Spinal Surgery

Spinal surgery is believed to be one of the most complex and sophisticated surgery which is to be done with utmost caution and precaution. It is said a little bit of carelessness can even cause death or complete paralysis in a patient.

The spine is made up of a series of bones called "vertebrae"; between each vertebra are strong connective tissues which hold one vertebra to the next, and acts as a cushion between the vertebrae. The disc allows for movements of the vertebrae and lets people bend and rotate their neck and back. The type and degree of motion varies between the different levels of the spine: cervical (neck), thoracic (chest) or lumbar (low back). The cervical spine is a highly mobile region that permits movement in all directions. The thoracic spine is much more rigid due to the presence of ribs and is designed to protect the heart and lungs. The lumbar spine allows mostly forward and backward bending movements (flexion and extension).

Spinal Fusion Surgery:
There are many surgical approaches and methods to fuse the spine, and they all involve placement of a bone graft between the vertebrae. The spine may be approached and the graft placed from the back (posterior approach), from the front (anterior approach) or by a combination of both. In the neck, the anterior approach is more common; lumbar and thoracic fusion is usually performed posteriorly.

The ultimate goal of fusion is to obtain a solid union between two or more vertebrae. Fusion may or may not involve use of supplemental hardware (instrumentation) such as plates, screws and cages. Instrumentation is sometimes used to correct a deformity, but usually is just used as an internal splint to hold the vertebrae together to while the bone grafts heal.

Whether or not hardware is used, it is important that bone or bone substitutes be used to get the vertebrae to fuse together. The bone may be taken either from another bone in the patient (autograft) or from a bone bank (allograft). Fusion using bone taken from the patient has a long history of use and results in predictable healing. Autograft is currently the "gold standard" source of bone for a fusion. Allograft (bone bank) bone may be used as an alternative to the patient's own bone. Although healing and fusion is not as predictable as with the patient's own bone, allograft does not require a separate incision to take the patient's own bone for grafting, and therefore is associated with less pain. Smoking, medications you are taking for other conditions, and your overall health can affect the rate of healing and fusion, too.

Currently, there is promising research being done involving the use of synthetic bone as a substitute for either autograft or allograft. It is likely that synthetic bone substitutes will eventually replace the routine use of autograft or allograft bone.

With some of the newer "minimally invasive" surgical techniques currently available, fusion may sometimes be done through smaller incisions. The indications for minimally invasive surgery (MIS) are identical to those for traditional large incision surgery; however, it is important to realize that a smaller incision does not necessarily mean less risk involved in the surgery.

Cervical Spine Surgery:
Cervical spine surgery may be indicated for a variety of cervical spine problems. Generally, surgery may be performed for degenerative disorders, trauma or instability. These conditions may produce pressure on the spinal cord or on the nerves coming from the spine.

The goal of cervical spine surgery is to relieve pain, numbness, tingling and weakness, restore nerve function and stop or prevent abnormal motion in the spine. Your surgeon does this by removing a disc or a bone and fusing the vertebrae together with a bone graft either in front of or behind the spine. The bone graft may be one of two types: an autograft (bone taken from your body) or an allograft (bone from a bone bank). Sometimes metal plates, screws or wires are also used to further stabilize the spine. These techniques are called instrumentation. When the vertebrae have been surgically stabilized, abnormal motion is stopped and function is restored to the spinal nerves.

Spine fusion instrumentation
The role of spine fusion instrumentation is to provide additional spinal stability while helping the fusion set up.

Various forms of instrumentation (medical devices) have been developed with the goal of improving the rates of successful spinal fusion. Because bone tends to fuse more effectively in an environment where there is little motion, instrumentation helps the fusion set up by limiting the motion at the fused segment.

There are three primary types of spine surgery instrumentation:
� Pedicle screws-Pedicle screws provide a means of gripping onto a vertebral segment and limiting its motion.