The spine, also known as the vertebral column, is a complex skeletal structure that extends from the neck to the lower back. It is composed of 33 irregularly shaped bones stacked on top of each other, with intervertebral disks in between. Its primary function is to provide structural support to the body, serving as the central axis around which the skeleton is organised.
The spine also enables us to maintain posture, balance, and an upright position, while allowing a wide range of mobility and flexibility for bending, twisting, and movement of the upper body. Additionally, the spine absorbs shock and distributes weight, protecting the vertebrae and intervertebral disks from damage during physical activity.
One of the most important functions of the spine is to protect the spinal cord, a large bundle of nerves that transmit signals between the brain and the rest of the body. Conditions affecting the spine can be debilitating, but surgery is considered high-risk due to the essential functions of the spine. Therefore, all non-surgical approaches to treatment will be exhausted before surgery is considered.
When surgery is necessary, the type of surgery conducted will depend on the condition to be treated. There are two major categories of spinal surgery: minimally invasive and open surgery. The extent of surgical exposure required to perform the procedure typically determines the invasiveness of surgery. Open surgeries are more invasive, requiring larger incisions and more tissue disruption, while less invasive surgeries can be performed using smaller incisions and specialized tools that cause less tissue damage.
Factors that can contribute to the invasiveness of surgery include the type of procedure being performed, the location of the surgical site, and the overall health and medical history of the patient. The decision to perform minimally invasive or open surgery is based on a careful evaluation of the risks and benefits of each approach, as well as the individual needs and preferences of the patient. The ultimate goal is to achieve the best possible outcome with the least amount of risk and trauma to the patient.
Minimally invasive spinal surgeries
Minimally invasive surgery involves smaller incisions and less disruption of surrounding tissues, resulting in fewer complications, less blood loss, reduced pain, and shorter recovery times. It may be appropriate for certain conditions, such as herniated discs, spinal stenosis, and some spinal deformities. Here are some examples of minorly invasive spinal surgeries:
Minimally Invasive Lumbar Decompression (MILD):
Minimally invasive lumbar decompression uses a small incision and specialized tools to remove small pieces of bone or tissue. It is used to treat spinal stenosis, a condition where the spinal canal narrows, causing pressure on the spinal cord and nerves. The procedure is designed to remove the excess tissue that is causing the narrowing, without the need for open surgery.
The procedure typically takes less than an hour to complete and is done on an outpatient basis under local anaesthesia.
A herniated disc, also known as a slipped or ruptured disc occurs when one of the intervertebral discs bulges or ruptures, causing the soft inner material of the disc to push out and press on the nerves or spinal cord. Herniated discs can occur in any part of the spine, but they are most common in the lower back (lumbar spine) and the neck (cervical spine).
A microdiscectomy is a procedure that uses a small incision and specialized tools to remove a portion of the herniated disc to relieve nerve pressure. An endoscopic discectomy uses an endoscope (a small camera) and specialised tools to remove a herniated disc, to preserve healthy disc tissue.
Transforaminal Lumbar Interbody Fusion:
Transforaminal Lumbar Interbody Fusion is a surgical procedure used to fuse two or more vertebrae to treat a variety of conditions affecting the lower back, including degenerative disc disease, herniated discs, and spinal stenosis.
During a Transforaminal Lumbar Interbody Fusion, the surgeon approaches the spine through a small incision in the back and removes a portion of the damaged disc, creating space between the vertebrae. A bone graft, often taken from the patient's hip or a donor, is then inserted into the disc space to promote fusion between the adjacent vertebrae. Metal screws, rods, or cages may also be used to provide stability and support during the healing process.
This technique is often preferred over other spinal fusion techniques because it provides greater access to the disc space, allows for removal of the disc without disrupting the spinal canal or nerve roots, and can be performed using a minimally invasive approach, resulting in less tissue damage, reduced pain, and faster recovery times.
The vertebrae and intervertebral discs of the spine are stacked together in such a way that they form the s-shame we associate with the normal posture of the back. Kyphosis is when there is an abnormal outward curvature of the spine, resulting in a rounded or hunched-back appearance. The condition can affect any part of the spine, but it most commonly occurs in the upper back or thoracic spine.
Kyphosis can have various causes, including poor posture, degenerative disc disease, osteoporosis, Scheuermann's disease (a condition that affects the growth of the vertebrae during adolescence), spinal fractures, and congenital abnormalities. Symptoms of kyphosis may include back pain, stiffness, and fatigue, and in severe cases, it can cause difficulty breathing, nerve compression, and spinal deformity.
Treatment for kyphosis depends on the underlying cause and severity of the condition. Mild cases may be managed with physical therapy, exercises to improve posture and pain relief medications. In more severe cases, spinal braces or surgery may be necessary to correct the spinal curvature and prevent further complications.
A Kyphoplasty involves inflating a tiny balloon in a compressed vertebra and then injecting bone cement to restore the height and shape of the vertebra. The restoration of height and shape of collapsed vertebrae also restores the overall normal curvature of the spine.
Radiofrequency ablation uses an electrical current produced by a radiofrequency generator, which heats a small area of nerve tissue and disrupts its ability to transmit pain signals. This is commonly used to treat chronic pain conditions, particularly in the neck, back, and joints.
It is recommended for patients who have not responded well to other treatments, such as physical therapy, medication, or steroid injections. Radiofrequency ablation is performed on an outpatient basis, typically using local anaesthesia and mild sedation.
Open spinal surgeries
Not all spinal conditions can be treated with minimally invasive surgery. Some surgeries require larger incisions and more extensive manipulation of tissues, allowing for greater visualization and access to the affected area. Open surgery may be necessary for more complex cases, such as spinal tumours, fractures, and severe deformities. Open surgery carries a higher risk of complications, including infection, bleeding, nerve damage, and prolonged recovery times. Rehabilitation and physical therapy are often necessary after open surgery to restore strength and mobility to the affected areas. Here are some examples of open spinal surgeries:
Open Spinal Fusion:
Open spinal fusion is a traditional surgical technique where a large incision is made in the back to access the spine, and screws and rods are used to fuse two or more vertebrae. This is an effective technique for stabilizing the spine, but it is associated with a longer hospital stay and recovery time, as well as a higher risk of complications.
Corpectomy is a surgical procedure that involves removing a portion of the vertebrae along with the adjacent intervertebral discs and ligaments. This is done to relieve pressure on the spinal cord or nerve roots that are being compressed due to conditions such as spinal cord injury, spinal tumours, herniated discs, or spinal stenosis.
During the procedure, the surgeon removes the vertebral body and replaces it with a bone graft, metal cage, or implant. The goal of this procedure is to restore stability to the spine and prevent further damage to the spinal cord or nerve roots.
Corpectomy is a complex procedure and is typically only done when other treatments, such as medication or physical therapy, have not been effective in relieving symptoms. It is usually reserved for patients with severe spinal cord compression or neurological deficits.
Vertebrectomy is a surgical procedure that involves the removal of one or more vertebrae from the spinal column. This procedure may be performed to treat a variety of spinal conditions, including tumours, spinal fractures, and severe spinal deformities.
During a vertebrectomy, the surgeon will make an incision in the back and use specialized instruments to remove the affected vertebra or vertebrae. Once the vertebra is removed, the surrounding vertebrae are often fused using screws, rods, or other implants to maintain stability and prevent further damage to the spine.
Disc Replacement Surgery:
Disc replacement surgery, also known as artificial disc replacement or total disc arthroplasty, is a surgical procedure used to treat chronic back pain caused by degenerative disc disease. The procedure involves removing the damaged or degenerated disc in the spine and replacing it with an artificial disc implant made of metal or a combination of metal and plastic. The prosthetic disc is designed to mimic the natural movement and function of a healthy intervertebral disc.
Disc replacement surgery is considered a less invasive alternative to spinal fusion and preserves more of the natural mobility and flexibility of the spine, which may lead to a faster recovery and better overall outcomes for some patients.
Surgical intervention for spinal conditions is considered high-risk and is only recommended when non-surgical treatments have failed. When surgery is necessary, the extent of surgical exposure required will determine the invasiveness of surgery. The decision to perform minimally invasive or open surgery depends on several factors such as the type of procedure, the location of the surgical site, and the overall health and medical history of the patient. The ultimate goal of surgery is to achieve the best possible outcome with the least amount of risk and trauma to the patient.