Spine or vertebrae is a part of the axial skeleton. The vertebral column is considered as the defining characteristic of a vertebrate. The spine is composed of 33 interlocking bones. These are separated by soft and compressible discs. These are divided into five segments and in each segment the vertebrae are numbered from top to bottom –
1. Cervical – neck
2. Thoracic – upper and middle back
3. Lumbar – lower back
4. Sacrum – pelvis
5. Coccyx – tailbone
There are different reasons due to which our spine gets problematic. These problems are solved with the help of surgeries. Some of the common reasons which lead to spine problems are given below –
1. Damage to nerve fibers can be traumatic or non-traumatic which affects our spine.
2. Vehicular accidents such as auto and motorcycle accidents are the leading cause of spinal cord injuries.
3. Consumption of alcohol affects around 25 percent of the total spine problem patients.
4. Athletic sports activities cause about 10 percent of spine injuries.
5. In some cases the injury does not get identified. This may cause accumulation of blood around the spinal cord.
6. Non traumatic injuries such as cancer, arthritis, osteoporosis, cancer can also cause spine pain.
There are different surgeries for correcting spine problems. These surgeries are imparted according to the requirement of the patient. Some of them are mentioned below –
1. Spinal fusion – In spinal fusion, two or more vertebrae are joined together. The main aim of the surgery is to remove bones and tissues which have become short and pressurizing the spinal nerves. It is the most common surgery for spine issues. In each of the technique, bone grafting is involved. It is done to help the bones heal together. After the spine is decompressed, bone graft is packed between the vertebrae to help them heal together. In most of the spinal fusion procedures, screws, rods and plates are supplemented.
2. Discectomy – discectomy is the surgical removal of herniated disc. In old age, herniated disc is the most common reason of spine pain. In herniated disc, spinal nerves are pressed on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc which causes pain. In discectomy, either a small part or the whole disc is removed. This process is preferred as it has high success rate. It is helpful in relieving leg pain which is also known as sciatica.
3. Spinal disc replacement – – spinal disc replacement is the latest technique in surgical treatment of spine. In this technique, the damaged disc is replaced with the help of an artificial one. Pain relief is bought by removal of the painful disc. Simultaneously, the motion of the body is maintained with the use of a prosthetic implant which is made up of metal with or without a plastic bearing surface. Before opting for surgeries, doctor examines the patient if he/she is a candidate.
4. Vertebroplasty – – it is a minimally invasive procedure which is done through a small puncture in the patient’s skin. This procedure is done to stabilize the spinal fracture and to stop the pain that is caused by the fracture. This procedure takes one hour to complete. A small needle in inserted through that small puncture. Specially formulated acrylic bone is injected under pressure.
5. Transforaminal lumbar interbody fusion (TLIF) – It is a surgical technique to stabilize the spinal vertebra and the disc between the vertebra. In this procedure an interbody space is inserted into the disc space. A bone graft is then placed into the interbody space. When this bone graft heals, it fuses the vertebra and forms one long bone.
6. Artificial cervical disc replacement (ACDR) – It is a procedure in which a painful disc in the neck is removed and replaced with an artificial one. This surgery is done to preserve motion at the disc space. This is a good option for reducing cervical degenerative disc disease of adjacent segments of the cervical spine.
7. Anterior lumbar interbody fusion (ALIF) – It is an interbody fusion technique that is undergone by patients who are suffering from discogenic back pain. In this procedure, graft is inserted into the empty disc space to support and create lumbar fusion. This procedure takes around 2-3 hours in total to get completed.
It should be the last resort and reasonable for diseases such as spinal stenosis, sciatica, spondylolisthesis etc.
In endoscopic discectomy, patients can go home the same day. In lumbar fusion surgery, patient can go home in 2-3 days.
Some patients return to full activity in about 6 weeks and other require more time. Physical therapy program is encouraged to all the patients.
The short term success is well known. The recovery is rapid and return to work is also very quick.