disease – It is one type of back pain that is caused by wearing away of the cushion that rests between the vertebrae of our spine. The spinal column is made of stacked bones called vertebrae. These bones are separated by a cushion at each level called a spinal disc. The disc is a tough but pliable tissue that helps maintain the position of the spine, but also allows motion between the vertebrae. With this design we have the stability to stand upright, but also the flexibility to bend and twist. Unfortunately, these discs can cause problems as they wear away. As the disc ages, it becomes more brittle and less flexible. The disc also becomes more prone to injury and degradation. It is important to understand that aging discs is normal! MRIs of patients with no symptoms of back pain often show wearing away of the discs. It should not be considered abnormal to have wearing of the spinal discs. That said, some patients can develop symptoms of back pain, and it is possible that their symptoms come from the spinal disc degeneration. It is very important to have this carefully evaluated by your orthopedic surgeon before embarking on any treatment plan.
Lumbar disc replacement is similar to other types of joint replacement. In the lumbar spine, the goal is to remove the damaged, painful disc, and replace this with a metal and plastic implant. The implant is designed to move like a normal disc.

Spondylolisthesis:

Spondylolisthesis is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal or compression of the exiting nerve roots

What Are The Symptoms Of Spondylolisthesis?
The most common symptom of Spondylolisthesis is lower back pain which is often worse after exercise especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back. Some patients may develop pain, numbness, tingling or weakness in the legs due to nerve compression . Severe compression of the nerves can cause loss of control of bowel or bladder function,.

How Is Spondylolisthesis Diagnosed?
In most cases it is not possible to see visible signs of Spondylolisthesis by examining a patient. Patients typically have complaints of pain in the back with intermittent pain to the legs. Spondylolisthesis can often cause muscle spasms, or tightness in the hamstrings. Spondylolisthesis is easily identified using plain radiographs. A lateral X-ray (from the side) will show if one of the vertebra has slipped forward compared to the adjacent vertebrae. Spondylolisthesis is graded according the percentage of slip of the vertebra compared to the neighboring vertebra.

If the patient has complaints of pain, numbness, tingling or weakness in the legs, additional studies may be ordered. A CT scan or MRI scan can help identify compression of the nerves associated with Spondylolisthesis. Occasionally, a PET scan can help determine if the bone at the site of the defect is active.

What Is The Treatment For Spondylolisthesis?
The initial treatment for Spondylolisthesis is conservative and based on the symptoms.
•A short period of rest or avoiding activities such as lifting and bending and athletics may help reduce symptoms.
•Physical therapy can help to increase range of motion of the lumbar spine and hamstrings as well as strengthen the core abdominal muscles.
•Anti-inflammatory medications can help reduce pain by decreasing the inflammation of the muscles and nerves.
•Patients with pain, numbness and tingling in the legs may benefit from an epidural steroid injections
•Patients with isthmic Spondylolisthesis may benefit from a hyperextension brace. This extends the lumbar spine bringing the two portions of the bone at the defect closer together and may allow for healing to occur.
•For patients whose symptoms fail to improve with conservative treatment surgery may be an option. The type of surgery is based on the type of Spondylolisthesis.
•Patients with isthmic Spondylolisthesis may benefit from a repair of the defective portion of the vertebra, or a pars repair.
•If an MRI scan or PET scan shows that the bone is active at the site of the defect it is more likely to heal with a pars repair. This involves removing any scar tissue from the defect and placing some bone graft in the area followed by placement of screws across the defect.
•If there are symptoms in the legs the surgery may include a decompression to create more room for the exiting nerve roots. This is often combined with a fusion that may be performed either with or without screws to hold the bone together. In some cases the vertebrae are moved back to the normal position prior to performing the fusion, and in others the vertebrae are fused where they are after the slip
Spondylolisthesis cannot be completely prevented. Certain activities such as gymnastics, weight-lifting and football are known to increase the stress on the vertebrae and increase the risk of developing Spondylolisthesis.