Spinal surgery is surgery on the spine that usually aims to overcoming pain spine or back.The type of spinal surgery performed depends on the type of disease suffered by the patient.
The spine consists of 33 vertebrae, with the top 24 vertebrae separated one by one, which make up the vertebral column from top to bottom. Between each vertebral column, there are cartilage pads called vertebral discs. In the middle of each vertebrae has a hole, so that between the holes one with the other forms a channel filled with spinal nerves along the spine.
Spinal surgery is a medical procedure that is usually performed after other treatments have failed to relieve spinal pain. In addition to relieving pain, spinal surgery can also treat complaints that occur in one or both arms or legs, which are caused by spinal cord disorders. Treatment methods that can be recommended for patients with spinal cord disease before surgery include:
- Rest
- Drug administration
- Physiotherapy
- Use braces or support
If these treatment methods are not effective in relieving spinal pain, then the new patient is recommended to undergo spinal surgery. The type of spinal surgery performed will depend on the type of disease suffered by the patient.
Types of Spine Surgery
Based on the technique, there are many types of spinal surgery. However, in general, spinal surgery can be divided into 2 types, namely decompression surgery and stabilization surgery. Both decompression surgery and stabilization surgery aim to relieve pain and paralysis due to disorders of the spinal cord.
Decompression surgery aims to relieve pain due to spinal cord disorders by removing the part of the spine that presses on the spinal cord. While stabilization surgery aims to relieve pain by stabilizing the position of the spine to prevent the reappearance of pressure on the spinal cord. If needed, decompression and stabilization operations can be performed simultaneously in one surgical procedure.
Spinal surgery that uses decompression techniques, including:
- Laminotomy.This procedure aims to reduce pressure on the spinal cord by cutting a portion of the lamina, which is the back of the vertebral column, so that the pressure on the spinal cord can ease.
- Laminectomy.Almost the same as a laminotomy, but in a laminectomy the entire spinal lamina will be removed. Laminectomy can help reduce inflammation caused by pressure on the spinal cord, although it doesn't feel immediately after the procedure.
- Discectomy.This procedure aims to relieve pressure on the spinal cord due to abnormal spinal disc shape and herniation or protrusion (hernia nucleus pulposus). Discectomy is done by cutting the spinal disc, so that there is more room for the spinal cord and the pressure on the nerves will decrease by itself. Discectomy can be combined with laminectomy for maximum results.
Spinal surgery that uses stabilization techniques, including:
- Spinal fusion. This procedure is done by adjusting the arrangement of the spine, then joining the vertebrae that are actually separated, to prevent movement that can cause pressure on the spinal cord. Spinal fusion may also be performed after decompression surgery to prevent back pressure on the spinal nerves.
- Vertebroplasty.This procedure is done by injecting a cement-like substance into the part of the spine that has been fractured. Injection of a substance such as cement is to make the spine more stable and restore the shape of the spine to its original shape.
- Kyphoplasty.Just like vertebroplasty, kyphoplasty is also performed by injecting cement into the part that has broken the spine. However, before the injection of cement, the part that has a spinal fracture will be widened with a special balloon.
Indications for spinal surgery
Spinal surgery is mostly not an emergency medical procedure. However, you should immediately consult an orthopedic doctor or neurosurgeon to plan whether to require surgery, if any of the following occur:
- Pain that does not subside or gets worse after two weeks.
- Stiffness or tingling in the arms or legs.
- There is weakness and loss of movement function in the arms or legs.
- Fever.
These symptoms can be a sign of a disease that requires spinal surgery, such as:
- Spinal stenosis.
- Myelopathy or disorders of the spinal cord.
- Damage or displacement of the spine.
- Tumors in the bones or spinal cord.
- Infection of the spine or spinal cord.
- Shifting or thinning of the spinal cushions.
Spine Surgery Warning
Not all people with spinal cord disease can undergo spinal surgery. In addition, each spinal surgery technique has different requirements.
In general, there are no absolute conditions that prevent a person from undergoing decompression surgery. However, spinal decompression surgery should be avoided if the patient:
- Have kyphosis.
- Still children.
- Have not undergone non-surgical therapy to the fullest.
As for spinal stabilization surgery, it should be done with extreme caution if there are:
- Osteoporosis.
- Severe injury to the protective layer of the spinal cord (epidural).
- Malignant tumors, especially of the spine.
- Spinal fracture.
- Infection.
Spine Surgery Preparation
Prior to spinal surgery, the patient will undergo a general medical examination to ensure that he is ready for surgery. The patient must notify the concerned doctor:
- Medicines you are currently taking, including vitamins, supplements, and over-the-counter medications.
- Suffering from drug allergies, especially allergies to anesthetics.
- Are pregnant or planning to become pregnant.
A few days before undergoing surgery, the patient will be asked to stop smoking and stop taking blood-thinning drugs. The patient must also fast for several hours before the operation begins. If the patient has thick hair around the surgical area, it will be shaved first. Patients will also undergo additional examinations before undergoing surgery, such as blood tests, X-rays, or MRI to provide additional information regarding the condition of the spine that will undergo surgery.
Spine Surgery Procedure
The patient will be asked to change into special surgical clothes and remove any jewelery he is wearing, then he will be taken to the operating room. After that, the patient is given general anesthesia so that he will not be conscious during spinal surgery, and is positioned according to the type of surgery, usually face down.
When the patient is unconscious, the doctor will begin to make an incision or skin incision in the spine area to be operated on. Incisions can be made in the neck, upper back, lower back, or abdominal area so that the spine can be operated from the front. The size of the incision made can vary according to need.
After the incision is complete, the doctor will then perform decompression or spinal stabilization. In decompression surgery, the doctor will remove the part of the spine that is causing pressure on the spinal cord. The doctor can remove the spinal segment (vertebrae) or the bearing of the spinal segment that is causing pressure on the nerves. During decompression surgery, doctors can also correct the position of the compressed spinal nerves by adjusting the nerve fibers to return to the spinal cord space. The spine and spinal pads that are the target of decompression surgery are often not removed completely, but only removed where the nerve is compressing.
Whereas in stabilization surgery, after an incision is made, the doctor will install a spinal balancing device in each spinal segment that experiences a shift. This tool is usually made of special metal that is attached using bolts directly to the spine.
After that, the doctor can add a bone graft to that part of the spine to speed up the fusion or union of the spinal segments undergoing stabilization. These bone grafts can be taken from the patient's own body or from a donor. However, in patients who undergo decompression and stabilization surgery simultaneously, the bone removed in the decompression procedure can be used as a graft during the stabilization process. In some cases, bone grafts can be replaced with synthetic materials so that the union between the vertebrae can run faster.
After the entire surgical procedure is complete, the doctor will then close the surgical area using sutures. The surgical area will also be covered with a sterile bandage to prevent infection. The patient will then be taken to the treatment room for hospitalization and postoperative recovery.
After Spine Surgery
Patients will generally stay in the hospital for 2-3 days. During the treatment and recovery period, the patient may feel pain and discomfort in the surgical area. Doctors can give pain relievers to take during hospitalization and outpatient treatment. During the recovery period, both in the hospital and at home, patients are encouraged to practice mobility or movement by walking.
Generally the total recovery period of patients undergoing spinal surgery is about 6 weeks. However, the length of this recovery period depends on how severe the pain is and the complexity of the spinal surgery being undertaken. In addition to feeling pain, patients can also feel pain and stiffness in the back undergoing surgery. To train the body to carry out physical activity again after the recovery period, the patient will be assisted with physiotherapy.
Sutures made during surgery, can use sewing threads that can be fused or that can not be fused with body tissue. If the suture is not attached to the body, the doctor will remove the suture after the surgical wound closes. Doctors will also schedule regular patient check-ups to monitor the recovery process during outpatient care.
Patients should contact their doctor immediately if they experience symptoms of infection, such as:
- Fluid discharge from the surgical wound.
- Fever.
- Shivering.
- Redness, swelling, or hardening of the tissue at the surgical site.
Risk of Spinal Surgery Complications
Complications that can occur after spinal surgery include:
- Infection.
- Bleeding.
- Blood clotting.
- Pain in the area of the bone removed for a bone graft.
- Damage to blood vessels or nerves near the surgery site.
- Surgical wounds that are difficult to heal.
- The reappearance of pain in the spine after undergoing surgery.
- The occurrence of a tear in the protective membrane of the spinal cord which causes leakage of cerebrospinal fluid and spinal cord.
- The face feels stiff and visual disturbances.
- Paralysis.
