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Title: Spine Surgery Overview


1
Spine Surgery Overview
If youve struggled with back pain for any length
of time, you may be wondering if spine surgery is
your only treatment option. Sometimes, surgery is
the only treatment. However, theres good
news. The vast majority of back problems can be
remedied with non-surgical treatments often
referred to as non-surgical or conservative
therapies. If youve struggled with back pain for
any length of time, you may be wondering if spine
surgery is your only treatment option. Sometimes,
surgery is the only treatment. However, theres
good news. The vast majority of back problems can
be remedied with non-surgical treatments often
referred to as non-surgical or con- servative
therapies.
2
CONSERVATIVE TREATMENT
As with all non-emergency spinal surgeries, a
trial of non-operative treatment, such as
physical therapy, pain medicationpreferably an
anti-in?ammatory, or bracing should be observed
before surgery is considered. The trial period of
conservative treatment varies, but six weeks to
six months is the general timeframe. Spine
surgery may be recommended if non-surgical
treatment such as medications and physical
therapy fails to relieve symptoms. Surgery is
only considered in cases where the exact source
of pain can be determinedsuch as a herniated
disc, scoliosis, or spinal stenosis.
3
MINIMALLY INVASIVE SURGERY
  • Traditionally, spine surgery is usually performed
    as open surgery. This entails opening the
    operative site with a long incision so the
    surgeon can view and access the spinal anatomy.
    However, technology has advanced to the point
    where more spine conditions can be treated with
    minimally invasive tech- niques.
  • Because minimally invasive spine surgery (MISS),
    does not involve long inci- sions, open
    manipulation of the muscles and tissue
    surrounding the spine is avoided, therefore,
    leading to shorter operative time. In general,
    reducing intraoperative (during surgery)
    manipulation of soft tissues results in less
    postoperative pain and a faster recovery.

4
IMAGING DURING SURGERY
  • Computer-assisted image guidance allows surgeons
    to view the operative site in far ?ner clarity
    than traditional visualization techniques. In
    addition, implants such as rods or screws can be
    inserted and positioned with a greater degree of
    accuracy than is generally achieved with
    conventional techniques.
  • In computer-assisted image guidance, images taken
    preoperatively (before surgery) are merged with
    images obtained while the patient is in surgery,
    yielding real-time views of the anatomical
    position and orientation of the operative site
    while the patient is undergoing surgery.
    Preoperative computed tomography (CT) and
    intraoperative ?uoroscopy (real-time x-ray) are
    generally used, as these enable surgeons to
    operate with a high level of precision and
    safety.
  • Not all patients are appropriate candidates for
    MISS procedures. There needs to be relative
    certainty that the same or better results can be
    achieved through MISS techniques as with an open
    procedure.

5
SURGICAL APPROACHES
  • Whether open surgery or MISS, the spine can be
    accessed from di?er- ent directions. These are
    referred to as surgical approaches and are
    explained below
  • ANTERIOR APPROACH As the name implies, the
    surgeon accesses the spine from the front of your
    body, through the abdomen.
  • POSTERIOR APPROACH An incision is made in your
    back.
  • LATERAL APPROACH The pathway to your spine is
    made through your side.

6
COMMON SURGICAL PROCEDURES
  • There are a number of conditions that may lead to
    spine surgery. Common procedures include
  • DISCECTOMY OR MICRODISCECTOMY Removal of a
    herniated interverte- bral disc. Therefore,
    removing pressure from the compressed nerve.
    Microd- iscectomy is a MISS procedure.
  • LAMINECTOMY Removal of the thin bony plate on
    the back of the vertebra called the laminae to
    increase space within the spinal canal and
    relieve pressure.
  • LAMINOTOMY Removal of a portion of the vertebral
    arch (lamina) that covers the spinal cord. A
    laminotomy removes less bone than a laminec-
    tomy.
  • Both laminectomy and laminotomy are
    decompressionprocedures. Decom- pression
    usually means tissue compressinga spinal nerve is
    removed.
  • FORAMINOTOMY Removal of bone or tissue at/in the
    passageway (called theneuroforamen) where nerve
    roots branch o? the spinal cord and exit the
    spinal column.
  • DISC REPLACEMENT As an alternative to fusion,
    the injured disc is replaced with an arti?cial
    one.

7
COMMON SURGICAL PROCEDURES
  • SPINAL FUSION A surgical technique used to join
    two vertebrae. Spinal fusion may include the use
    of bone graft with or without instrumentation
    (eg, rods, screws). There are di?erent types of
    bone graft, such as your own bone (autograft) and
    donor bone (allograft). A fusion can be
    accomplished by di?erent approaches
  • ALIF, PLIF, TLIF, LIF All pertain to lumbar
    interbody fusion used to stabilize
  • the spinal vertebrae and eliminate movement
    between the bones.
  • Anterior Lumbar Interbody Fusion Posterior Lumbar
    Interbody Fusion
  • Transforaminal Lumbar Interbody Fusion indicates
    a surgical approach through the foramen.
  • Lateral Interbody Fusion in which the minimally
    invasive approach is from the side of the body.

8
SPINAL INSTRUMENTATION
  • Computer-assisted image guidance allows surgeons
    to view the operative site in far ?ner clarity
    than traditional visualization techniques. In
    addition, implants such as rods or screws can be
    inserted and positioned with a greater degree of
    accuracy than is generally achieved with
    conventional techniques.
  • In computer-assisted image guidance, images taken
    preoperatively (before surgery) are merged with
    images obtained while the patient is in surgery,
    yielding real-time views of the anatomical
    position and orientation of the operative site
    while the patient is undergoing surgery.
    Preoperative computed tomography (CT) and
    intraoperative ?uoroscopy (real-time x-ray) are
    generally used, as these enable surgeons to
    operate with a high level of precision and
    safety.
  • Not all patients are appropriate candidates for
    MISS procedures. There needs to be relative
    certainty that the same or better results can be
    achieved through MISS techniques as with an open
    procedure.
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