In cases of lumbar disc herniation where, either because of the symptoms reported by the patient or because of the X-ray or MRI findings, we suspect spinal instability, it will be necessary to perform a technique to correct this instability.
Traumatology offers various fixation systems, among which are rigid transpedicular screws, semi-rigid and dynamic systems, interspinous fixation systems, ligamentoplasties, etc… The choice of procedure will be individualized in each case, depending on factors such as the degree of instability, age, type of work…
Spine surgery by transpedicular fixation
This fixation system consists of placing screws through the vertebrae, generally one on each side, and they are joined to the screws of other vertebrae by means of bars or plates. When the objective of the intervention is to achieve a complete vertebral fusion, we will use rigid bars or plates, associated with the placement of bone to obtain a good fusion. In those cases where a fusion is not desired, the union between the screws will be carried out with semi-rigid or dynamic systems and bone placement will not be performed. There are also mixed systems that allow us to combine fixed segments with dynamic segments.
Interspinous fixation spine surgery
When the degree of instability of the spine is less, instead of using a transpedicular fixation system, we can use this less invasive procedure. It consists of placing a device between the spinous processes located in the posterior part of the vertebrae. This device provides greater stability to the affected lumbar segment and avoids overloading the facet joints. This technique is performed without the need for further aggression on the spine. And the objective is not to achieve a fusion-rigidity on the vertebrae but to stabilize this segment.
Ligamentoplasty spine surgery
We also use it in minor degrees of instability or in those cases in which the use of more invasive procedures, such as transpedicular fixation, is contraindicated. Ligamentoplasty consists of reinforcing the vertebral junction with a synthetic cord that is interwoven between the spinous processes of the vertebrae. This device reinforces the spine of the affected segments without the need to fuse the vertebrae.
Intersomatic Spine Surgery Fixation (PLIF-ALIF-TLIF)
It consists of the placement of two implants (titanium & peek) generally filled with bone material between the vertebral bodies. Once the disc has been completely removed, these implants are placed in its place, either anteriorly (ALIF), posteriorly (PLIF) or laterally (TLIF) in order to fuse both vertebral bodies.
What are the complications of spine surgery?
-Neurological deficit due to nerve root involvement of a transient type with pain, tingling, or also of a persistent type (0.8-1.9%).
-Wound infection in 0.9%.
-Cerebrospinal fluid leakage in 0.1 to 0.9%.
-Complications due to surgical position.
-Injury to abdominal vessels and/or ureter and/or other abdominal organs (exceptional but serious), 1 in 6,000-8,000 lumbar disc surgeries.
-Complications in other organs (pneumonia, gastritis, gastrointestinal bleeding, thrombophlebitis).
-Recurrence of the hernia requiring a second operation.
-Risk of death (0.02%).