Spinal surgeries could be performed by neurosurgeons or orthopedic surgeons as spine lesions are the boundary between both specializations.
Spinal surgery treats the abnormalities due to wear and tear (degenerative lesions), tumors, inflammatory diseases, fractures, sprains, congenital deformities and acquired deformities.
What is spinal surgery about?
Mostly degenerative diseases, caused by wear and tear, are treated by a spine surgeon. The cases are usually diagnosed by a rheumatologist or neurologist, and the treatment is supplemented by physiotherapist, and masseur to improve the patient’s condition.
Even if degenerative lesions are very common, surgical intervention is rarely required, only if non-surgical, conservative treatments do not lead to a result. Rarely, if the patient’s neurological condition deteriorates quickly (e.g. dysfunction in the legs) due to the damage or compression of the spinal cord, or the nerve roots, urgent surgery may be needed.
Although there are types of fractures, inflammatory diseases, and even tumors affecting the spine, that do not require treatment at all, or do not necessarily require surgery, the opinion of a spine surgeon is always recommended.
What complaints are worth to consult a spine surgeon?
Specialists refer a patient to a spinal surgeon when conservative (non-surgical) treatments do not lead to a satisfying result.
Regarding the symptoms, mostly local, spinal pain or a radiating pain is felt in the limbs. Less commonly, numbness, a sensory deficit occurs in the limbs, or even on the body. Rarely the spinal disorder is accompanied by the weakening of the muscles of the limbs, a disorder of movement of the limbs, or a disorder of urination or defecation.
If a sudden decrease in muscle strength occurs (e.g. the patient is unable to move his feet, or objects fall out of his hands because he cannot hold them, or the patient becomes unable to walk), it is recommended to consult a specialist immediately. Sudden difficulty in urination or defecation, which may be associated with hypoesthesia in the buttocks, around the anus, or inside the thighs are also symptoms to visit a specialist. In these cases, it is recommended to go to an emergency department where the diagnosis can be set quickly.
What disorders belong to the field of spinal surgery?
In general, spinal surgery is recommended for the static and stability problems of the spine, as well as the pinching of the spinal cord, or the nerve roots entering and leaving the spine, and for their lesions.
Disc hernia (spinal hernia) is a very common lesion that can affect all moving parts of the spine (neck, back, waist).
The deformation of the formulas forming the walls of the spinal canal is also very common, which can lead to spinal stenosis. This condition means the narrowing of the spaces within the spine, which puts pressure on the nerves that travel through the spine. Over the ages, degenerative processes often lead to deformities, but the causes of these deformities can be congenital deviations or unknown causes too.
Spinal fractures or sprains usually caused by an accident, but vertebral fractures are mostly the result of osteoporosis. These fractures develop under low energy loads because of the thinned bone structures.
Cancerous diseases are less common, which can affect the spinal cord, the nerve roots entering and leaving it, the membrane system embracing these formulas, and the structural elements of the spine (bone, cartilage, etc.).
Inflammatory diseases, which may be part of an immune disease or of infectious origin, are also rare. Other developmental disorders are even rarer.
The main spinal diseases treated by spinal surgery are the following:
- Disc herniation (spinal hernia)
- Spinal canal stenosis (central stenosis), nerve root canal stenosis (lateral stenosis)
- Scoliosis of the spine
- Vertebral slippage (spondylolisthesis)
- Sagittal imbalance
- Spinal fractures
- Osteoporotic vertebral fracture
- Spinal tumors (may be metastatic and locally developing)
- Spinal cord tumors
- Meningeal tumor (meningioma)
- Inflammation of the disc and surrounding vertebrae (spondylodiscitis)
It is important to know, that the listed lesions often occur together, building on each other. Basically, most degenerative diseases are the diseases of the two affected vertebrae, which dysfunction could cause various lesions.
Disc herniation, for example, is not a disease in itself, but a problem of the connection between the two vertebrae, where the disc becomes damaged. This is important to understand because many times the patient’s problem can’t be simplified for disc herniation, the effective solution can be more complicated than a minor “disc hernia surgery”.
The spinal surgery examination
In the case of diseases that can affect the spine, the patients are usually first seen by a neurologist, rheumatologist, orthopedist, or general practitioner.
Depending on the complaints and symptoms, if the examining doctor finds that imaging is not necessary (MR, CT, RTG), he or she will recommend non-surgical treatments first.
If the lesion can’t be diagnosed by manual tests, the patient is referred for imaging tests. Depending on the symptoms and the test results, the rheumatologist, neurologist, orthopedist reassigns the patient, to a spine specialist.
For the spinal surgery consultation please take all your imaging findings (MRI, CT, X-ray). At the spinal surgery consultation, the specialist reviews the spinal images, and other test results that may be useful or necessary for the diagnosis (e.g., bone density test result, electrophysiological test result). Then he/she examines the patient and forms an opinion. If the spine specialist finds that surgical care is recommended or may be considered, he or she will inform the patient about the details and advantages of the intervention.
Why spinal surgeries are recommended?
The aim of spinal surgery is to eliminate the patient’s pain and neurological symptoms. The interventions are basically aimed to ensure that the patient has a loadable, stable, balanced spine and that the nerve formulas passing through the spine are released from the pressure. In the case of cancerous diseases, the main goal is to remove the tumor and reduce its size. In inflammatory diseases, the goal is to clean the inflamed area and identify the pathogen.
To achieve the listed benefits, various types of surgeries are available.
The release of the nerves and the spinal cord can be achieved by different methods, in a direct or indirect way. The direct way means that by revealing the spine the specialist eliminates the stenosis. The indirect method means that the environment of the affected formula is treated to have the narrowing eventually eliminated.
For stabilization and deformation correction, rod-screw, plate-screw, connecting vertebrae implants, mobile or fixed spacers, are placed in the spine, or in some cases “bone cement” can be injected to strengthen the vertebrae.
In many cases, a minor intervention is enough, where implantation is not necessary, while in other cases they are essential.
The spine can be accessed and explored with minimally invasive methods, from small incisions and punctures, but in some cases the classic, open intervention is necessary.
The surgical plan is always based on the assessment of the complaints, symptoms, imaging test results, and last but not least the general condition and comorbidities of the patient.