Pain in the back is the most complaint seen in clinical practice. Indications for spinal surgery are, back pain recalcitrant to conventional medicine and physiotherapy, when the pain causes significant disruption in patient’s professional or personal life or development of neurological complications.
The types of spinal surgeries depend on the approach and the pathology involved. The common ones are (1) –
This type of surgical procedure involves removing the tissues that compress the nerves in the back. During the surgery process, the surgeons removes parts of the bone that constricts the nerves in the spinal column. As stability of the spine is sometimes affected, a procedure called spinal fusion is also done.
- Laminectomy- it is considered in spondylolisthesis and stenosis. Occasionally performed along with spine fusion in case of instability. The aim is to decompress the spinal nerve.
- Spinal disc replacement- Here the prolapsed or desiccated disc is replaced by an artificial disc. The advantage is that, it offers spine mobility and does away with spine fusion.
- Spine Fusion- it is achieved by joining two vertebrae to enhance spine stability. Here stability is achieved at the cost of mobility.
- Discectomy-It is considered in cases of herniated disc giving rise to radicular pain along the climb due to nerve impingement. Discectomy can be partial or complete.
Since last decade there is an uprise in the number of minimally invasive spinal (MIS) surgery performed. Percutaneous techniques are used to take care of segment fixation of the cervical, thoracic, and lumbar spine. MIS has gained popularity over the open spine surgeries because of its reduction in soft tissue destruction, blood loss, and postoperative pain (2).
ADVANTAGES of spinal surgery (3).
- Improved range of motion.
- Regain physical regime in the form of exercise and outdoor activity.
- Less use of pain medicines due to significant pain relief achieved post surgery.
- Uplifts the mood, since the physical restriction due to pain is relieved.
- Resume to professional and sports activity.
As with all surgery, there are risks involved due to the anaesthesia used, any pre-existing co morbid condition or due to the surgical procedure itself (4). It is imperative to understand the reason for the surgery, the implications and the anaesthesiologist needs to take a thorough case study regarding medical history of the patient, any allergy or habits (smoking, alcohol). The general complications are-
- Anesthesia-since general anesthesia is there is a risk of heart attack, stroke, brain damage, and death.
- Post-operative Infection- this can be dealt by taking intravenous antibiotic immediately before surgery and continuing it post operatively.
- Thrombophlebitis-Deep vein thrombosis (DVT) causes thrombophlebitis due to enhanced clotting mechanism.
- Spine Surgery Instrumentation Failure- due to disruption of devices such as metal rods, plates, and screws used to stabilize the spine.
- Pseudoarthrosis: Failed Fusion arises from non-healing.
- Potential Neurological Complications in Spine Surgery Procedures occurring due to inevitable nerve damage and/or spinal cord injury.
Persistent Pain in unfortunate cases of unsuccessful surgery (4).