How is a Spinal Operation Performed?

The Function of the Spine or Spinal Column

The spine, or spinal column, is a complex structure with functions of support, movement, and protection of the nerve structures contained within the vertebral canal. It is formed by the superposition of bony segments to create a robust column capable of supporting axial loads passing through the anterior, somatic part, and in the posterior part, the articular processes, such as shear forces. The main elements are the vertebrae, intervertebral discs, and muscles, with functions of support and movement, but also of protection of the nerve structures.

The spine or spinal column is composed of a series of functional units, each consisting of two superimposed and contiguous vertebrae with their intermediate tissues. From a functional point of view, it can be said that the anterior part of the functional unit formed by the vertebral bodies is the part that presides over static absorption and shocks. The posterior part, on the other hand, formed by the arches and apophyses, is the kinetic, dynamic part, that is to say the one that determines the movement of the vertebral bodies.

The nucleus, moving within the annulus fibrosus, allows for a fixed and upright position as well as extension, flexion, and rotation movements.

The intervertebral disc is capable of resisting even considerable loads, by deforming and regaining its shape and size after the disappearance of the mechanical stress. However, if it is subjected to an excessive load that exceeds the limits of tolerance, degenerative processes can occur in the disc, leading to pain.

Spinal Pathologies

Spinal pathologies are essentially pathologies of degenerative, traumatic, infectious, or tumoral genesis, affecting the bony, articular, and ligamentous structures of the spine and which, most often at a later stage, can also affect the nerve structures.

The most common cause of spinal problems is degenerative. Degenerative spinal pathology can lead to a herniated disc, disc disease with narrowing of the spinal canal (stenosis), or slippage of one vertebra over another (spondylolisthesis) with alteration of the shape of the spine (degenerative scoliosis).

Here are some pathologies that most often require spinal surgery:

• Stenosis: This is the narrowing of the spinal canal within which the nerve structures are located. Stenosis can be congenital, i.e., present at birth, or occur over time due to arthritic phenomena that reduce the diameter of the spinal canal (acquired stenosis) and can be cervical or lumbar;
• Osteoporosis: This is a systemic skeletal disease characterized by low bone mineral density and progressive alteration of the internal microarchitecture of bone tissue. The most common forms of osteoporosis are postmenopausal, senile, and secondary;
• Spinal Tumors: Warning signs for these neoplasms are pain in the spine and neurological deficits in the lower limbs, such as loss of strength and sensation in the legs or arms;
• Scoliosis is an abnormal deviation of the spine, manifested by lateral inflexion and rotation of the vertebrae. If the patient bends their upper body forward, looking at them from the front and back, you will also see the hump, the protrusions caused by the curvature;
• Spondylolisthesis: This is the forward slippage of one vertebra over the vertebra below. It affects the lumbar spine, mainly the fifth and fourth lumbar vertebrae. Spondylolisthesis causes complaints such as low back pain and/or radicular pain (sciatica);

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Spinal Surgery and Operations

Due to the different origins of spinal problems and the different diagnostic and therapeutic approaches, a large number of specialists may approach the patient at different times, sometimes proposing solutions that may seem different or even in "conflict" with each other, even if basically the patient wants to find the best back surgeon.

Generally, surgical treatment of the spine aims to improve the patient's quality of life in the presence of otherwise uncontrolled painful symptoms, or even neurological deficits (in the latter case, surgical treatment is almost mandatory).

The surgical techniques used are at the cutting edge of progress, both for their low biological invasiveness and for the innovative nature of the methods. Mini-invasive or percutaneous approaches and the almost permanent use of the operating microscope, guaranteeing small skin incisions and minimal manipulation of the paravertebral muscles, allow even the oldest patients to be quickly mobilized and to resume their usual daily activities.

When looking for the best spinal surgeon, or the best spinal column surgeon, you must ensure that the specialist in question has recognized skills in performing the following interventions:

• Discectomy: involves removing the herniated portion of the disc to access the inflamed nerve and relieve its irritation;
• Laminectomy: the bone covering the vertebrae is removed, creating space to relieve pressure generated by stenosis;
• Fusion: spinal fusion mainly consists of joining two or more bones of the spine. It can relieve pain by ensuring stability of a fracture or simply eliminate pain caused by the movement of the vertebrae, which can degenerate or damage certain vertebral discs;
• Disc Implant: a disc implant exists as an alternative to arthrodesis, although it cannot be used in everyone;

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