Spine Surgery

How is the spine formed?

The spine is composed of 32 vertebrae separated by fibrocartilaginous discs. It consists of five regions:

• cervical;
• thoracic;
• lumbar;
• sacral;
• coccygeal;

The cervical vertebrae are made up of small bodies, the lumbar and sacral ones are much larger, as the body weight becomes heavier in the lower vertebrae.

Various problems can affect the spine. In less serious cases, rehabilitation can help relieve pain, backaches or spinal deviations. In some cases, however, surgery is the only solution.

A typical problem that can occur after spine surgery is thrombophlebitis. This is a situation where a vein becomes inflamed due to a blood clot, an intravenous injection or an infection in the surrounding tissues. These conditions usually cause tension and pain in the tissues surrounding the affected vein. Surgery can also lead to pulmonary complications. These problems may be due to the administration of anesthetics or long periods of bed rest, which can cause respiratory problems or infections. Sometimes, implants of metal screws, rods or plates may break or shift. These situations can cause pain and require a second surgical intervention to replace or repair the damaged parts.

In what cases is spine surgery necessary?

Spine surgery should be considered for the following conditions:

• Serious spinal diseases;
• Neurological deficits such as paralysis and loss of sensation;
• Herniated disc;
• Spinal stenosis;
• Scoliosis;
• Vertebral instability;
• Conditions that have not responded to rehabilitation therapies and medications;

Minimally invasive spine surgery: what does it consist of?

Open surgery, which was once the only possible approach, is increasingly being replaced by minimally invasive surgery.

While open surgery involves opening the affected area with a long incision, thus exposing all the vertebral structures, minimally invasive surgery does not require large incisions, reducing the surface area subjected to surgical manipulation.

Thus, minimally invasive spine surgery offers clear advantages in terms of reduced symptoms and postoperative recovery time. Of course, in some cases, open surgery remains essential.

The most common types of surgery performed on the spine are:

• Discectomy and microdiscectomy: removal of the herniated and intervertebral disc material. Microdiscectomy is a minimally invasive procedure;
• Laminectomy: removal of the posterior bony part of the vertebra;

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What are the risks of spine surgery?

Like any type of surgery, spine surgery can carry some risks. Minimally invasive surgery carries more or less the same risks, but to a lesser extent.

The most common risks of spine surgery are:

• Infections;
• Bleeding;
• Pain at the bone graft site;
• Nonunion, i.e. absence of bone fusion;
• Neurological damage;
• Embolism;

What are the most common approaches to spine surgery?

In both open and minimally invasive surgery, the surgeon can access the spine through different points, called "approaches":

• Anterior approach: the surgeon accesses the spine from the front of the body;
• Posterior approach: this is the most common approach, involving one or more incisions in the back;
• Lateral approach: the surgeon enters from the side;
• Foraminotomy: involves removing bone and/or cartilage tissue that obstructs the intervertebral foramen by compressing the root of a spinal nerve;
• Disc replacement: a new alternative to traditional spinal fusion;
• Spinal fusion: used to block the mobility of two or more adjacent vertebrae and involves the use of bone grafts;

Stabilization of the spine with open or minimally invasive technique

This is a surgical technique for the treatment of serious lumbar spine problems such as degenerative spondylolisthesis, spinal stenosis, adult scoliosis, multiple lumbar disc disease. It is characterized by the placement, under strict intraoperative radiological control, of titanium screws at the level of each affected vertebra, connected to bars of appropriate shape, in order to stabilize the pathological stretching of the spine responsible for the reported chronic pain. When necessary, this intervention can be associated with the need to release the nerve structures by removing the most posterior part of the vertebra (lamina) or by removing the degenerated and thickened ligaments between contiguous vertebrae (laminectomy - recessotomy).

The most modern technologies and advanced methods allow, in some cases, to perform these procedures minimally invasively, through small skin incisions, respecting as much as possible the soft tissues of the skin and muscles.

Spine tumor

The surgical evaluation of a spinal tumor must begin with a fundamental question: are the nerve structures of the spine, that is, the spinal cord and the nerves that branch from it, in danger?

The alteration of these structures can lead to loss of motor function, and even more, paralysis of more or less extensive areas depending on the location of the damage. Securing the nerve structures is therefore a top priority and is achieved in two ways: eliminating the direct compression of the nerve structures by the tumor when present, and ensuring or restoring the stability and structural integrity of the spine. A tumor that does not compress the spinal cord but has invaded the bony structure of the spine can also lead to neurological damage due to a structural failure of the spine itself and, consequently, compression and damage to the nerves.

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