Spine surgery is necessary when pain or nerve or spinal cord compression cannot be controlled with drugs or with physical therapy or rehabilitation measures. It is also necessary when there is objective evidence that irreversible injury is occurring.
It is important to eliminate from our minds the concept of “surgery last” and we must have the concept of “surgery when it is necessary”. If we wait for the last option, in many cases patients will improve, but they will not recover as we neurosurgeons would like.
What types of spine surgery exist today?
There are many types. Minimally invasive in problems of punctual compressions, herniated discs, etc… or large stabilizations in very complex problems such as scoliosis.
These procedures can be done with microsurgery, endoscopy or open surgery and with multiple imaging techniques that help us in the operating room. We even have treatments to control pain acting directly without surgery and lately we can even implant stem cells in very selected cases.
We could say that there are as many types of surgery as there are patients. This is what we now understand as personalized medicine, in this case personalized neurosurgery. We adapt to each case and each patient.
What advances have been made in recent years in this field?
A lot. We have much better diagnostic imaging that allows us to better identify where the problem is, we have better materials, more inert and more powerful and versatile to adapt to each vertebra and each condition, we have elements to see on a larger scale such as spinal microscopes and endoscopes.
Very important now is that we have imaging equipment in the operating room, such as CT scans, MRI, fluoroscopy, ultrasound… and also very important, we have a better knowledge of the problems our patients suffer.
And one of the most recent developments is that we now have stem cell therapies in serious conditions such as spinal cord injury, or in other disabling conditions such as discogenic pain. Above all, it is indicated in young people, who are physically active and who do not want to undergo surgery with screws and want to try to regenerate the tissues and the discs.
What are the main advantages of minimally invasive spine surgery?
Minimally invasive surgery (MIS) allows for rapid patient recovery, “breaking” few or no muscle and tendon structures and approaching the injury through small corridors that reduce pain and the need for stabilization or “screwing” in many cases.
As a general rule, what does the surgery itself consist of (steps to be followed)?
The first thing is to identify that the patient is the ideal candidate. Not all pathologies and not all cases can, nor should, be treated by MIS.
The next step is, in the operating room, to access the area that causes the problem through the smallest “pinhole” that causes the least damage to the tissues and structures of the spine and that is possible. For this we use very precise tunnels that we guide by image.
At this point we can already decompress the nerve tissue of pieces of disc that have come out of place, bone spikes or osteoarthritis and that are generating the problem. For this we also have very specific material that we can introduce through these tubes, endoscopes or runners.
When the surgery is finished, the wounds to be repaired are usually minimal.
And finally, and most importantly, within a few hours the patient can be performing a more normalized activity and quickly return to a normal life.
Is spine surgery a risky surgery?
There are high-risk procedures, of course, but most of the time, with the case well studied and planned, the means we have in our operating room, and expert hands, most of the surgeries are extremely safe for the patient.
How are the results usually?
If the case is well studied, the imaging tests are clear and the clinical presentation of the patient is consistent with the above, the results are very satisfactory in most cases, with relief rates in more than 90% of patients.
For more information, please consult a Neurosurgery specialist.