A Brief outline of commonly performed Spine Procedures:
Minimally Invasive Spine Surgery (MISS):
The most advanced spine procedure where the same surgical goal is achieved with small incisions, less tissue damage, less blood loss and early ambulation. The ambit of this procedure is rapidly expanding. Some of the procedures commonly done are :
Posterior cervical Discectomy.
Vertebroplasty and Kyphoplasty.
Percutaneous Endoscopic Lumbar Discectomy (PELD):
Trans-foraminal or inter-laminar endoscopic discectomy is evolving as the cornerstone procedure in patients requiring only discectomy. It can be done under local anesthesia and patient can be ambulated very early. Selected cases benefit the most. A small incision around 5 mm on the lateral aspect of back is sufficient for trans-foraminal surgery.
Cranio-vertebral Junction stabilization:
This procedure is done for unstable Cranio-vertebral junction. The joint between the skull and first two vertebra of spine is called as cranio vertebral junction. The instability can arise from birth defects, injuries, Rheumatoid arthritis, infections or postoperatively after excision of tumors at this location. Procedures commonly done are:
Occipito- cervical fusion
Odontoid screw fixation.
A prerequisite to such procedures is detailed CT scan of CVJ with 3D reconstruction and MRI. Vertebral artery CT angiogram may be needed. Screws are put into the bones and anchored together with contoured rods. Decompression done as per requirement. Bone grafts facilitate fusion over time.
Spine Fracture Fixation
Spine fractures resulting in instability of the spine are fixed with instrumentation, adequate decompression of neural elements is done with reduction of bony deformity and fusion with bone grafts. It most commonly involves pedicle screw fixation of thoracic & lumbar fractures; anterior cervical discectomy and fusion, sometimes posterior or 360 degree stabilization of cervical spine.
Tumors of Spine:
Tumors may be present in the vertebral column, inside the spinal column without encroaching the neural tissue (extradural), inside the spinal covering layer (dura) but not involving the cord tissue (Intradural extra medullary) or intramedullary (involving the spinal cord tissue). The last category being most devastating. Most commonly seen tumors are Neurofibroma, meningioma etc. which are in a intradural extramedullary location. If timely intervention is done, neurological weakness can be completely reversed.