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KNOW YOUR SPINE

SPINE-The spine (backbone) is the framework over which the body is built. It plays a vital role in mobility, stability and protection of the spinal cord. It is made up of 33 bony segments called vertebra/vertebral bones. The upper 24 vertebrae are highly mobile with intervening jelly like fibrous tissue called intervertebral discs between them. The lower vertebrae are fused. The vertebra and discs together form the spinal column from the head to the pelvis.

VERTEBRA-Each vertebra is made up of two parts, the front cylindrical strong portion called the body and the back portion is referred to as the vertebral or neural arch around the spinal cord.

The individual vertebrae are named according to their region and position. From top to bottom, the vertebrae are:
Cervical spine: 7 vertebrae (C1–C7)
Thoracic spine: 12 vertebrae (T1–T12)
Lumbar spine: 5 vertebrae (L1–L5)
Sacrum: 5 (fused) vertebrae (S1–S5)
Coccyx: 4 (3–5) (fused) vertebrae (Tailbone)

VERTEBRAL ARCH

The laminae are a pair of flat arched bones that form a component of the vertebral arch. The transverse processes spread out from the side of the pedicles, like wings, and help to anchor the surrounding muscle. The spinous process extend backwards at the apex of the laminae.It is palpable directly under the skin.

INTERVERTEBRAL DISC

The upper 24 vertebrae are highly mobile with intervening jelly like fibrous tissue called intervertebral discs between them. They act as shock-absorbers of the spine and are also responsible for mobility. Each disc is made up of the annulus fibrosus (outer, fibrous ring of an intervertebral disc) which allows the nucleus pulposus (the soft, central portion of an intervertebral disc) to stay contained within.

SPINAL CANAL

The spinal canal is a longitudinal space formed by the placement of vertebrae on top of each other. The spinal canal is formed by the vertebral body in front and the vertebral arch on the other sides and protects the spinal cord along the whole length

PARTS OF THE SPINE

The spine can be divided into 4 parts: cervical (neck area), thoracic (mid-back), lumbar and sacral region (low back area). The thoracic spine has an outward curve called kyphosis, whereas the lumbar spine has a slightly inward curve, which is called lordosis.

FACET JOINTS

These are two interlocking bony knobs connecting two vertebrae at any level, one on either side of the spine. These joints are meant for stability and also aid in the free movement of the spine. Articular cartilage covers the surfaces of the facet joints to assist in smooth, frictionless movement between the bones in the joint.

NEURAL FORAMEN

There are a pair of small holes/narrow tunnels between two vertebrae on either side, through which two nerves leave the spine. Each nerve has a sensory part(for sensation) and a motor part to supply muscles. These nerves can get compressed due to disc prolapse, ageing (degeneration), injury, trauma,bone spurs etc. which result in narrowing of the foramen and compression of the nerve.

spine surgery hospital in coimbatore
spine surgery hospital in coimbatore

Disc Herniation (Slipped Disc)

There is a tear in the annulus fibrosus (outer, fibrous ring of an intervertebral disc) which allows the nucleus pulposus (the soft, central portion of an intervertebral disc) to bulge out beyond the damaged outer rings. This herniated disc can press on the nerve/cord to varying degrees. Unless there is compression of the nerves or spinal cord, there may not even be symptoms.

The disc can slip out of position due to (a)ageing, (b)repetitive stress or (c)following an acute predisposing event. In general, the reason is usually multifactorial. Genetics, smoking, high body mass index and sedentary lifestyle also plays a role.

Ageing can cause degenerative wear and tear and hence the disc may prolapse out.
Repetitive stress includes contact sports, constant sitting/squatting for long durations and daily travelling.
Some examples of acute predisposing events includes bending forward to lift weights, long distance travel by two-wheeler/car, bumpy journey, sudden jump on the road bumper, sudden fall on the buttock etc.

Sports involve high velocity, sudden impacts and abrupt bending or torsional movements of, the lower back.

When the spine is straight, such as in standing or lying down, internal pressure is equalized on all parts of the discs. While sitting or bending to lift, internal pressure on a disc can move from 17 psi (lying down) to over 300 psi (lifting with a rounded back). Herniation of the contents of the disc into the spinal canal often occurs when the anterior side (stomach side) of the disc is compressed while sitting or bending forward, and the contents (nucleus pulposus) get pressed against the tightly stretched and thinned membrane (anulus fibrosus) on the posterior side (back side) of the disc. The combination of membrane thinning from stretching and increased internal pressure (200 to 300 psi) results in the rupture of the confining membrane. The jelly-like contents of the disc then move into the spinal canal, pressing against the spinal nerves, which may produce intense and potentially disabling pain and other symptoms.

Symptoms of disc prolapse can vary depending on the location of the herniation, severity/grade of the prolapse and the structures upon which the disc presses upon. The common symptoms are:
1.PAIN-neck/back pain of mild to severe grades is the cardinal symptom.
2.RADIATING PAIN-the pain may radiate to the arms (cervical disc) or the legs (lumbar disc) due to pressure and irritation of the nerve roots. Often, herniated discs are not diagnosed immediately, as the patients come with undefined pains in the thighs, knees, or feet.
3.SENSORY CHANGES-numbness, tingling, paresthesia
4.MOTOR CHANGES-muscular weakness, paralysis. Pain from a disc prolapse is usually continuous or at least is continuous in a specific position of the body. Pain due to muscle spasm is intermittent/pulsating type.
5.BOWEL /BLADDER INCONTINENCE
It is possible to have a disc prolapse without any pain. This depends on the location of the disc. Such discs are picked up on MRI incidentally. A clinician usually correlates the relation between the clinical symptoms and the MRI findings to identify if the disc prolapse is significant or not.

Rarely a large disc prolapse can press on the cauda equina (nerves within the spinal column). This is a surgical emergency as it can cause irreversible damage/paralysis. The nerve damage can result in loss of bowel and bladder control as well as sexual dysfunction. This disorder is called cauda equina syndrome.

Disc Prolapse is usually diagnosed based on medical history, physical examination, neurological examinations and followed by diagnostic imaging (usually X-rays and MRI scan)

The Differential Diagnosis of disc prolapse include:
Mechanical pain
Myofascial pain
Spondylosis or spondylolisthesis
Spinal stenosis
Abscess
Hematoma
Discitis or osteomyelitis
Mass lesion or malignancy
Myocardial infarction
Aortic dissection

More than 95% cases of Disc Prolapse do not need surgery. Conservative treatment includes pain-killer medications, physical therapy modalities (Interferential therapy/TENS/Ultrasonic massage/cervical/lumbar traction), spine core exercise program, corset/back-belt supports, bed rest and avoiding certain strenuous activities.

When conservative treatment fails, epidural injection of steroids along with local anaesthetics may reduce the inflammation and edema of the nerve root/cord. Epidural corticosteroid injections provide a slight and questionable short-term improvement in those with sciatica, but are unlikely of any long-term benefit. The complications are usually very less only.

Surgery is indicated for:
1.Failed conservative treatment
2.Severe initial pain
3.Presence of Neurological deficits
4.Progressive Neurological deficits
5.Cauda Equina Syndrome
6.Recurrent Symptoms
7.Significant Canal Stenosis

1.Micro-discectomy
2.Spinal decompression along with discectomy and fusion is usually done to remove the affected disc and fuse the adjoining vertebrae in order to stabilize the spine.

Microdiscectomy is a surgical procedure done to remove the herniated disk which is pressing on the spinal cord/ nerve. This surgical procedure involves use of a surgical microscope and microsurgical techniques to gain access to the spine. The microscope magnifies and illuminates the area of operation. Only a small portion of the herniated disc that pinches on the nerve roots is removed.
Additional procedure called Foraminotomy enlarges the neural foramen from which nerve roots emerge if there is impingement of the nerve roots there. Another additional procedure involves removal of the bony projections called as spondylophytes/bone spurs which cause pinched nerves.

This surgery is indicated in the presence of a significant disc prolapse along with instability of the spine which is detected in flexion-extension views of the spine. In this surgery, the affected disc is removed and then bone graft from the removed lamina with or without a metallic prosthesis called cage is used to fuse the two adjacent vertebrae which are unstable and moving abnormally with spine bending movements.

Lumbar disc surgery is usually performed with a skin incision on the back region. But the cervical discs can be approached from the front (anterior cervical discectomy +/- fusion) and posterior cervical discectomy. Due to further advancement in technology, discectomy can be performed through minimally invasive techniques that employ a small incision for the operation. These advanced techniques have diminished recovery time, followed by an improved success rate.

Spondylosis (Arthritis of the spine)

Spondylosis is the equivalent of Osteoarthritis of the knee joint. This is a degenerative condition where the bones that make up the spine (vertebrae) degenerate. Typically this degeneration forms bony projections (bone spurs) and reduces the height of the spongy discs between the vertebrae.

Spondylosis can affect the neck (cervical spine), upper, mid and lower back (thoracic spine and lumbar spine). The most common area affected is that of the lumbar spine and cervical spine.

Spondylosis is due to:
1.Age, which leads to wear and tear of spinal ligaments and bones
2.Weakened and degenerated intervertebral discs
3.Spinal cord injury
4.Genetic predisposition

WHAT ARE THE COMMON SYMPTOMS OF SPONDYLOSIS?

The signs and symptoms of spondylosis include:
1.Back and neck pain due to nerve compression
2.Numbness and tingling of arms and legs
3.Muscle spasms/cramps, referred to as claudication
4.Sciatica (low back pain extending down the leg)
Sometimes Incidental Xrays may show spondylosis, but patient may not show any symptoms. It is hence wise to consult your doctor and confirm the clinical relevance of the Xray findings.

Along with clinical examination, Xrays and if required MRI scans are needed to confirm the diagnosis. A special flexion-extension lateral view maybe needed to identify any associated instability of the spine. Nerve Conduction study maybe needed to confirm the diagnosis in some cases.

Non-surgical treatment is usually tried for most cases first and includes:
1.Adequate rest and activity restriction
2.Heat and/or ice therapy to lessen the pain
3.Special cervical pillows to relieve neck pain while sleeping
4.Exercises to strengthen your back and stomach muscles.
5.Regular walking and yoga
6.Chiropractic spinal manipulations- to correct the spinal alignment and improve your body’s function.

1.Guided steroid injections
2.Radiofrequency denervation
3.Spine decompression – Microdiscectomy
4.Spine decompression-Laminectomy
5.Spine decompression and Fusion
6.Spine decompression and Instrumentation
The nature of surgery depends on the clinical, Xray and MRI findings for each patient.

A good suitable mix of Steroids and Local Anaesthetic agents may be injected into facet joints (joints between adjacent vertebrae), epidural space (space around the spinal cord), or intervertebral disc spaces based on clinical examination, to reduce acute pain and pain radiating into a limb. This may need repetition at a later date.

Radiofrequency denervation is a technique wherein the nerves causing pain are detected and treated, to stop the transfer of pain messages. A radiofrequency probe is used to target the affected site. It wirks on the principle of converting electrical energy into thermal energy.

Spondylolysis

Spondylolysis is defined as a defect/stress fracture in the pars interarticularis (which is a part of the vertebral arch).

The vast majority of cases occur in the lower lumbar vertebrae (L5), but spondylolysis may also occur in the cervical vertebrae.

Atheletes are usually prone for spondylolysis. Any Sport involving repetitive/ forceful hyperextension of the spine, especially when combined with rotation can break the pars interarticularis leading to spondylolysis. The stress fracture of the pars interarticularis occurs on the side opposite to activity. For instance, for a right-handed player, the fracture occurs on the left side of the vertebrae.

Spondylolysis has a higher occurrence in the following activities:
1.Baseball
2.Military service
3.Tennis
4.Diving
5.Cheerleading
6.Gymnastics
7.Football
8.Wrestling
9.Weightlifting
10.Cricket
11.Rugby
12.Volleyball
13.Gym
14.Ballet
Males are more commonly affected by spondylolysis than females.The mean age of individuals with spondylolisthesis is 20 years of age.

Some classical features of spondylolysis are:
1.Unilateral low back pain
2.Pain that radiates into the buttocks or legs
3.Pain that can restrict daily activities
4.Pain that worsens after strenuous activity
5.Pain aggravated with lumbar hyperextension
6.Pain on completion of the stork test (placed in hyperextension and rotation)
7.Excessive lordotic posture
8.Unilateral tenderness on palpation

Along with clinical examination, Xrays and if required MRI scans are needed to confirm the diagnosis. A special flexion-extension lateral view maybe needed to identify any associated instability of the spine. The classical Xray finding in spondylolysis is a fracture line in the pars called Scottie dog fracture/beheaded Scottish terrier appearance.

1.Treatment for spondylolysis ranges from bracing, activity restriction, extension exercises, flexion exercises and deep abdominal strengthening, that is administered through physical therapy.
2.The duration of physical therapy a patient receives varies upon the severity of spondylolysis, however typically ranges from three to six months.
3.The goal of physical therapy is to minimize movement at the unstable defect of the pars interarticularis.
4.Once a patient completes physical therapy, and displays no symptoms or inflammation in the lower back, they are cleared to continue with daily or athletic activities. However, a patient may need to maintain a variety of rehabilitation techniques after physical therapy to prevent the recurrence of spondylolysis.
The aim of deep abdominal co-contraction exercises is to train muscles surrounding the lumbar spine which provide stability of the spine. Spondylolysis results in a spinal instability and disrupts patterns of co-recruitment between muscle synergies. Specifically, local muscles that attach directly to the spine are affected. The lumbar multifidis and transversus abdominis play a direct role in stabilizing the lumbar spine. Instead the local muscles in individuals with spondylolysis are vulnerable to dysfunction, which results in abnormal spinal stability causing chronic low back pain. To compensate, the large torque producing global muscles are used to stabilize the spine.

When the patient presents with pain and spondylolysis has been diagnosed, treatment often consists of a short rest period of two to three days, followed by a guided physical therapy program. There should be restriction of heavy lifting, excessive bending, twisting and avoidance of any work, recreational activities or participation in sport that causes stress to the lumbar spine.

Antilordotic lumbrosacral brace (Boston brace) is used to control and limit spinal movement, reduce stress on the injured spinal segment, immobilize the spine in a flexed position for a short period to allow healing of the bony defect in the pars interarticularis. Bracing maybe needed for 6–12 weeks depending on the severity of the symptoms.

Surgery
Most patients with spondylolysis do not require surgery.
Surgery is indicated if the symptoms are not relieved with non-surgical treatments, or when the condition progresses to high grade spondylolisthesis. There are two main types of surgery for this condition.

1.Spinal fusion and Instrumentation:

This procedure is recommended when a set of vertebrae becomes loose or unstable. The surgeon joins two or more bones (vertebrae) together through the use of metal rods, screws, and bone grafts. The bone grafts complete their fusion in 4–8 months following the surgery, securing the spine in the correct position.

2.Laminectomy:

Often performed when spinal stenosis occurs in conjunction with spondylolysis. The procedure surgically removes part or all of the lamina from the bony ring of the vertebra to reduce the pressure on the spinal cord. Laminectomy removes the bony arches over the spinal cord to decrease the pressure on the spinal nerves.

Spinal Stenosis/Spinal Canal Stenosis

Spinal canal stenosis is a condition of abnormal narrowing of the spinal canal/ neural foramen resulting in pressure on the spinal cord or nerve roots. The symptoms are typically gradual in onset and they improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Some common causes of spinal canal stenosis include:
1.Ageing
2.Osteoarthritis
3.Rheumatoid arthritis
4.Spinal tumors
5.Trauma – following injury (usually burst fracture or spine fracture-dislocation), the bone fragments may enter the spinal canal and press on the spinal cord
6.Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal[23]
7.Paget's disease of the bone
8.Scoliosis
9.Spinal Instability
10.Spondylolisthesis
11.Congenitally narrow canal by birth

There are many factors with ageing causing spinal canal stenosis:
Thickening of the Spinal ligaments called ligamenta flava
Bone spurs (spondylophytes) develop on the bone and project into the spinal canal or foraminal openings
Severe Intervertebral disc prolapse
Facet joints may thicken/ break down
Non-traumatic Spontaneous Compression fractures of the spine, (common in osteoporosis)

1.It can be classified by the part of the spine affected into cervical, thoracic, and lumbar stenosis.
2.Lumbar stenosis is the most common followed by cervical stenosis.
3.Patients with cervical myelopathy caused by narrowing of the spinal canal are at higher risks of acute spinal cord injury if involved in accidents. Besides cervical myelopathy itself can cause major body weakness and paralysis.

Pain in the neck/back
Standing discomfort
Radiating pain across arm/legs
Numbness and/or weakness of arms/legs

Treatment may involve pain-killers, B12 tablets/injections, bracing, stretching and strengthening exercises, Limitation of certain activities or finally surgery (decompressive laminectomy usually). The surgeriesfor lumbar canal stenosis are:
1.Lumbar decompressive laminectomy
2.Lumbar decompression and fusion
3.Lumbar decompression and instrumentation
The surgeries for cervical canal stenosis are:
1.Cervical decompression laminectomy
2.Anterior cervical discectomy and fusion

Spinal Instability

Spinal Instability is a condition characterised by failure of the spinal column to maintain its normal structure leading to slipping of the vertebral bones over one another in specific movements of the spine. Normally, the spine functions to protect and provide support to the body and its internal organs. An unstable spine is incapable of holding various spinal structures such as spinal muscles, ligaments, bones and discs in place. Mild spinal instability may resolve on its own, while a severe spinal instability may damage the spinal cord, nerve roots and lead to spinal deformity.

The common causes of spinal instability are:
1.Injury or trauma to the spinal column
2.Spinal degenerative disease
3.Tumor in the vertebrae, discs or ligaments
4.Congenital defects

1.Back pain – perhaps in certain spine positions
2.Nerve irritation causing deep, severe pain starting from the back and radiating to the legs
3.Painful muscle spasms
4.Numbness or weakness in the leg, foot or arms

Xrays of the spine are taken in bending position of the spine (called Flexion and Extension views) are taken to identify which level of the spinal segments slip over each other.
MRI scan maybe useful to identify any compression of the cord/nerve roots.

Treatment may involve pain-killers, B12 tablets/injections, bracing (contoured/flexible), stretching and strengthening exercises, Limitation of certain activities or finally surgery. Treatment varies depending on the severity and cause of spinal instability. Pain and vertebral slippage in cases of mild spinal instability can be relieved with physical therapy. However, trauma to the spinal column or congenital instability requires surgical treatment.
Spinal Instrumentation and/or Spinal fusion

Tuberculosis Spine (Pott’s spine)

Tuberculosis can affect any part of the body. In the skeletal system, the spine is the most common site of affliction.

Dorsolumbar spine is the commonest site, however any part of the spine can be affected.

Back pain of varying grades
Radiation of pain to arms/legs
Weight loss, appetite loss
Low grade fever, sometimes more in the evenings
Night sweats
Weakness/numbness of arms/legs

An Xray is the first line of investigation where corrosion of the bone and disc space can be seen. MRI scan is done to see the extent of involvement of the vertebrae, the soft tissues, presence of cold abscess (Cold abscess is a collection of pus near the damaged bones due to liquefaction of the dead tissues which may press on the spinal cord/nerves etc..)
Blood tests and sputum culture samples, chest Xray are taken also to aid in diagnosis.

No, patients are classically treated as under MIDDLE PATH REGIME. Unless definitely indicated, they are first managed conservatively and observed on regular periods for future surgery.

Severe pain, severe weakness/numbness, progressive weakness/numbness, difficulty walking/altered gait pattern, collapse of the bony framework on MRI are warning signs for need for surgery.

Some common procedures for Tuberculosis spine are:
1.CT guided biopsy and/or aspiration of the cold abscess
2.Spine laminectomy, decompression and/or instrumentation

Tumors

Spine tumor is the abnormal growths of uncontrolled tissues or cells in and around the spinal cord. Tumors can either be cancerous (malignant) or non-cancerous (benign).
Benign spinal tumors- osteoma, osteoblastoma, hemangioma, and osteochondroma.
Malignant spinal tumors- chondrosarcoma, Ewing’s sarcoma, lymphoma, osteosarcoma, and multiple myeloma.
Tumors that begin in the spine are called as primary spinal tumors. Tumors that spread to the spine from other parts such as the breast, prostate, lung, and other areas are called secondary spinal tumors.

Spine tumors are usually diagnosed only by imaging as symptoms produced are similar to disc prolapse, canal stenosis, spinal instability etc.. hence there is a variable presentation of chronic back pain, numbness, burning and tingling sensation, loss of sensation in legs, arms, ankle, knee, and difficulty in balancing, and also experience bladder or bowel control problems.

Xray, CT,MRI, PET scan, Biopsy maybe needed

Medications such as corticosteroids and anti-inflammatory drugs are prescribed to reduce inflammation and swelling around the spinal cord. External braces are also used which provide support and control pain.

Other treatments include chemotherapy, radiation therapy, surgery, and physical therapy which may provide permanent relief.

It is done to remove the tumor confined only to one portion of the spine. To minimize nerve damage, electrodes are used to test different nerves of the spine. In some cases sound waves are used to break tumors and the remaining tissues are removed.

This method uses high beam of radiations to destroy the cancer cells. It is used after surgery to destroy the remaining cancer cells. An advanced device called cyberknife, painless and non-invasive treatment that passes high doses of radiations to the targeted areas of the spinal cord is used in radiotherapy.

Combination of anti-cancer drugs is used to destroy the cancer cells. Chemotherapy is used to shrink the cancer cells, to stop the division of cancer cells, and prevent them from spreading to surrounding tissues. The drugs enter the bloodstream and reach the cancer cells to destroy them. Some of the commonly used drugs are methotrexate, doxorubicin, cyclophosphamide, carboplatin, and ifosfamide.
Some of the complications observed after surgery are temporary loss of sensation, nerve tissue damage, and bleeding

Exercises may be needed to improve muscle strength and the ability to function independently.

SPINE SURGERIES

Spine decompression

Spine decompression is a surgery performed when there is pressure over the spinal cord and perhaps the nerve roots. The spinal cord is normally located in the spinal canal which is surrounded on all sides by bones (vertebral bone body in the front and the vertebral elements on the other sides). The most common reason for spine decompression surgery is Spinal Canal Stenosis.

Spinal canal stenosis is a condition of abnormal narrowing of the spinal canal/ neural foramen resulting in pressure on the spinal cord or nerve roots. The symptoms are typically gradual in onset and they improve with bending forwards. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

Some common causes of spinal canal stenosis include:
• Ageing
• Osteoarthritis
• Rheumatoid arthritis
• Spinal tumors
• Trauma – following injury (usually burst fracture or spine fracture-dislocation), the bone fragments may enter the spinal canal and press on the spinal cord
• Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal[23]
• Paget's disease of the bone
• Scoliosis
• Spinal Instability
• Spondylolisthesis
• Congenitally narrow canal by birth

There are many factors with ageing causing spinal canal stenosis:
1.Thickening of the Spinal ligaments called ligamenta flava
2.Bone spurs (spondylophytes) develop on the bone and project into the spinal canal or foraminal openings
3.Severe Intervertebral disc prolapse
4.Facet joints may thicken/ break down
5.Non-traumatic Spontaneous Compression fractures of the spine, (common in osteoporosis)

• It can be classified by the part of the spine affected into cervical, thoracic, and lumbar stenosis.
• Lumbar stenosis is the most common followed by cervical stenosis.
• Patients with cervical myelopathy caused by narrowing of the spinal canal are at higher risks of acute spinal cord injury if involved in accidents. Besides cervical myelopathy itself can cause major body weakness and paralysis.

Treatment may involve pain-killers, B12 tablets/injections, bracing, stretching and strengthening exercises, Limitation of certain activities or finally surgery (decompressive laminectomy usually). The surgeriesfor lumbar canal stenosis are:
1. Lumbar decompressive laminectomy
2. Lumbar decompression and fusion
3. Lumbar decompression and instrumentation
The surgeries for cervical canal stenosis are:
1. Cervical decompression laminectomy
2. Anterior cervical discectomy and fusion

There are many factors with ageing causing spinal canal stenosis. Each of these factors can be tackled during decompression surgery:
1.Thickening of the Spinal ligaments called ligamenta flava – flavectomy (removal of the flava)
2.Bone spurs (spondylophytes) develop on the bone and project into the spinal canal or foraminal openings- excision of the bony spurs
3.Severe Intervertebral disc prolapse- read about MICRODISCECTOMY
4.Facet joints may thicken/ break down-removal and instrumentation
5.Non-traumatic Spontaneous Compression fractures of the spine, (common in osteoporosis)- stabilisation with instruments

Spinal fusion

The normal nature of spine is to have both stability and mobility at varying levels in different parts of the spine. But there are some situations where the spine needs to be fused at some spinal segment level. This surgery is called spinal fusion.

Fusion of the vertebrae involves insertion of secondary bone tissue obtained either through auto graft (tissues from the same patient) or allograft (tissues from the other person) to augment the bone healing process. Usually the autograft is derived from the bones of laminectomy/spinous processes. Additional bone maybe taken from the iliac crest (hip region), since this is an expendable region.

There are various spinal conditions which may be treated though spinal fusion such as:
1.Spinal stenosis
2.Damaged disc
3.Spinal tumour
4.Fractures of the spine
5.Scoliosis and Kyphosis (abnormal curvatures of the spine)

Spinal fusion can be performed through different angles (from the front/back) depending upon the specific advantages of each and the choice of your surgeon. The lumbar/thoracic spine is usually accessed from the back only. The cervical spine can be accessed from the front/back depending on the indication for surgery.
Spinal fusion can be performed by:
1.Pure bony fusion -It may involve interbody fusion where bone graft is placed in the space present between the two vertebras.
2.Bony fusion with additional Cage Insertion- A specially designed device made either from plastic or titanium may be placed between the vertebrae. This helps in maintaining spine alignment and normal height of the disc.

Spinal fusion and Instrumentation:

This procedure is recommended when a set of vertebrae becomes loose or unstable. The surgeon joins two or more bones (vertebrae) together through the use of metal rods, screws, and bone grafts. The bone grafts complete their fusion in 4–8 months following the surgery, securing the spine in the correct position. The procedure is also used to treat spinal instability, fractures in the lumbar spine and, severe degenerative disc disease.
The fusion process is followed by fixation that involves fitting of metallic screws, rods, plates or cages to stabilize the vertebrae and accelerate bone fusion. After surgery, 6-12 months is the ideal time for complete fusion to take place.
The screws(called pedicle screws) are passed through the pedicles of the vertebra and they enter into the body of the vertebra and grip them.

Laminectomy

Laminectomy removes a part or all of the lamina (bony arches over the spinal cord) to decrease the pressure on the spinal nerves and the spinal cord.

This is performed over a single or multiple levels depending on the nature of the disease. The laminectomy is commonly performed on the vertebrae in the lower back and in the neck

Laminectomy is performed as a part of many surgeries like disc surgery, spinal canal stenosis etc..

Following a laminectomy, the patient may observe an immediate improvement of some or all symptoms or sometimes a gradual improvement of the symptoms also may be seen. The patient usually walks after the first day of the surgery. A brace maybe needed for a few days after surgery.