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Dr. Paresh Bang
Consultant Spine Surgeon
Surgery For Complex Spine Pathologies In Amravati
Surgery For Complex Spine Pathologies
WHAT ARE THE SYMPTOMS OF COMPLEX SPINAL DISORDERS?
Because of the way the spinal cord is structured and how it functions, damage to the spine often produces specific patterns of symptoms based on where the damage has occurred.Some of these symptoms may include:
- Back pain
- Weakness
- Loss of feeling, which may include an inability to feel pain, temperature, or touch; in some cases, this may include a loss in the ability to sense where the limbs
- Changes in reflexes
- Loss of bladder or bowel control
- Erectile dysfunction
WHAT ARE THE TREATMENT OPTIONS FOR COMPLEX SPINAL DISORDERS?
Today, complex spine surgery may be used to treat many types of spinal disease and spine conditions including spinal tumors, infections, spine fractures and instabilities. Surgical treatment for these conditions often includes advanced procedures, such as stabilization with surgical hardware like plates and rods or pedicle screws. Titanium devices are sometimes used and bone grafts may be necessary in some cases.
For true stabilization, patients often require surgical fusion of the spine. Spinal fusion is an operation that creates a solid connection between two or more vertebrae, stopping them from moving separately. This procedure may assist in strengthening and stabilizing the spine by reducing the amount of motion in the bones. When performed by a skilled and experienced spine surgeon, it can help alleviate severe neck or back pain and prevent future spinal cord or nerve injuries.
Common Complex Spine Pathologies:
- Spinal Deformities:
- Scoliosis: Abnormal lateral curvature of the spine.
- Kyphosis: Excessive outward curvature of a spine, causing a hunchback appearance.
- Spondylolisthesis: Forward slipping of the one vertebra over another.
- Flatback Syndrome: Loss of the natural lumbar curve, leading to postural and mobility issues.
- Degenerative Spine Conditions:
- Degenerative Disc Disease (DDD): Breakdown of intervertebral discs causing pain, instability, and nerve compression.
- Spinal Stenosis: Narrowing of the spinal canal leading to compression of the spinal cord and nerves.
- Facet Joint Disease: Degeneration of the small joints between the vertebrae, leading to pain and stiffness.
- Spinal Trauma:
- Spinal Fractures: Vertebral fractures due to trauma or osteoporosis.
- Spinal Cord Injury: Injury to the spinal cord leading to paralysis or loss of function below the level of injury.
- Spinal Tumors:
- Primary Tumors: Tumors originating from the spinal cord, vertebrae, or surrounding tissues.
- Metastatic Tumors: Cancer that has spread to the spine from other parts of the body.
- Infections:
- Spinal Infections: Conditions like osteomyelitis, discitis, or epidural abscess that can damage the vertebrae, discs, or spinal cord.
Surgical Approaches for Complex Spine Pathologies:
- Spinal Fusion:
- Indication: Used for conditions like scoliosis, spondylolisthesis, degenerative disc disease, and spinal fractures where stability is compromised.
- Procedure: Involves fusing two or more vertebrae to eliminate motion between them and provide stability. Bone grafts, rods, screws, and plates are used to hold the spine in place while it heals.
- Types:
- Posterior Spinal Fusion: Performed through an incision in the back.
- Anterior Spinal Fusion: Access to the spine is gained through the abdomen.
- 360-degree Fusion: Involves both anterior and posterior fusion for more extensive stabilization.
- Osteotomies:
- Indication: Often used to correct severe spinal deformities like kyphosis or scoliosis that cannot be corrected with simple fusion.
- Procedure: Involves removing a portion of the bone (vertebrae) to the realign the spine. Types of osteotomies include:
- Smith-Petersen Osteotomy: Removes part of the vertebra to allow increased flexibility.
- Pedicle Subtraction Osteotomy (PSO): Removes a wedge-shaped portion of the vertebra for more substantial correction.
- Vertebral Column Resection (VCR): Removal of an entire vertebra for major spinal deformity correction.
- Decompression Surgery:
- Indication: Performed to relieve pressure on the spinal cord and nerves in conditions like spinal stenosis, herniated discs, and spinal tumors.
- Procedure: Involves removing part of the vertebra (lamina) or disc material to create more space for the spinal cord or nerve roots.
- Laminectomy: Removal of the lamina to the relieve pressure.
- Foraminotomy: Enlarging the openings where nerves exit the spinal column.
- Discectomy: Removal of the herniated disc that is pressing on a nerve.
- Vertebroplasty and Kyphoplasty:
- Indication: Used for treating spinal fractures, particularly in osteoporotic patients or those with spinal tumors.
- Procedure: Involves injecting bone cement into the fractured vertebra to stabilize it (vertebroplasty). In kyphoplasty, a balloon is first inserted and inflated to restore the vertebra’s height before cement injection.
- Tumor Resection:
- Indication: Removal of spinal tumors that are compressing the spinal cord or destabilizing the spine.
- Procedure: May involve removing the tumor entirely (en bloc resection) or debulking the tumor (partial resection) followed by radiation or chemotherapy.
- Complex Spinal Revision Surgery:
- Indication: Required for patients who have previously undergone spinal surgery but experience failed results or complications such as hardware failure, pseudoarthrosis (non-fusion), or recurrent deformity.
- Procedure: Often involves removing previous implants, correcting spinal alignment, and re-stabilizing the spine with new hardware.
- Minimally Invasive Surgery (MIS) for Complex Spine Conditions:
- Indication: Can be used in certain complex pathologies to minimize damage to surrounding tissues, reduce recovery time, and lower the risk of complications.
- Procedure: Small incisions are made, and specialized instruments, including endoscopes and navigation systems, are used to perform surgeries like fusion, decompression, or tumor removal with less tissue disruption.
Advanced Techniques in Complex Spine Surgery:
- Intraoperative Navigation:
- Uses real-time imaging (CT scans or MRI) and computer-assisted guidance to ensure precise placement of implants, screws, or rods during surgery.
- Robotic-Assisted Spine Surgery:
- Surgeons use robotic systems to enhance accuracy, particularly in placing screws or performing complex deformity corrections.
- Neuromonitoring:
- Continuous monitoring of the spinal cord and nerves during surgery to prevent damage and ensure that neurological function is preserved.
- 3D-Printed Implants:
- Customized spinal implants made using 3D printing technology can be used for complex cases where standard implants do not fit or provide adequate support.
Risks and Complications:
As with any major surgery, complex spine surgeries carry risks, including:
- Infection
- Excessive bleeding
- Nerve damage or paralysis
- Non-fusion (pseudoarthrosis)
- Implant failure
- Chronic pain
Conclusion:
Surgery for complex spine pathologies requires a specialized and experienced spine surgeon. These procedures are often necessary to restore function, alleviate pain, and correct spinal deformities that cannot be treated with conservative methods. Due to the complexity of these surgeries, they are usually performed by a team of specialists using advanced technology to improve outcomes. Proper diagnosis, planning, and rehabilitation are key components of a successful recovery.Visit Our Hospital