Spine Surgery

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
• 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