Spine surgery

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  • Spine Surgery Department

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    Disc Herniation
    Lumbar & Cervical

    Discs are strong, elastic, jelly like structures, placed between the adjacent surfaces of the vertebral bodies (individual bone of spinal column) and are contained by a strong cover around it.

    This structure is mainly responsible for weight transmission and bears the shocks of bending, jumping and routine other biomechanics forces that the spinal column is subjected in our daily activities.

    Over a period of time,the elastic properties of the disc reduce s and they start hardening and develop cracks in it (Fissuring) —like an agricultural field cracks when it is dry.

    Why and how
    Discs  Herniate

    When some sudden unexpected force is applied on the spine like unguarded sudden awkward bending, this hard fissured disc material, tears the capsule cover and herniates outside its confinement like a toothpaste coming out of its can and irritates the nerve roots and spinal cord behind to produce typical root pain and radicular pain or sciatica. Depending on the extent of herniation, symptoms may be just a simple back pain, radiating pain along the lower limbs and upper limbs, along the particular nerve root affected. In case of large and severe herniation, focal neurological deficit like weakness of muscle or a movement or numbness.

    What should I do :
      Rest for Spine

    •   No weight bearing on spine, meaning you are allowed to get up for attending toilet needs and other acts like eating. If the body’s weight is not loaded on the spine, there is a good chance that the herniated disc may get back to its place, with reduction of pain.
    • Simple pain killers like NSAID’s helps a lot.

    When to
    consult Doctor ?

    • If radiating pain or limb pain is severe and excruciating and prevents you from performing routine activities
    • When you experience numbness of feet, leg or finding it difficult to grasp objects or walk.
    • If there are symptoms of difficulty in passing urine.

    Epilepsy
    Surgery

    The well-established epilepsy surgery programme at our Hospital comprises a multidisciplinary group of health care professionals who specialise in investigation and treatment of epilepsy.

    Investigations doctor
    would like to do:

    • A thorough clinical neurological examination to define the particular nerve root affected and quantify the extent of neurological dysfunction.
    • MRI scan which will outline the exact nature and extent of herniation.
    • X-ray of the spine, to confirm the stability of the spine and state of bone.

    Neuropsychology
    Inpatients

    Inpatient referrals are accepted from any neuroscience ward within Salford Royal Hospital and from any health professional involved in the care of the patient.

    When surgery
    is advocated

    • When limb pain is more than neck pain or back pain.
    • If straight leg raising test elicits pain within 40 degrees.
    • MRI should demonstrate a sizeble disc material at the appropriate level corresponding to the nerve root in which pain occurs like L5 or S1 dermatomes
    • Failure of absolute bed rest > 5 to 7days.

    What surgical Procedure
    Minimally invasive Spine surgery

    • Usually herniated lumbar disc or cervical disc are removed with minimal access spinal surgery employed with various gadgets like spinal endoscopy and microscopy.
    • The procedure is performed under General anaesthesia with X-ray guidance. Usually a 1.5- 2cm incision made and the endoscope is inserted and access to disc is easily obtained. No spinal bone is disturbed as the Endoscope travels through normal avenues to the spine. All the herniated free discs are removed and roots made free. Alternatively endoscope is inserted under local anaesthesia also ( Spinal foraminoscopy)
    • Usually, the surgery takes 30-40minutes and pain relief is instant and is finished as a day care surgery
    • No complications are usually seen and if it is, it is very negligile

    Key Procedures

    • Endoscopic discectomy
    • Microsurgical discectomy

    Spinal instrumentation utilizes surgical procedures to implant titanium, titanium-alloy, stainless steel, or non-metallic devices into the spine. Instrumentation provides a permanent solution to spinal instability. Medical implants are specially designed and come in many shapes and sizes. Typically these include rods, hooks, braided cable, plates, screws, and interbody cages. Cages are simply structures that support bones (either between bones or in place of them) while new bone growth occurs through and around them.


    Spinal fusion is a process using bone graft to cause two opposing bony surfaces to grow together. In medical terminology, this is called arthrodesis. Bone graft can be taken from the patient (termed autologous or allograft bone) during the primary surgical procedure or harvested from other individuals (termed allograft bone). Another option for some patients undergoing lumbar (low back) spine surgery is bone morphogenetic protein (BMP). BMP stimulates new bone to grow.

    Endoscopic Spine Surgery is a type of state-of-the-art surgery that uses small tubular system or micro incisions, assisted with an endoscope for visualization. This type of Minimally-Invasive Spine Surgery (MISS) provides patients with quicker recovery and less pain than traditional spine surgery.

    Microsurgery may be used to remove a tumor or tangle of blood vessels in the spinal cord, a procedure called microsurgical spinal cord tumor resection. It may be used to remove part of a damaged disc, as in a cervical microdiscectomy or a lumbar microdiscectomy.

    A traumatic spinal cord injury may happen because of a sudden blow or cut to the spine.

    A spinal cord injury often causes permanent loss of strength, sensation and function below the site of the injury.

    Rehabilitation and assistive devices allow many people with spinal cord injuries to lead productive, independent lives. Treatments include drugs to reduce symptoms and surgery to stabilise the spine.

    Also called swayback, the spine of a person with lordosis curves significantly inward at the lower back. Kyphosis.Kyphosis is characterized by an abnormally rounded upper back (more than 50 degrees of curvature).Scoliosis.

    The craniovertebral junction (CVJ) comprises the occiput, atlas, and axis and is visible in most magnetic resonance (MR) imaging studies of the brain. Craniometric measurements used in radiologic assessment of CVJ anomalies include the Chamberlain line, Wackenheim clivus baseline, Welcher basal angle, and atlantooccipital joint axis angle.

    Vascular malformation is a general term that includes congenital vascular anomalies of only veins, only lymph vessels, both veins and lymph vessels, or both arteries and veins. Only veins: venous malformation (VM) Only lymph vessels: lymphatic malformations(LM)




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