Spine surgery is an elective surgical treatment applied for relieving pain (referred to as a radiculopathy or sciatica) or body weakness. There are two types of the spine surgery, namely decompression and fusion surgery.
Decompression surgery aims usually to relieve the pain resulting from nerve root impingement. Decompression surgery involves the removal of a small portion of the bone over the nerve root (laminectomy) and/or disc material under the nerve root (microdiscectomy). Nerve root pressure is resulted from herniated disc or spinal stenosis, especially, in the cervical and/or lumbar region.
Fusion surgery aims to stop or relieve the pain at a painful motion segment in the spine. The pain usually results from degenerative disc disease or spondylolisthesis. The procedure involves the fixation of the spinal bones using a bone graft or instrumentation to stop the motion at a painful vertebra segment which involves more than two vertebras.
The spine, which is a bridge between the head and the coccyx, consists of bones, joints and discs that carry a large portion of the body’s mass. Among the most important parts of the central nervous system and including the spinal cord, 23 of the 33 vertebrae in the spine have the ability to move. A healthy spine appears as a straight column when viewed from behind. When viewed from the side, it has a curved structure.
The spine can be damaged due to many different conditions such as aging, trauma, structural abnormalities and posture disorders. Spinal problems usually first manifest themselves with pain. The aim is to eliminate symptoms with non-surgical treatments and conservative applications. In more serious cases, spinal surgery procedures may be required.
What is Spine Surgery?
The surgical specialty that deals with surgical treatment applications of diseases related to the spine is called spine surgery. Structural, functional or mechanical problems that occur in the spine may manifest as pain and limited movement, loss of strength and sensation.
Negative conditions may occur in the spine due to reasons such as disc problems, spinal curvatures, calcification (arthrosis) in the vertebral joints, hernia, tumor, infection, and some congenital diseases. The treatment of these problems is carried out by Brain and Nerve Surgery or Orthopedics and Traumatology specialists who have received special training in the field of spine surgery.
Spine surgery clinics work with a multidisciplinary perspective, primarily in coordination with medical units such as neurology, physical therapy and rehabilitation due to their field of work. In spine surgery clinics, diagnosis, treatment and follow-up processes of many diseases such as spiral traumas, scoliosis, lumbar and neck hernias, degenerative diseases, spinal tumors and infections are carried out.
Surgical procedures performed within the scope of spine surgery are extremely delicate operations. The main priority of these surgeries is to stop the progression of the existing disease and then provide a significant clinical correction.
The spine is an extremely complex structure and the surgical treatment procedure for each region of the structure in question and each problem located in this region is different. In this context, certain types of spine surgery can be listed as follows:
Discectomy and Microdiscectomy
When the cartilage cushions between the vertebrae are damaged and put pressure on the spinal cord and/or the nerve roots coming out of the spinal cord, it is called disc herniation (lumbar-cervical herniation). Discectomy surgery is performed to eliminate this herniation. Performing discectomy procedures with minimally invasive methods is called microdiscectomy.
Disc Prosthesis Placement
This is a procedure in which the spine surgeon removes the damaged spinal disc and replaces it with artificial discs produced for this purpose. Although it is generally used in cervical region (neck) surgeries, it is also possible to apply this method to the lumbar (waist) region in selected patients.
Laminectomy
Laminectomy, which is applied to patients with spinal stenosis in the spinal canal, aims to increase the canal diameter. For this purpose, the thin bony part called lamina located at the back of the spine is partially or completely removed. In this way, the pressure on the spinal cord and nerve roots is eliminated. Laminectomy is the most commonly performed type of surgery for the treatment of lumbar spinal stenosis. This procedure can be combined with spinal fusion surgery in cases where it is not sufficient on its own.
Spinal Fusion/Stabilization
33 vertebrae with extremely complex functional and mechanical bonds come together to form the spine. Due to some diseases, there is a risk of the mechanical and functional integrity of two or more vertebrae being disrupted. As a result, various problems such as vertebral displacement, lateral spinal curvature, and hunchback may occur.
To eliminate such disorders, spinal fusion/stabilization is performed to permanently connect two or more bones in the spine. This procedure is a method frequently used in the treatment of spinal fractures, damage, trauma and degeneration related to discs. Depending on the use of devices such as screws and rods, the operation can be performed with or without instrumentation or with different methods such as using bone tissues taken from another part of the body.
Corpectomy
Corpectomy, in which one or more of the vertebrae are partially or completely removed; is usually applied in cases where the integrity of the spine is completely lost due to diseases affecting the main body of the spine and the damaged vertebra cannot be restored with other treatment methods.
What Diseases Are Treated in Spine Surgery?
Many different diseases are treated within the scope of spine surgery. So, what does spine surgery look for?
Degenerative diseases that are not trauma, inflammation or tumor and develop due to cell damage: Lumbar disc herniation, spondylolisthesis (Slippage), cervical disc herniation, cervical spondylotic myelopathy (neck canal stenosis), facet syndrome, aging spine and spinal canal stenosis
Tumors: Malignant tumors, benign tumors, spinal cord tumors, tumors that have spread to the spine (metastatic tumors), tumors of the spine itself (primary spinal tumors)
Infections: Epidural abscess, Pott abscess, spinal cord abscess (intramedullary abscess), spondylodiscitis
Traumas caused by work accidents, falls from heights, motor vehicle accidents: Lumbar disc herniations, spinal fractures, traumatic disc herniations, connective tissue injuries (ligamentous damages), fractures due to osteoporosis
Spinal curvatures: Kyphosis, congenital deformities, scoliosis (idiopathic, Scheuermann’s kyphosis)
Do Spine Surgeons Perform Pain Management?
Spine surgeons primarily apply conservative treatment procedures to relieve pain originating from the spine. If these methods are not sufficient, preoperative pain management procedures may be considered. Pain management procedures such as epidural steroids, ultrasound-guided radiofrequency ablation procedures, pain pacemakers (spiral cord simulator, SCS), cassette joint injections and root blocks can be performed to help patients have a pain-free period.
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