The spine is a structure formed by bones, ligaments and intervertebral discs, whose mission is to support and articulate the trunk. It is formed by four different segments: cervical, dorsal or thoracic, lumbar and sacrum that are interposed between the skull (head) and the pelvis, which connects the trunk with the lower limbs.
This structure contains in its interior the spinal cord, which is a set of nerve fibers that electrically connect the brain with all our muscles and joints. Through it circulate impulses for motor and sensory activity throughout our body.
What problems can the spinal column suffer?
The spine can be affected by the following problems:
- Degenerative (wear and tear)
- Traumatic (fractures)
- Tumors
- Infectious
- Deformities (scoliosis and kyphosis).
1. Degenerative pathology
Degenerative vertebral pathology usually affects the cervical and lumbar spine. These conditions include disc herniation (which can cause cervicobrachialgia and lumbosciatica), cervical and lumbar degenerative disc disease, lumbar or cervical canal stenosis with or without myelopathy (compressive involvement of the spinal cord) and spondylolisthesis (with different causes).
Many times, these degenerative problems do not require surgical treatment and their fundamental management consists of modifying dietary and physical exercise habits, generally accompanied by pharmacological measures such as analgesics or anti-inflammatory drugs.
In cases in which surgical measures are required, current medicine offers different options of little or greater aggressiveness, depending on the type and extent of the affectation, the age of the patient and the affectation of the quality of life that the problem poses for the sufferer. Simple discectomies (removal of the disc) to spinal fusion procedures, also called vertebral arthrodesis, can be performed.
2. Traumatic pathology
In this pathology, the vertebral fracture may be secondary to high-energy trauma (sports accidents, traffic accidents, falls from heights, etc.) or secondary to the increased bone fragility that accompanies osteoporosis (less calcium in the bone), which means that the vertebra can fracture in the event of minor trauma or without obvious trauma.
The treatment of high-energy injuries is usually surgical, whenever spinal stability is compromised, i.e. whenever the ability of the spine to maintain its load distribution and shape without causing nerve disruption and pain is compromised. In such cases, implants are placed to restore the spine to its normal shape and neutralize the forces that are detrimental to it. These implants can be placed percutaneously or by open surgery. The indication for one or the other procedure will depend on the type of injury. It is an individualized treatment for each type of injury.
The lesions produced by fragility, that is to say, by osteoporosis, appear fundamentally in older people, more frequently postmenopausal women, or in people who have undergone treatment with corticoids for other pathologies. In these cases the spine becomes very painful and limiting of normal activity.
Many of these fractures only require treatment with external immobilization by means of braces or corsets, but others require surgical procedures, generally percutaneous, such as vertebroplasty or kyphoplasty or percutaneous instrumentation with screws. As with the other problems, the choice of the type of treatment is individualized according to the type of injury.
3. Tumor problems
Tumor problems may be primary lesions of the vertebra (quite rare) or metastatic from another origin. For these problems, current spinal surgery offers diagnostic techniques (biopsies), in order to define the origin and decide on the ideal type of treatment; palliative techniques, to control pain or spinal cord involvement due to its growth; and curative techniques, which allow complete removal of the affected vertebra or vertebrae, with reconstruction of the anatomy of the spinal column while preserving the function of the spinal cord.
As in the rest of the vertebral pathologies, the choice of technique is individualized and is decided with the collaboration of a multidisciplinary team of oncologists, radiotherapists and surgeons, who select the best technique and treatment for each patient.
4. Infectious problems
The vast majority only require diagnostic procedures such as biopsy, because the basic treatment is medication with antibiotics. It is true that surgery has its role when there are nerve compressions, deformities due to bone destruction or pain that cannot be controlled with analgesia.
5. Vertebral deformities
These can affect children as well as adolescents and adults. They are all different, considering the growth potential of children, the rapid progression during the hormonal change of adolescence and the stiffness, degenerative changes and bone fragility that join the deformity in the adult.
They can affect both the frontal plane (front view) producing scoliosis and the lateral plane (profile view) producing kyphosis, but both deformities can also be joined.
The treatment of these problems is very varied depending on age, degree of deformity, growth potential, statics affectation, presence or absence of neurological symptoms, among others, and can be based on the use of corsets or surgical treatment.
Surgical treatment in our group is performed according to international standards accepted worldwide, aimed at solving the problem with the greatest possible surgical and postoperative safety. Therefore, we use criteria of saving levels to operate, preoperative blood saving techniques (improving hemoglobin levels) and intraoperative and postoperative (blood recovery), control of spinal cord function and postoperative pain control.
In addition to this group of pathologies, we also treat the sequelae of other surgical procedures, i.e. we perform reconstructive surgery of the spine. This is probably the most technically demanding surgery at present.